- Obstructive sleep apnea
Lifestyle and home remedies (2)
- Sleep tips: 7 steps to better sleep
- Napping: Do's and don'ts for healthy adults
Risk factors (2)
- Depression (major depression)
- Stress symptoms: Effects on your body, feelings and behavior
Tests and diagnosis (1)
- Polysomnography (sleep study)
Treatments and drugs (3)
- Prescription sleeping pills: What's right for you?
- Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills
- Sleep aids: Understand over-the-counter options
Insomnia treatment: Cognitive behavioral therapy instead of sleeping pills
Insomnia is a serious disorder, and effective insomnia treatment can be crucial to getting the sleep you need. Until fairly recently, there were few safe, effective, nondrug insomnia treatments.By Mayo Clinic staff
Insomnia is a common problem characterized by trouble falling asleep, staying asleep or getting restful sleep. Cognitive behavioral therapy for insomnia is an effective insomnia treatment for chronic sleep problems.
Cognitive behavioral therapy for insomnia is a structured program that helps you identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep. Unlike sleeping pills, cognitive behavioral therapy for insomnia helps you overcome the underlying causes of your sleep problems.
How does cognitive behavioral therapy for insomnia work?
The cognitive side of cognitive behavioral therapy for insomnia teaches you to recognize and change beliefs that affect your ability to sleep. The behavioral part of cognitive behavioral therapy for insomnia helps you develop good sleep habits and avoid behaviors that keep you from sleeping well.
Cognitive behavioral therapy for insomnia contains one or more of the following elements:
- Sleep education. To make effective changes, it's important to understand the basics of sleep — for example, understanding sleep cycles and learning how beliefs, behaviors and outside factors can affect your sleep.
- 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. Lying in bed when you're awake can become a habit that leads to poor sleep. Limiting the amount of time you spend in bed can make you sleepier when you do go to bed. That way you're more likely to fall asleep and stay asleep.
- Remaining passively awake. This involves avoiding any effort to fall asleep. Paradoxically, worrying that you can't sleep can actually keep you awake. Letting go of this worry can help you relax and make it easier to fall asleep.
- Stimulus control therapy. This method helps remove factors that condition the mind to resist sleep. For example, you might be coached to use the bed only for sleep and sex, and to leave the bedroom if you can't go to sleep within 15 minutes.
- Sleep hygiene. This method of therapy involves changing basic lifestyle habits that influence sleep, such as smoking or drinking too much caffeine late in the day, drinking too much alcohol, or not getting regular exercise. You may be told to avoid napping and taught to maintain a consistent sleep schedule. It also includes tips that help you sleep better, such as ways to wind down an hour or two before bedtime.
- Relaxation training. This method helps you calm your mind and body. Approaches include meditation, hypnosis and muscle relaxation.
- Biofeedback. This method allows you to observe biological signs such as heart rate and muscle tension. Your sleep specialist may have you take a biofeedback device home to record your daily patterns. This information can help identify patterns that affect sleep.
- Sleep diary. To understand how to best treat your insomnia, your sleep therapist may have you keep a detailed sleep diary for one to two weeks. In the diary, you'll write down when you go to bed, when you get up, how much time you spend in bed unable to sleep, total sleep time and other details about your sleep patterns.
The most effective treatment approach may combine several of these methods.
Cognitive behavioral therapy vs. pills
Some newer sleeping medications have been approved for long-term use. But they may not be the best long-term insomnia treatment.
Sleep medications can be a very effective short-term treatment — for example, they can provide immediate relief during a period of high stress or grief.
Cognitive behavioral therapy for insomnia may be a good treatment choice if you have long-term sleep problems. You may want to try it if you're worried about becoming dependent on sleep medications, if medications aren't effective or if they cause bothersome side effects.
Unlike pills, cognitive behavioral therapy for insomnia addresses the underlying causes of insomnia rather than just relieving symptoms. But it takes time — and effort — to make it work. In some cases, a combination of sleep medication and cognitive behavioral therapy for insomnia may be the best approach.Next page
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- Cognitive behavioral therapy. American Academy of Sleep Medicine. http://www.sleepeducation.com/Treatment.aspx?id=5. Accessed Dec. 1, 2010.
- Cognitive behavioral therapy for insomnia. National Sleep Foundation. http://www.sleepfoundation.org/article/hot-topics/cognitive-behavioral-therapy-insomnia. Accessed Dec. 1, 2010.
- Babson KA, et al. Cognitive behavioral therapy for sleep disorders. Psychiatric Clinics of North America. 2010;33:629.
- Pigeon WR. Treatment of adult insomnia with cognitive-behavioral therapy. Journal of Clinical Psychology. 2010;66:1148.
- Certified behavioral sleep medicine specialists. American Academy of Sleep Medicine. http://www.aasmnet.org/BSMSpecialists.aspx. Accessed Dec. 20, 2010.
- Choosing a CBT for insomnia specialist. National Sleep Foundation. http://www.sleepfoundation.org/article/ask-the-expert/choosing-cbt-insomnia-specialist. Accessed Dec. 20, 2011.