When you struggle with getting to sleep or staying asleep, your body, mind and relationships can really suffer. When sleep is healthy, we kind of take it for granted. It is not until something goes sideways with the sleep that we realize – sleep affects EVERY aspect of our lives. Insomnia (having a hard time getting to sleep, staying asleep, waking up too early in the morning or feeling like the sleep is not restful) is a very common problem, affecting 1 in 3 adults.

Troubled sleep can lead to difficulties concentrating, memory problem, low energy, feeling irritable, chronic headaches and, if left untreated, significant medical or mental health problems. In fact, research has shown links between insomnia and increased risk for depression, anxiety, obesity, cardiovascular disease and chronic pain. Until relatively recently sleep medications, or over-the-counter sleep aids were the only treatment available for insomnia.

Sleep Medications

Although sleep medications can be very beneficial when traveling or when used short-term during periods of stress, they are not a long-term solution due to:

• Side effects which may include: impaired learning and memory, daytime sedation, dependency, and increased risk of overdose and depression as well as mental sluggishness and confustion.
• Risk of dependency and overdose. Some prescription sleep medications create dependency – meaning it becomes hard to sleep without the medication and most patients need to take more, over time, as the brain develops a tolerance to the drug.
• Sleep medications are not effective for most people. After an initial period of helpfulness, many sleep medications do not work better than placebo, resulting in an average sleep improvement of 10 minutes faster to sleep onset in the beginning of the night. They do not allow you to sleep longer and create an “amnestic” effect so you may not remember waking up in the middle of the night.

Sleep Therapy

Fortunately, sleep scientists have developed an alternative and equally effective treatment option for improving sleep. Cognitive Behavioral Therapy for Insomnia (CBTi) is a highly specialized approach (not “sleep hygiene”) designed to address insomnia and poor sleep quality. CBTi is a customized set of interventions developed from what we know about the science of how sleep works. According to the Mayo Clinic, “CBT-I helps you overcome the underlying causes of your sleep problems.”

Behavioral sleep specialists utilize Cognitive Behavioral Therapy for Insomnia (CBTi) and a number of other evidence-based techniques to help patients:

• Fall asleep faster
• Stay asleep through the night and early morning
• Get more restful sleep
• Reduce or eliminate use of sleep medication
• Adjust to continuous positive airway pressure therapies (CPAP) for sleep apnea
• Adjust the body clock (for night owls or morning larks)
• Reduce effects of jet lag
• Reduce effects of shift-work

How does it work?

Cognitive Behavioral Therapy for Insomnia (CBTi) is designed to be a short-term treatment focused on rebooting the sleep system and training the body to sleep naturally and healthily. Typical treatment involves an initial intake session followed by 4-5 treatment sessions. Complex cases may require more extensive treatment but over 85% of patients experience significant sleep improvement within 4-5 sessions. Session length varies from 30-60 minutes.

This treatment is not a “one size fits all” but is highly tailored to your individual sleep patterns and is based on both objective and subjective sleep data collected during the course of treatment. This customized and data driven approach ensures the highest possible success rates.

Will it work for you?

The National Institutes of Health (NIH) have recommended CBTi as first-line treatment for insomnia given that 85% of patients experience significant improvement. Research studies done at Universities across the U.S. have found that CBTi is as effective, if not more effective, than sleep medication. Behavioral sleep medicine interventions have been shown to improve sleep in 80-90% of people, enabling most to reduce or discontinue the use of sleep medication.

The American Journal of Psychiatry reports that sleep therapy “puts people to sleep faster than sleeping pills” and the Journal of Family Practice states that CBTi “works better than sleeping pills.” CBTi takes time (4-6 sessions over 1-2 months) and it requires your active participation to work successfully. Depending on your sleep goals, your lifestyle and time availability, a combination of sleep medication and CBTi may be recommended. In addition, there are currently only 300 board certified providers nationwide so finding a qualified sleep specialist in your area could prove to be a challenge.

If you have had several nights of difficult sleep or weeks, months or years of interrupted or non-restful sleep you will likely benefit from brief treatment. If you have started worrying during the day about whether you will be able to sleep, you are likely to benefit from treatment. Many of the intuitive things people due to improve sleep in the short-term can worsen the sleep in the long run.

The Clinic is one of only a few healthcare organizations nationwide that provide behavioral sleep medicine treatment and Cognitive Behavioral therapy for Insomnia in particular. We have board certified behavioral sleep medicine specialists that can design a sleep improvement program specifically for you. Contact us to learn more or to make an appointment.

Author: Britney Blair, Psy.D.