Mayo Clinic Health Manager

Get free personalized health guidance for you and your family.

Get Started

Free

E-Newsletter

Subscribe to receive the latest updates on health topics. About our newsletters

  • Housecall
  • Alzheimer's caregiving
  • Living with cancer

continued:

Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills

How does cognitive behavioral therapy work?

Cognitive behavioral therapy helps you change the thoughts and actions that interfere with your ability to get restful sleep. The approach is based on the idea that how you think (cognition) and act (behavior) affects the way you feel.

The cognitive portion of CBT teaches you to recognize and change false beliefs that affect your ability to sleep. For example, you may believe that you must get eight hours of sleep every night to function. In fact, seven hours of sleep may be adequate for you. Cognitive therapy also deals with misperceptions about the amount of time you actually spend sleeping. People with insomnia often sleep more than they realize.

The behavioral portion of CBT helps reprogram the part of your brain that governs the sleep-wake cycle. It targets specific behaviors — what sleep experts call "sleep hygiene" — that negatively affect your sleep. Such behaviors include failing to exercise or drinking beverages that contain caffeine just before bedtime.

When used as an insomnia treatment, cognitive behavioral therapy usually requires four to eight 30-minute sessions with a trained sleep therapist. The approach works on multiple levels and contains one or more of the following elements:

  • Cognitive control and psychotherapy. This type of therapy helps you control or eliminate negative thoughts and worries that keep you awake. It may also involve eliminating false or worrisome beliefs about sleep, such as the idea that a single restless night will make you sick.
  • Sleep restriction. This approach tries to match the time spent in bed with your actual sleep requirement. Reducing the amount of time you spend in bed without sleeping will actually increase your desire to sleep.
  • Remain passively awake. Called paradoxical intention, this involves avoiding any effort to fall asleep, with the goal of eliminating any anxiety you may feel about falling asleep easily.
  • Stimulus control. This method helps disassociate any negative cues you attach to the bedroom environment and condition a positive response with getting into bed. For example, you might be coached to use the bed only for sleep and sex.
  • Sleep hygiene. This method of therapy involves correcting basic lifestyle habits that influence sleep, such as smoking or drinking too much coffee or alcohol late in the day and failing to exercise regularly. It also includes tips that help you sleep better, such as winding down an hour or two before bedtime with a warm bath.
  • Relaxation training. This method helps you relax to reduce or eliminate the arousal that disturbs sleep. Approaches include meditation, hypnosis and muscle relaxation.
  • Biofeedback. This method measures certain physiological signs, such as muscle tension and brain wave frequency, with the intent of helping you control them.

The most effective treatment approach may combine a number of these methods. Realize that unlike sleep medications, CBT requires steady practice and that some approaches may cause you to lose sleep at first. Stick with it, and you should see results.

Insomnia as a symptom of another disorder

Because insomnia can be associated with many underlying disorders, such as depression, substance abuse or another sleep disorder, a thorough sleep evaluation is key in determining the appropriate treatment. In these cases, the root cause should be addressed simultaneously.

Finding help

The American Academy of Sleep Medicine has developed a standardized process and certification for behavioral sleep therapists, and you can locate a practitioner through its Web site.

However, there is currently a shortage of certified sleep therapists, and you may not live near a practitioner who can help. Further, the type of treatment — such as group versus individual — and frequency of sessions, may vary depending on the provider.

You may have to do some searching to find a trained practitioner and a treatment schedule and type that fits your needs. Start by obtaining a list of sleep centers from the National Sleep Foundation Web site. Many are associated with major hospitals. If you can't find one close to you, try locating a therapist who offers phone consultations. CBT books and CDs may be a good option until you find someone to help.

Previous page
(2 of 2)
References
  1. Means M, et al. Nonpharmacologic treatment of insomnia. Current Treatment Options in Neurology. 2008;10:342.
  2. Kristo D. Cognitive behavioral therapy. American Academy of Sleep Medicine. http://www.sleepeducation.com/Treatment.aspx?id=5. Accessed Nov. 10, 2008.
  3. What is cognitive behavioral therapy? National Sleep Foundation. http://centers.sleepfoundation.org/site/c.dpIOK2OAJoG/b.2465999/k.5971/What_is_Cognitive_Behavioral_Therapy.htm. Accessed Nov. 10, 2008.
  4. Morin C, et al. Psychological and behavioral treatment of insomnia: Update of the recent evidence (1998-2004). SLEEP. 2006;29:1398.
  5. Schutte-Rodin S, et al. Clinical Guideline for the evaluation and management of chronic insomnia in adults. Journal of Clinical Sleep Medicine. 2008;4:487.
  6. Whitworth J, et al. Which nondrug alternatives can help with insomnia? The Journal of Family Practice. 2007;56:836.
  7. Morgenthaler T, et al. Practice parameters for the psychological and behavioral treatment of insomnia: An update. SLEEP. 2006;29:1415.
  8. Harvey A, et al. An open trial of cognitive therapy for chronic insomnia. Behavior Research and Therapy. 2007;45:2491.

SL00013

Jan. 16, 2009

© 1998-2010 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "EmbodyHealth," "Enhance your life," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research.

Print Share Reprints

Text Size: smaller largerlarger