Cognitive Behavioral Therapy for Insomnia

It is very important not to underestimate just how disruptive and destructive insomnia can be. Insomnia prevents you from being able to get to sleep easily but it goes beyond that as this in itself leads to lots of serious side effects. If you can’t sleep, then you will find that you are less able to form new memories, that you struggle to concentrate the next day and that you will be more prone to becoming ill. You may get headaches, you will be more stressed and you will have no energy. Thus this one mental health issue can end up having knock-on effects on almost every other aspect of your life. If you’re not getting proper sleep then you won’t be enjoying your experiences to the fullest and you won’t be performing as well as you could be.

The Problem With Drugs and Lifestyle Changes

There are many potential treatments for insomnia but not all of them will prove effective all of the time. In many cases for instance, doctors might prescribe medications which can result in an increase of certain neurotransmitters, the main ones usually being melatonin (the main sleep hormone) or GABA (the ‘inhibitory neurotransmitter’). By doing this, the brain slows down and your thoughts stop going in circles allowing you to get to sleep.

Unfortunately though, the use of such drugs carries a number of side effects and can potentially lead to dependence, addiction and abuse. Other techniques such as lifestyle changes might have only minor effects on your ability to get to sleep and so the problem persists for many people.

CBT however provides another option which is both safe and highly effective in many cases.

What Is CBT?

CBT stands for ‘Cognitive Behavioral Therapy’ and is a ‘psychotherapeutic’ approach – or a talking cure. Unlike some other forms of therapy however, CBT is not interest in uncovering repressed memories or looking back to your childhood, rather it focusses on giving you tools you can use in the here and now in order to address mental health concerns. It can be used to treat all kinds of conditions from anxiety, to phobias, to depression… to insomnia. CBT has been shown to be a highly effective and minimally invasive form of treatment and the great thing about it is that it’s something you can start using from the comfort of your own home (1, 2).

Because CBT involves the use of particular mental skills, this means that a patient can use it on their own once they grasp the basics. While you will likely have more success by seeking professional help, you can nevertheless enjoy significant benefits simply by understanding the concepts behind CBT and then applying them in your own life.

How CBT Works

One of the main ideas behind CBT for insomnia is to identify the negative thought patterns that might be preventing you from getting to sleep. In many cases it is the general activity of the brain that makes it hard for patients to fall into a restful sleep and they can actually experience bouts of stress and anxiety when they should be settling down for the night. This then gets further compounded by the fact that they are stressed about not being able to get to sleep.

If you are suffering with insomnia then, you might well go to bed thinking ‘I must get to sleep by X time’. This then in turn causes you to actually be stressed about sleeping which might also cause your heart rate to increase and even triggers the ‘fight or flight’ response. As you might imagine, it’s very hard to sleep when you’re in this amped up state.

Other people might find their mind racing about other things. Perhaps you are worrying about all of the things you still need to do at work. Perhaps you are stressed about an upcoming social event, or maybe it upsets you that the kitchen isn’t tidy. Whatever the cause, you can often find yourself stressing over things that are outside of your control right at a time when you should be winding down.

CBT then helps you to identify these thoughts that are causing you to become agitated and from there to then try and address them and reduce them. This process is called ‘cognitive restructuring’.

How You Can Start Using Cognitive Restructuring to Treat Your Own Insomnia

If you are struggling with insomnia and you want to try using the ideas behind CBT to address the issue, then follow the steps below…

Step 1 – Mindfulness

The first thing to look at is what the precise negative thoughts are that are contributing to your difficulty with sleeping. Are you stressing about the day’s events? Or are you stressing mainly about feeling tired the next day?

While you’re lying there, don’t try to prevent these thoughts but for now just be aware of them and make a mental note of specifically what you’re thinking that might be preventing you sleeping and causing that unwanted fight or flight response.

This is what is called mindfulness.

Step 2 – Cognitive Restructuring

Now, once you have identified the thoughts that are the root of the problem, the next stage is to try and reduce those negative thoughts and replace them with more constructive thoughts that help you to get to sleep. This means consciously challenging those negative ruminations and attempting to replace them with thoughts that will be more positive and that will help you to get to sleep.

For instance, if you are currently worrying about work, then a better thought to have would be ‘there’s no point in worrying about work right now’, or ‘I’ll be better equipped to deal with that if I give myself a break’. Convince yourself not to think about those things and practice repeating these phrases until you believe them.

Similarly, if you find yourself thinking that ‘I must get to sleep right now’ or ‘if I don’t get to sleep now, I’ll feel awful tomorrow’ then you can try replacing these thoughts with ‘as long as I’m resting, that’s the main thing’ or ‘I’m perfectly capable of functioning on six hours’ sleep’. The point in this case is to give yourself permission to simply relax. Try telling yourself that even if you’re just relaxing, that will still help to refresh you for tomorrow.

You can even go one step further and focus on how comfortable you are and how much you enjoy lying in bed. Tell yourself ‘I’m so comfortable, I’m enjoying just lying here under the covers’. These thought patterns will help you to relax and enjoy yourself and as soon as you enjoy being in bed, you’ll be much more likely to fall asleep quickly.

Ultimately, the aim is to convince yourself to think these more positive things by default rather than stress and letting your thoughts run out of control. Eventually you will find that you unconsciously think things like this and that they come naturally so you no longer need to actively change your thinking.

You can also try to distract yourself from these destructive thoughts by thinking something that doesn’t stress you out and that you enjoy thinking about. Maybe try daydreaming about winning the lottery, or thinking about something you find interesting but not stimulating enough to keep awake. I actually look forward to going to bed as a chance to think about things I care about and to mull over creative ideas – invariably I get little chance to do so.

This process is cognitive restructuring.

Step 3 – Hypothesis Testing

Hypothesis testing means testing your own fears in order to challenge your negative beliefs. This is what will help you to actually believe your new positive thought patterns and that will make them much more effective, much more quickly.

In the case of insomnia, one of the primary beliefs that will be preventing you from sleeping is the idea that unless you try harder to get to sleep, you are going to feel awful in the morning. Of course we have discussed that this is untrue – especially as you can’t effectively force yourself to sleep.

To prove to yourself that an hour doesn’t really make that much difference in the grand scheme of things, try just lying there and accept the fact that you aren’t going to sleep as an experiment. This will test your theory that you have a lot to be stressed about.

Likewise, if you think you need to ‘remember something important for tomorrow’, try testing that idea and letting yourself forget it.

Under these experimental circumstances you will allow yourself to simply relax and this will then disprove your previous unconscious assumptions and teach you that the best way to sleep is just to not care about sleeping. Ironic though it may sound.

This is hypothesis testing.

Other Factors

CBT will not prove effective in 100% of cases but it has a great track record and as you can try it completely safely and free at home, it is certainly worth giving a try to see if it can help you. If you have no luck on your own then try seeing your GP and getting referred to an actual therapist.

Once you learn to use CBT you can then also use this to address other issues in your life and generally to lead yourself towards healthier thinking in general. This can have beneficial knock-on effects for your insomnia. For instance, insomnia may be caused by general stress and CBT can be a very effective tool for addressing stress more generally. Likewise, insomnia and depression often go hand in hand and CBT can be effective for depression too.

It’s also a good idea to give yourself the best chances of success, which means making all the other lifestyle changes that can help you to sleep. So make sure that you are avoiding working on the computer late at night, try taking warm showers before bed and give yourself something to read to quieten your brain down.

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