CBT-I for Insomnia
Insomnia is a sleep disorder that results in loss of sleep. A person might fight difficulty in falling asleep or
wake up too early. This drains out all of the energy and makes one feel tired throughout the day. It
adversely affects an individual’s regular life and efficiency and needs to be addressed as soon as possible.
There are various approaches that can be used to treat insomnia.
What is CBT-I?
CBT-I stands for Cognitive Behavioural Therapy for Insomnia. It is an approach that helps to identify those
thoughts, beliefs, and actions that cause and worsen insomnia so that one can replace them. In short, it
helps identify the root cause of insomnia and take productive measures to deal with it. It is often
referred to as a multi-component therapy as the sessions include behavioral, educational, and cognitive
components.
Techniques used in CBT-I :
Stimulus Control Therapy: It is often observed that people suffering from insomnia develop habits that
do not promote sleep. They use the bed for almost all activities other than sleep like watching television,
eating, using the phone or computer, etc. Patients are instructed to use the bed only for sleep and sex.
They are advised to avoid naps and to get out of their bed if they cannot fall asleep for more than 10
minutes and get back only when they are tired.
Sleep Restriction: This is a method by which the time a person spends sleepless in bed is reduced. For
example, if a person is trying to sleep for 7 hours but actually falls asleep only for 4 hours, he is made to
spend only 4 hours and 30 minutes in bed. Gradually, as the duration of sleep increases, the time is
further increased to 7 hours of quality sleep.
Relaxation techniques: Lying awake in bed can become very frustrating and lead to racing thoughts,
tension and anxiety. These techniques stimulate the natural relaxation process of the body. It includes:
● Breathing exercises – Focussed, slow breathing can increase slow heart rate and reduce tension,
anxiety, anger, and depression. It very effectively helps us calm down.
● Autogenic training – An individual is trained to focus on a certain part of the body to feel
sensations such as warmth, heaviness, etc.
● Progressive Muscle Relaxation(PMR) – It involves tensing and relaxing different groups of
muscles. It is often combined with breathing exercises to get better results.
● Meditation – Practising meditation has a variety of health benefits as it is relaxing and reduces
stress and anxiety.
● Biofeedback – A sleep specialist uses technology to get information about brain waves, muscle
tension, heart rate, breathing, and body temperature.
● Sleep hygiene – It aims at eliminating habits that are detrimental to sleep and including the ones
that promote sleep. For example, consumption of caffeine late in the day, smoking, etc are not
good for sleep whereas following a sleep ritual such as staying away from electronic devices at
least one hour before bed time, exercising regularly, etc can help in achieving good sleep.
Psychoeducation: It is important to educate an individual about the practices of good sleep hygiene and
its importance. One can follow it only if she is mentally convinced about it. Going to bed at a particular
time on a clean and comfortable bed, with dim lights in the bedroom are some of the practices that one
should follow on a regular basis.
Effectiveness of CBT-I :
Approximately, 70-80% of the patients with primary insomnia are benefitted from CBT-I. Practicing it
regularly has numerous benefits like falling asleep quickly, and getting an improved quality and quantity of
sleep. It is also recommended as the first line of treatment for adults suffering from insomnia. Some
people such as pregnant women, people suffering from post-traumatic stress disorder(PTSD), those who
are undergoing cancer treatment are more prone to insomnia. CBT-I is observed to work well for them
also. It is more effective as compared to medications with almost no side effects.
CBT-I is generally administered by trained professionals such as doctors, counselors, psychiatrists,s or a
therapist. It is a widespread need that has been digitized now. Online applications have been
developed for the same. This reduces the cost of treatment and makes it available to a wider audience.
Hence, we conclude that identifying and dealing with insomnia is the most important for the mental and
physical well-being of an individual. If practiced sincerely with a positive attitude one experiences a
reduction in the amount of time required to fall asleep and also gets a sound sleep. Therefore, it is
important that one seeks professional help and pours in a personal effort to cure insomnia.
References:
https://www.sleepfoundation.org/insomnia/treatment/cognitive-behavioral-therapy-insomnia
https://www.mayoclinic.org/diseases-conditions/insomnia/symptoms-causes
Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M., & Cunnington, D. (2015). Cognitive Behavioral
Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Annals of internal medicine,
163(3), 191–204. https://doi.org/10.7326/M14-284
