Cognitive behavioral therapy (CBT) is a popular and well-studied type of psychotherapy, but did you know it can also help people with sleep disorders?
One type of CBT, CBT-I, is an effective treatment for insomnia. It involves changing the behavior you have when you can't sleep and altering anxious thoughts about sleep. The big difference between CBT and CBT-I is that it incorporates principles and practices from sleep medicine, explains Michael Perlis, M.D., director of the Behavioral Sleep Medicine Program at the University of Pennsylvania.
Over the past 15 years, Perlis and Don Posner The course has taught health care professionals how to administer cognitive behavioral therapy for insomnia (CBT-I), a treatment for insomnia that has been used by 25 to 40 people, Mr. Posner, an adjunct clinical associate professor at the Stanford University School of Medicine and president of SleepWell Consultants. This year, 435 people have expressed interest in taking the course.
The data supporting the effectiveness of CBT-I has been around for about 30 years, but it's only now that “it's starting to get attention,” Posner explains.
Anne Increasing numbers If you worry about your sleep but fall into habits that don't help you sleep in the long run, Melatonin In reality, easy solutions are often not the best way to get back into the swing of good quality sleep, and the basics of CBT-I help explain why.
When does sleep become a problem?
Lack of sleep is common. According to a 2024 study: Gallup Poll57% of American adults say getting more sleep would improve their mood.
About one third Approximately 1 in 10 adults experience acute insomnia, which can last from a few days to a few weeks. Chronic insomniaIt is defined as occurring at least three nights a week for at least three months.
Acute insomnia is almost always the result of some kind of stressor, Posner explains, but it's not necessarily a bad stressor. Maybe it's a cold or jet lag, or you're excited about an upcoming event. Once the stressor is over, the insomnia will likely follow.
But when insomnia becomes chronic, it can continue even when the stressor is gone, Posner says. This is because other factors, like going to bed earlier to compensate for the lack of sleep or worrying about not getting enough sleep, may be to blame. Perpetuating insomnia.
Insomnia is a common problem Impacts on mental and physical health, including fatigue, reduced quality of life and increased risk of disease.
What is CBT-I?
CBT-I targets difficulties related to initiating and maintaining sleep. It combines cognitive therapy, behavioral interventions, and educational interventions.
the Core Components These elements are typically taught by a healthcare provider and practiced by the patient at home.
SRT may sound intimidating, but it's Reduce bedtime Rather than restricting your sleep time, try to do more while you're awake. Improved Sleep efficiency.
SCT aims to strengthen the connection with sleep clue – your bed, your bedroom, your bedtime, etc. – and you will be able to fall asleep easily and sleep better. This means avoiding any activities in the bedroom other than sleep and sex, and only lying in bed when you feel sleepy.
There are also two complementary components: sleep hygiene and cognitive therapy. Sleep hygiene promotes healthy habits that support sleep. Avoid alcohol Before going to bed. The cognitive component involves adjusting or restructuring unhelpful behaviors or thoughts, such as “I can't sleep without my sleeping pills” or “I'm scared of having another sleepless night.”
CBT-I is typically delivered over five to eight sessions, each lasting 30 to 90 minutes, though the length of treatment depends on the patient's adherence, Posner explains. He likens it to physical therapy: If you do all the exercises prescribed, you're more likely to finish treatment sooner.
Who can CBT-I help?
Data from multiple controlled clinical trials 70% to 80% 100% of chronic insomniacs who try CBT-I experience improved sleep quality, and studies suggest that these benefits are lasting.
In the early 2000s, research began to focus on how effective CBT-I was for secondary insomnia — insomnia that stems from a major event such as a medical illness or psychiatric disorder, Perlis says.
Initially, researchers thought that treating the main symptom would cure insomnia, but they now increasingly know that chronic insomnia does not generally go away if left untreated, even if other symptoms improve.
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Research has shown that CBT-I is a promising treatment for insomnia that is accompanied by other symptoms, such as: Chronic pain and anxietyPlus, there's a “halo effect,” Perlis explains: For example, treating insomnia that's also occurring in depression tends to improve the depression.
CBT-I may be effective for daytime functioning. Fatigue and sleepiness People who don't suffer from chronic insomnia but have poor quality sleep.
CBT-I principles can also help people who need help with sleep in general. For example, Perlis says it's better to get out of bed than toss and turn for hours. Do something fun, like read a book, during this time, and then go back to bed when you feel sleepy.
“Sure, you might get a little less sleep, but it will help you overcome temporary insomnia and make waking up in the middle of the night less scary,” he says.
How does CBT-I compare to other insomnia treatments?
CBT-I Highly regarded It is a treatment. Recommendation by the American College of Physicians (ACP) and the U.S. Department of Veterans Affairs First-line therapy For chronic insomnia.
Experts often advise insomniacs to develop good habits, such as getting enough exercise during the day. Some research The researchers suggest that its long-term effectiveness is comparable to CBT-I. Doctors may prescribe medication. According to the CDC, approximately 10% Thirty percent of adults had taken a sleeping pill in the past 30 days.
Perlis is 2012 Review Five studies comparing CBT-I with prescription and over-the-counter medications concluded that CBT-I is as effective as medication in treating insomnia and that its effects may be more durable. Side effects Symptoms such as memory loss and nausea may be associated with some sleep medications.
Perlis and other authors identified two main drawbacks of CBT-I. First, people with chronic insomnia may not see improvement until the first few weeks of treatment, and second, some people may experience fatigue at the beginning of treatment and over the course of the treatment. These drawbacks may lead some people to discontinue treatment prematurely. Therefore, CBT-I is Underutilized Some people I quit easilyAnd because there is a shortage of qualified medical providers, people tend to turn first to medicines and other agents such as melatonin.
“There aren't many people who can really implement this treatment well and meet the need, because the need is so prevalent,” Posner said, “but things are getting better.”
How can I get CBT-I therapy for insomnia?
If you're worried about your sleep, talk to a medical professional. Posner says many people seek help after struggling with insomnia for a long time.
There are about 1,000 knowledgeable CBT-I providers around the world, Perlis said. You can find one at the University of Pennsylvania. International CBT-I Provider Directory.
When evaluating whether to work with a therapist who claims to offer CBT-I, Perlis says, “If they're told that the core approach to treating insomnia is either relaxation or sleep hygiene, patients might want to look a little deeper. “Proper CBT-I requires SRT and SCT.
How you receive CBT-I is also important. the study Although some have suggested that learning about CBT-I through self-help books and other sources is beneficial, the majority of evidence supports the strongest outcomes for face-to-face interventions. the study showThrough video-based telehealth.
American Academy of Sleep Medicine Recommendation People who can't get CBT-I in a therapist setting can try it on an app while they wait for an appointment. For example, the U.S. Department of Veterans Affairs Free App.
“When you look at the data, that's [apps] “It's a good start, but it's not as effective as in-person therapy,” Posner says.
