The MLRA Therapy Blog

Insights and ideas from the therapist team at Meghan L. Reitz and Associates.

CBT-I: Cognitive Behavioral Therapy for Insomnia

Recently I watched a very interesting documentary on people with sleep disorders. The focus of the program was mainly on individuals who struggled with insomnia. According to the dictionary, INSOMNIA is defined as:

habitual sleeplessness; inability to sleep

There is a plethora of information online and off about how to get better sleep. Some tips are definitely better than others, but sometimes the frustration alone of not being able to sleep and finding dead-ends with potential remedies increases the hopelessness of the situation. The human body performs more efficiently with consistent and appropriate amounts of sleep. Research is showing that inadequate sleep can lead to major health problems like heart disease and diabetes. If this isn't enough to move you in the direction of getting healthy sleep, I don't know what will!

So let's go over the usual "options" to help people fall asleep or stay asleep:

  1. Medications- both over the counter (OTC) and prescribed medications
  2. Self-medicating- alcohol, marijuana, other drugs or substances
  3. Making your sleep environment conducive for sleep (complete darkness, cool temp, aromatherapy, etc.)
  4. Grabbing sleep when you can- naps, etc.
  5. Seeking medical help to rule out other medical issues
  6. Seeking counseling or specialists in sleep disorders

I am probably leaving out a lot of other "usuals" but these are the main ones that come to mind. As you can see, some are healthy, some are not, and some are a mixed bag. Let's talk about sleep medications.

Many doctors prescribe sleep aids when patients complain about sleep problems. These typically come in the forms of benzodiazpines and hypnotics. These medications can be habit forming and shouldn't used for more than a short period of time. Over time, the body can build resistance to these medications and higher doses may be required to get the same effect. More research is showing that medications like Ambien, which is a hypnotic, can have adverse effects such as sleep walking and memory loss. For short term sleep issues, these medications, while prescribed by your physician, may help but should be monitored closely.

Many of my clients will indicate that a drink before bed helps them to relax. In reality, alcohol does not help sleep- you may fall asleep initially, but your sleep will be fitful and not re-energizing. Using substances not prescribed by a physician can lead to addiction and or misuse of the substance that could lead to further behavioral/emotional problems.

Making your sleeping environment conducive for sleep is a MUST. Invest in a comfortable bed. Dark environments are best to sleep in. Keep the temperature cool. Remove the television, computer, smart phone, or any other electronic devices that could disturb sleep. Wind down. Meditate. Your bedroom should be for sleep and sex ONLY.

Grabbing a nap here or there might sound like a good idea- but can lead to you not being able to sleep at night. If you are an active person and catching that 15-20 minute catnap in the afternoon can be ok. However, if you take long or frequent naps during the day, and are typically inactive, you are likely to have trouble sleeping at night. 

A big culprit of sleep is Sleep Apnea. SLEEP APNEA is defined by:

a disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. Breathing pauses can last from a few seconds to minutes.

If you are having trouble with sleep, you may consider consulting a sleep disorder specialist. Your ENT can also request a sleep study as well. During a sleep study, they can monitor your breathing and how deep or shallow your sleep is. When we are gasping for air, snoring, etc. it can wake you up and keep you from getting much needed REM sleep. If you are diagnosed with sleep apnea, your doctor may suggest diet changes, a weight loss program, and/or a CPAP machine which can help you breathe and sleep better at night.

If you've ruled out any medical issues and you continue to struggle with insomnia, then your next best option is CBT-I. Cognitive Behavioral Therapy for Insomnia has been proven to be very successful with clients who truly invest in it. It takes time and effort, but can be quite worth it without the need for medications.

A good website to check out on CBT-I is through the National Sleep Foundation:

You will need to meet with a therapist, counselor, social worker, or psychologist who works with people with sleep issues. They will tailor a sleep program for you which will include the following:

  1. Setting consistent bed times and wake up times (going to bed at the same time every night and getting up at the same time every morning places your body on a sleep/wake cycle clock).
  2. When you can't fall asleep or you've woken up and can't get back to sleep, if after 15 minutes of laying in bed, get up. Go do something boring- fold laundry, read a book (preferably not on your Kindle or iPad- but a real book so you're not looking at a lit up digital screen). Light wakes the brain up. Once you start to feel sleepy again, go back to bed. If you don't sleep well, still get up at the same time that next morning and TRY to avoid a nap during the day.
  3. Exercise daily. Walk. Move around. Something. Anything. Do something like this in the morning or earlier in the day.
  4. Your bedroom should be for sleep and sex only. Stay off your computer, television, iPad, etc. for at least an hour before bedtime if possible.
  5. Avoid alcohol, caffeine, and cigarettes. These substances upset the sleep cycle.
  6. Consider getting a "happy light" for day time use. This can help reset your circadium rythyms. A good place to get one is: 

These are just a FEW tips and ideas that CBT-I can provide you with in getting better and more consistent sleep patterns down. Sleep is necessary, just like food, water, and shelter. Having better sleep will improve your emotional, mental, and physical well-being. So start today!

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