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Dr. Bhanu Kolla, a psychiatrist at the Mayo Clinic who specializes in sleep disorders, shared, “It’s just as effective, but the effects last longer. Once you’ve invested the time, effort, and made the necessary changes, the benefits continue to grow and persist.”
CBT-I incorporates a variety of techniques that address insomnia from different angles.
CBT-I offers a broad range of strategies, providing an adaptable approach to managing sleep disorders.
Insomnia is a complex condition, involving a variety of sleep-related issues. While some individuals struggle with falling asleep, others face difficulties staying asleep. The causes behind this can differ. “You have to tailor it to what your problem is,” explained Dr. Temitayo Oyegbile-Chidi, a neurologist at UC Davis who specializes in sleep disorders. “For example, if anxiety is causing your insomnia, the focus will be on how to calm your racing thoughts.”
CBT-I works by encouraging individuals to alter their habits and thought patterns surrounding sleep. “CBT-I is all about shifting your perspective on insomnia and sleep,” stated Oyegbile-Chidi. This involves confronting the frustrating cycle of tossing and turning at night, wondering why sleep won’t come, which can be just as exasperating as the sleep deprivation itself.
A key component of CBT-I is cultivating healthy sleep habits, like ensuring your sleep environment is quiet, dark, and comfortable, keeping a consistent sleep schedule, avoiding alcohol and caffeine before bedtime, and finding methods to relax before sleep. “All of this is part of sleep hygiene,” explained Kolla.
Stimulus control strengthens the connection between the bedroom and sleep.
Alongside good sleep hygiene, stimulus control is another key technique in CBT-I. It helps train your mind to link the bedroom specifically with sleep. This involves getting out of bed if you can’t fall asleep within a set amount of time. “The more we engage in other activities, like watching TV or reading, or just lie awake anxious, the weaker that connection becomes,” Kolla noted. “You want to reinforce that link.”
Kolla advises his patients to only go to bed when they’re actually feeling sleepy. If they haven't fallen asleep within 10-15 minutes, they should get out of bed and engage in a calming activity, returning only when they feel drowsy. “Over time, you will subconsciously start associating the bed with the place where you fall asleep,” he said.
Sleep restriction enhances sleep efficiency and the drive to sleep.
With sleep restriction, the approach is simple: if you wake up at 2 a.m., stay awake until bedtime the following night, rather than lying in bed, frustrated by your inability to sleep again. This technique helps improve both sleep efficiency and sleep pressure.
Sleep efficiency refers to the percentage of time spent actually sleeping while in bed, rather than tossing and turning, while sleep pressure is the feeling of needing to sleep. “What you’re doing is aligning the time spent in bed with the time you’re actually asleep,” Kolla explained. This process strengthens the association of the bedroom with sleep and makes it easier to fall asleep at the right time.
While initially uncomfortable and frustrating, the sleep pressure technique has been proven to help individuals fall asleep more quickly and stay asleep longer over time.
In-person therapy is not the only way to access CBT-I.
Although it’s always ideal to consult a sleep specialist, finding one can be challenging, insurance may not always cover the costs, and it may be hard to find the time for a full, intensive treatment plan. However, alternative resources such as books and online courses have also proven to be helpful. Some good places to start include *Say Good Night to Insomnia*, *The Sleep Workbook: Easy Strategies to Break the Anxiety-Insomnia Cycle*, *Somly*, *CBT-i Coach*, and *Sleepio*.
“In-person therapy with a therapist may be slightly more effective than using a book or online CBT-I program, but all of these methods have been shown to work,” Kolla explained.
The most important factor is consistency. It’s crucial to make these changes part of your lifestyle, even if it’s just small adjustments at first. “It’s best to focus fully on the process when you’re working on it,” said Oyegbile-Chidi. “To make it a true habit, you need to work on it steadily, day by day.”
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