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What is CBT-I Therapy and How Does it Work?

What is it?

Cognitive behavioral therapy for insomnia (“CBT-I” for short) is an evidence-based treatment for sufferers of insomnia. Unlike some other therapy treatments, CBT-I sessions are short in length (6-8 sessions in total) and highly structured.

How does it work?

 Step 1-Your therapist will learn your sleep history.

Your psychologist will work with you to first identify what your current pattern of sleep looks like. They will likely want to know if you’re having difficulty falling asleep, staying asleep, or even both. They’ll also want to know if you’re waking up earlier than you want to-or the opposite-struggling to wake up when you’re supposed to. They’ll ask you specifics about your sleep schedule such as what you do before getting into your bed, what time you usually get into bed, how long it takes you to fall asleep, how many times you wake up in the night, and what time you wake up in the morning.

Your therapist will also gather additional information about your sleep history including any other sleep disorders you may have been diagnosed with, your circadian tendencies (are you a night owl vs. early bird?), medications you’re taking, substances you’re using and your mental health history. As you’ve likely experienced by now, there are so many factors that can affect your sleep and because of that your therapist will want to be as comprehensive and thorough as possible in gathering your background sleep data during this initial phase of treatment.

Step 2-Your therapist will ask you to keep a sleep diary.

Your therapist will then provide you with a “sleep diary” and will ask you to track your sleep for the next one-two weeks (pro tip: keep your sleep diary log and a pen on your bedside table and then simply fill it out every morning as soon as you wake up so you don’t forget!).

While it can be tempting to try and get better sleep during this initial tracking phase, it’s best to avoid making any changes to your sleep schedule (try your best to stick to your usual routine!). This way your therapist will get an accurate picture of your current sleep schedule (and can better spot the weaknesses!) and can help you make the necessary adjustments.

Step 3-Your therapist will assign you new bed & wake times.

When you bring your completed sleep diary with you to your next session, your therapist will look through it and together you two will select a new bed and wake up time. This decision will actually be based on a simple math equation!

Your therapist will calculate the total time you spent asleep on a typical night (this will NOT include the time you spent in bed on your phone, watching TV, reading etc.). Then, your therapist will adjust your bedtime to reflect this amount, plus 30 minutes. For example, you may be in your bed for an average of 9 hours each night but if you’re only asleep for 6 of those hours, your therapist will adjust your bed and wake time so that you’re only spending 6 hours and 30 minutes total in your bed.

Although the idea of spending LESS time in bed may seem challenging at first, you’ll soon notice that after doing this you’ll be sleeping through the night more instead of laying awake in bed wishing for sleep to come. The idea here is that your sleep efficiency (SE %) will increase and you will mentally begin to pair “bed” with “sleep”. Once this has occurred and you’re able to consecutively sleep through the night, your therapist will then gradually increase your overall time in bed.

Does it actually work?

 Yes! While it may seem counterintuitive to spend LESS time in bed when you already can’t sleep well, it is actually scientifically proven to work! Research shows that as many as 70% to 80% of insomnia sufferers find improvement with CBT-I and positive results often remain stable over time. Additionally, CBT-I is the recommended first-line approach for insomnia as it can be more effective than medications for some patients.

If it’s this straightforward, why can’t I just do it by myself?

It’s important to note that when changes are made to your sleep schedule there can be uncomfortable side effects as a result (i.e., fatigue, negative changes in mood, exacerbation of mental health issues, changes in concentration, etc.). Working with a professional who is trained in CBT-I can help minimize these risks. Along with guiding you through sleep restriction and adjustments to your sleep schedule, your therapist will also work with you to learn cognitive restructuring, sleep hygiene (see other article here), stimulus control (see other article here), and mindfulness techniques to ensure CBT-I is successful for you.

Call to Talk to a Sleep Therapist Today!

Dr. Ruth Robbins is now offering evidence-based Cognitive Behavioral Therapy for Insomnia (CBT-I) and is currently accepting new sleep patients. Give her a call at (310) 453-8788 or fill out a contact form to speak with Dr. Robbins today so you can learn more about how CBT-I can help you finally sleep better.

Works Cited

Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M., & Cunnington, D. (2015). Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Annals of internal medicine, 163(3), 191–204.

Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., Denberg, T. D., & Clinical Guidelines Committee of the American College of Physicians (2016). Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. Annals of internal medicine, 165(2), 125–133.

Jacobs, G. D., Pace-Schott, E. F., Stickgold, R., & Otto, M. W. (2004). Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Archives of internal medicine, 164(17), 1888–1896.

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