Insomnia: Think Your Way to Sleep

By Barbara Pierce

 

Holly Vanderhoff is the director of student counseling service at SUNY Upstate Medical University and an expert in sleeping habits.

Insomnia is a common sleep disorder that makes it hard to fall asleep or stay asleep. Cognitive behavioral therapy for insomnia, called CBT-I, can effectively treat long-term sleep problems.

Generally, it’s the first treatment recommended for chronic insomnia.

“I’m stunned with how well it works,” said Holly Vanderhoff, director of student counseling service at SUNY Upstate Medical University. She has been trained in CBT-I. “Research shows that it’s effective.”

CBT-I helps you find which thoughts and behaviors are causing your sleep problems and are making your sleep problems worse. Unlike sleeping pills, CBT-I helps you overcome the causes of your sleep problems.

CBT-I can benefit nearly anyone with sleep problems. It can help people who have insomnia due to lifestyle habits, medical issues, physical problems or mental health conditions. The positive effects of CBT-I seem to last and there is no evidence that it has harmful side effects.

CBT requires steady practice and some approaches may cause you to lose sleep at first. But stay with it and you’ll likely see lasting results.

“It’s a short-term therapy, usually just eight to 10 sessions cures the insomnia,” said Vanderhoff. “We don’t get into other issues you may be having; we just focus on the insomnia.”

“Poor sleep habits contribute,” she explained. “That’s the B for behavior. C is for cognitions, the thoughts and beliefs that cause you to have difficulty sleeping.”

Regarding behaviors that promote good sleep, one is having a consistent sleep schedule, she said.

“Go to bed and get up at the same time every day,” she said. “Don’t sleep in on the weekends if you have to get up during the weekdays at 6 a.m.”

An environment conducive to sleep is important. This includes quiet, no TV, a cool temperature, (a cool temperature promotes good sleep) and dark. Even small sources of light like the glow from your alarm clock can interfere with your sleep; be alert to that, she added.

Have a night time routine, wind down before bed. Step away from your screen before bedtime, do calming activities, like reading, taking a warm bath or shower, listening to calming music. Avoid caffeine, alcohol, exercising, engaging in mentally taxing tasks.

Sleep restriction is another thing helpful for insomnia, but it can be brutal, she said. Limit the time you spend in bed without sleeping; this will help. When you can’t sleep, get up and do something relaxing then go back to bed when you feel more relaxed. People with insomnia often spend a lot of time lying in bed awake, which weakens the association between bed and sleep and makes it harder to fall asleep.

Associate your bedroom with good sleep. Many people use their bedroom for other things, like a place to work, to watch TV, to exercise. If you have insomnia, get those things out of your bedroom, she recommended.

“The other component to CBT-I therapy is the ‘C’ — your thoughts or beliefs,” she said.

CBT-I helps you find out which thoughts about sleep could be causing your sleep problems and making them worse. You learn to replace these thoughts with thoughts that support sleep.

“Your thoughts can create anxiety about sleep, as most of these thoughts are catastrophizing,” said Vanderhoff. You may be thinking: “I’ll never fall asleep!” “I’ll feel awful tomorrow; this is terrible!” “Why can’t I fall asleep?”

The things you are telling yourself about your insomnia makes you more anxious and upset, said Vanderhoff.

“The key is to identity your thoughts or beliefs about sleep and modify them,” she suggested. “For example, replace a catastrophizing thought with a more balanced one. A more balanced thought would be something like: ‘I may or may not sleep well, but I will be able to function tomorrow; I’ll get through the day. Whatever happens, happens.’”

CBT-I may be a good treatment choice if you have long-term sleep problems or you’re worried about becoming dependent on sleep medicines. It can also be a good choice if medicines aren’t effective or cause bothersome side effects.

“You do need a specialist trained in cognitive behavioral therapy for insomnia,” she added. “They are few and far between. A general therapist won’t be helpful if you have chronic insomnia,” she said.

“There’s a program available through the VA (even if you aren’t a veteran) called ‘CBT-I Coach’ that is really good,” she added.

This is an app that can be found at https://mobile.va.gov.

“There are also links to some programs at sleepfoundation.org,” she suggested.”