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The Sleep Doctor Is In

To paraphrase Homer Simpson,  sleep is the cause of, and solution to, most of life's problems.  This may sound like an exaggeration, but if you've ever experienced a sleepless night (or week, or month) I'm sure you recognize just how much a good night's sleep, or lack thereof, impacts your mental and physical health.  Don't just take my word for it though, check out this short article from Harvard University  outlining the various risks that insufficient sleep poses to physical well-being.  When it comes to mental health, there's a complicated line between cause and symptom, but as mental health professionals, we now have more to offer clients than medication management referrals and sleep hygiene tips.  A treatment for Insomnia known as Cognitive Behavioral Therapy for Insomnia or CBT-I offers the promise of relief from insomnia, whether it's Primary Insomnia or a symptom of another psychological concern, such as anxiety.  But, what is it, how does it work, and what can I expect when I meet with a CBT-I provider?

  • CBT-I works by helping you to determine what is getting in the way of getting more (and perhaps more importantly) better quality sleep, by identifying the thoughts and behaviors that are maintaining your sleeping difficulties.  This means that following the initial assessment, there won't be much focus on how your sleeping difficulties began, because it's likely that what's keeping them going is quite different than what kicked them off in the first place.  


  • Of course you can expect some initial assessment about the origin of your sleeping problem in order to ensure that CBT-I is the appropriate course of treatment.  Your provider will ask you a lot of questions about the history of your problem, which will likely involve getting some medical information directly from your physicians.  It's important at this stage to rule out any physical difficulties (such as sleep apnea), which might be responsible for your insomnia.  If the cause of your insomnia is primarily medical, your provider should recommend that you have the underlying medical issues addressed first, and then return to manage any residual sleeping difficulty.


  • Once it's determined that you're a good candidate for CBT-I based on your provider's assessment, you're going to be asked to gather a lot of information about your sleep, in the form of sleep diaries or logs, so that your provider can get a sense of how much time you're in bed, and how much of that time you're actually sleeping.  We sleep geeks like to refer to this number as Sleep Efficiency.  


  • As you're gathering data, you can expect some instruction in sleep hygiene.  While sleep hygiene is not the be all end all of treatment, making changes to your sleep routine that are in line with good sleep hygiene will assure that you're getting the most out of your treatment.


  • Once you and your provider have a sense of your sleep efficiency, and how much sleep you're actually getting per night, you will begin the most effective part of CBT-I, known as Sleep Restriction.  Put simply, let's say your sleep logs reveal that you're getting approximately 4.5 hours of sleep per night; you and your provider will fix a set bed time and wake time so that you are only permitted to spend 4.5 hours per night in bed.  As sleep efficiency increases, time in bed is increased in 15 minute increments until optimal results are achieved.


  • Ok, you had me until the 4.5 hours of sleep per night thing?  You're kidding right?  I thought therapists were supposed to help people, not torture them!  Well, first things first, I am absolutely not kidding, when it comes to insomnia, sleep restriction is the most effective component of treatment.  It is difficult though, you are right about that (although you're not right about the torture thing).  During this time, your provider will also work with you on identifying and disputing Cognitive Distortions that you might have related to sleep.  For example, if your sleep diaries demonstrate that you're actually only getting 4.5 hours a night, then in reality, you're not actually getting any less sleep than you were before, you're merely spending less time in bed not sleeping. 


  • As sleep restriction proceeds, your therapist will also work with you on making specific behavior changes to increase the quality and quantity of your sleep.  As someone who struggles with insomnia, it's likely that you've developed a pretty negative relationship with sleep, and in addition to improving sleep, the goal of CBT-I is to change the way you think about sleep, and call a truce in your ongoing battle against the Sandman.


  • Sure, that mostly sounds great, and moderately horrifying, but does it actually work?  Well, yes, in fact it does!  Recent NIH Guidelines based on several studies suggest that CBT-I should be used as a first line treatment for insomnia, and is more effective in the long-term than drug therapies for sleeplessness.

Are you ready to make some changes, increase the quality of your sleep, and increase the quality of your life?  I offer CBT-I to residents of NY, FL, and internationally, through a secure video platform.  Interested in setting up a free, 20 minute consultation?  Call me at 888-535-5671, or email me at [email protected].  You can also check out The Association for Behavioral and Cognitive Therapies to find a therapist near you who offers CBT-I.  

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