Why Cognitive Behavioral Therapy for Insomnia Works

Why Cognitive Behavioral Therapy for Insomnia Works

Cognitive behavioral therapy (CBT) for insomnia is a combination of mental exercises (the cognitive part) and lifestyle adjustments (or behaviors) that can help you establish a more consistent, restorative sleep schedule. When you visit a doctor for insomnia, he or she may initially suggest some components of CBT even before prescribing sleep medication. These may include better sleep hygiene—no daytime napping, avoiding caffeine and alcohol, creating a peaceful sleep environment—and relaxation techniques. 

If simple changes don't lessen the severity of your sleep problems, your next options are medication or structured CBT sessions with a sleep specialist. Often, people try CBT when medication no longer keeps them asleep or when they don't want to feel dependent anymore.

First, you need to learn your sleep pattern. The first step of CBT will be to keep a sleep log—a detailed account of how and when you sleep over the course of a few weeks to a month. Using a log, your therapist will evaluate your current sleep schedule and develop a plan for you, says Matthew R. Ebben, PhD, a behavioral sleep medicine specialist at Weill Medical College of Cornell University. 

"People come in wondering what their problem is, and they might be going to bed and waking up at different times every day," he explains. "The biological rhythms in your body can't adjust to those constant fluctuations—no wonder they have insomnia." 

Second, get back on track. "Once they start keeping a log, a lot of people realize how erratic they are and they begin to fix it," Ebben continues. "They'll come into the office and say, 'You know, I started to follow a routine and I really feel better.'"

Other times patients need strict instructions. "We tell them they can't go to bed before a certain time," says Ebben. "They can stay up later, if they're not tired, but then they still have to get up at a specific, given time—even if it's just an hour later—every day. No sleeping in, no napping."

At first this may lead to even more sleep deprivation than normal, but it's the quickest way to retrain your body and brain to embrace sleep when bedtime comes around again. 

The next, conquering fear, embracing relaxation. A big piece of CBT is learning to manage your fears. People with insomnia have a tendency to think that their lack of sleep will have disastrous consequences, says Ralph Downey III, PhD, director of the Sleep Disorders Center at Loma Linda University Medical Center in California. 

If patients worry that they can't survive on the amount of sleep they're getting, Downey reminds them that they can be just as healthy as someone who sleeps for eight hours every night. "It can really help," he says. "Self reassurance is a very important part of cognitive behavior therapy." A therapist can also teach you relaxation strategies to take home and use night after night, including meditation and progressive muscle relaxation. 

Next, you don’t have to believe it-just do it. It may take a few weeks or even months to see results from CBT. Your therapy schedule could vary, anywhere from weekly visits to check-ins once a month or less. The important thing is that at home, every night, you practice what you've learned.

"I tell my patients that they just have to be willing to try," says Ebben. "They don't have to believe that it will do any good—and many of my patients don't at first—but they have to at least try it for a few weeks." 

That's a choice that people with insomnia have to make on their own, and many don't want to be bothered by the time investment, says Ebben.