CBT for Sleep Disturbance & Insomnia

CBT for insomnia (CBT-i) targets both behaviours related to sleep and distorted beliefs around sleep that may be contributing to insomnia. 

It involves targeting common problematic beliefs related to sleep, such as: 

• I need 8 hours of sleep to survive. 

• If I don’t get a good night’s sleep, then ... [something bad will happen]. 

• If I'm having trouble sleeping, I need to try harder. (Paradoxical intention refers to the way badly wanting to sleep can paradoxically make it harder to sleep.) 

• If I have a bad night of sleep I should try to catch up on sleep later. 

Behaviourally, a major focus is limiting the amount of time that you’re spending in bed awake. This means not going to bed until you’re actually sleepy and getting out of bed if you’re lying there awake for more than 10-15 minutes. Sleep efficiency is the ratio of the time spent asleep to the total time spent in bed. To start improving sleep efficiency, you need to start spending less time in bed. 

Rather than having a set bedtime, you’re supposed to have a set wake-up time, and always get up at that time, regardless of how much/little you’ve slept. You’re also not supposed to nap during the day. This allows you to boost your sleep drive, which comes from the amount of time you’ve spent awake, which will make it easier to fall asleep at night. 

CBT-i can actually mean sleeping less initially, but it’s got a strong evidence base as one of the most effective treatments for insomnia. 

Here are some self-help resources: 

• NHS inform self-help guide: https://www.nhsinform.scot/illnesses-and-conditions/mental- health/mental-health-self-help-guides/sleep-problems-and-insomnia-self-help-guide • Sleepwalk CBT-i resources: https://mysleepwell.ca/cbti/ 

• Veterans Affairs has a CBT-i Coach app: https://mobile.va.gov/app/cbt-i-coach 

• Veterans Affairs also has an Improve Your Sleep guide: https://mirecc.va.gov/docs/visn6/ Improve_Your_Sleep_Self-Guided_Approach_for_Veterans_with_Insomnia-March-2017.pdf 

The University of Washington has a CBT-i manual that’s meant for therapists rather than clients, but it can give you an idea of what’s involved in doing CBT-i with a therapist. https:// aims.uw.edu/nyscc/training/sites/default/files/CBTi%20Manual.pdf


Pritam Chakraborty

As I was moving through life, I occasionally saw brief glimpses of beauty.

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