Sleep better with CBTi: Does it really help?
Cognitive behaviour therapy for insomnia (CBTi) is a psychological and behavioural treatment for insomnia that has been developed and refined over the past 30 years by leading sleep experts around the world. The non-drug treatment involves learning core skills to train the mind and body to work harmoniously with the body’s natural sleep processes. It typically requires changing unhelpful behavioural habits and thinking patterns that interfere with sleep. People learn to sleep better by creating conditions within the mind, body and environment, which allows sleep to occur naturally.
CBTi is most commonly delivered face-to-face in individual or group sessions with a qualified psychologist or mental health professional, yet there are now several options for learning CBTi online. The length of treatment will depend on the mode of delivery and whether or not you have other physical or mental health issues to work on with your therapist. Typically, structured CBTi courses that cover all the treatment components (more about this later) will run weekly for about 4 to 8 weeks.
Does CBTi really help?
The answer is: yes it does! In fact, CBTi is the most effective long-term treatment available for insomnia, as reported in a recent scientific review.
Most people with sleep disorders seeking help from their GP, however, will be prescribed medication to assist with sleep. While sleeping pills can be effective in the short term, there are several disadvantages compared to CBTi. First, sleeping pills have side effects, the most bothersome often being residual daytime drowsiness. They also carry a risk of dependency, which causes some people to rely on them for years. The most significant advantage is that in the long term the effect tends to wear off and the underlying causes of the insomnia remains untreated.
CBTi, on the other hand, has no side effects and once you address the underlying causes of insomnia, you can use the skills for years to come to improve sleep for the long term.
How does CBTi work?
CBTi addresses the underlying factors that cause insomnia to persist. If you’ve had insomnia for several months, you’re probably feeling some degree of frustration, sadness or even anxiety about the problem. Realising you have no control over sleep can be daunting, and might result in you putting in a great deal of effort to overcome the problem, trying all the tricks and tips you can find to sleep better. Unfortunately for many people this frantic effort to sleep better can result in unhelpful habits or behaviours that, although well intentioned, have the opposite effect and interfere with sleep. Overthinking the problem, getting wound up or frustrated, only makes matters worse. The harder you try to sleep, the worse the insomnia, creating a vicious cycle!
The irony, of course, is that sleep cannot be controlled or forced, and the true path to sleeping better is to let go of trying to sleep. Instead, you can focus on laying down healthy foundations for sleep, by establishing behaviours and thinking patterns that allow sleep to occur naturally.
CBTi teaches you how to set up conditions that support natural, healthy sleep. Here is a summary of the five key components of CBTi:
- Sleep hygiene involves setting up a good foundation for sleep with steps such as reducing caffeine and alcohol intake, increasing daily exercise, creating a comfortable and relaxing bedroom environment for sleep, etc.
- Stimulus control suggests that you only use the bed for deep rest and sleep, which mean getting out of bed and going to the lounge room if you can’t sleep, returning to bed only when you feel sleepy. It also means keeping all stimulating activities, such as watching TV, using your phone or computer, out of the bedroom.
- Sleep consolidation involves matching the time in bed more closely to the average time you are actually sleeping to reduce the time you are awake in bed. This might mean going to bed later or getting up earlier.
- Relaxation training involves actively learning how to release tension in the mind and body using a range of techniques to slow down your breathing rate, relax the muscles and focus the mind on peaceful images.
- Cognitive Therapy is the skill of identifying unhelpful thinking patterns and learning to generate more balanced and helpful thinking about sleep.
I often see people in my private practice who say they have “done CBTi” yet still have trouble sleeping. More often than not, the problem is they have only been exposed to one or two of these five components (typically sleep hygiene and relaxation training) and have not experienced the full CBTi treatment package.
While you may not need to implement all five components, it is worth understanding how and why each component works, so you can make an informed decision about what approaches would be most suitable for you. It’s also important to give yourself enough time to put each of the strategies in place, which is why a 4-6 week treatment program is generally required.
What about mindfulness? Does it fit in with CBTi?
Mindfulness training is a new development in the treatment of insomnia, and the results from scientific studies have been impressive. It complements CBTi beautifully and adds to the treatment in a number of ways. We will be publishing an article shortly on the ways mindfulness complements CBTi so stay tuned!
Where can I go for more help or information on CBTi or MBTi?
Talk to your GP about a referral to a psychologist or mental health professional who has experience treating insomnia with CBTi or MBTi.
A Mindful Way offers online training in mindfulness and all five components of CBTi to help people overcome insomnia. This six week course is called A Mindful Way to Healthy Sleep. The mindfulness training is extensive and thorough and is delivered in conjunction with a full CBTi treatment package. Find out more about the course here.
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You can find more information about insomnia here. And you can learn more about the influence of thinking on sleep in the related articles When the mind won’t stop thinking, just sit back and watch and Are you stuck with insomnia, chronic fatigue or anxiety?