Close up of sleep-deprived person

On Sleep & CBT-I

Poor sleep is an opportunity to experiment with something new. Test the strategies of CBT-I to improve a fundamental aspect of your mental health.

OVERVIEW: ON SLEEP & CBT-I

We mention in a previous blog post that many people struggle with sleep. This can include difficulty getting good sleep, staying asleep, and feeling rested throughout the day. We may have varying patterns with sleep: a few days of solid sleep, a few weeks of insufficient sleep there, or a history of a satisfactory belief in your ability to get good rest. And then a life event changes this routine or perspective. You might grow frustrated at a lack of sleep impairing your daily functioning.     

Sleep difficulty might form into a diagnosable condition. The International Classification of Sleep Disorders names eight groups, including insomnias. Insomnia disorder affects 30% of the general adult population. The diagnosis can be characterized as “the subjective perception of difficulty with sleep initiation, duration, consolidation, or quality, which occurs despite adequate opportunity for sleep, and results in some form of daytime impairment.” Even more, it can be helpful to group insomnia alongside other types, such as: chronic insomnia, acute insomnia, paradoxical insomnia, sleep-onset insomnia, sleep-maintenance insomnia, fatal insomnia.  

Why & How We Sleep

One of the basics of improving well-being includes getting enough sleep. The condition allows our brain and body to process events through non-rapid eye movement (NREM) and rapid eye movement (REM). In these moments, NREM and REM support your brain as it works with your body to recover from daily stressors, develop circuits, find new pathways, convert memories, . 

Poor sleep and insomnia are connected to many experiences, including mood fluctuations, difficulty focusing or organizing tasks, irritability, hallucinations, and disproportionate reactions. Knowing these ranging experiences, it makes sense a lack of sleep can feel disempowering. Relief seems unreachable. Even more, many factors within and outside our control influence our time and ability for quality sleep, including genetic, cultural, environmental, and lifestyle concerns. And yet there is an opportunity to experiment with something new. Cognitive Behavioral Therapy for Insomnia may be of help.

History of CBT-I

Cognitive Behavioral Therapy for Insomnia (CBT-I) is a first-line treatment of insomnia. The style of therapy can be viewed alongside Dr. Michael L. Perlis’s advancements in Behavioral Sleep Medicine (BSM). The treatment follows aspects of CBT, in which how and what you think about sleep influences your mood and behavior. These elements create a spiral directing upward or downward, stunting or improving growth. There are several parts to CBT-I. When used together, this can bring powerful results.  

Sleep Hygiene

Sleep Preparation & Relaxation Training. When pursuing better sleep, it’s important to create an environment that brings a sense of calm. What items, sounds, textures, and thoughts soothe your body for rest? What items, substances, and environments prime my body to remain alert and awake? This might mean lighting a candle or journaling. This might mean limiting your intake of certain stimulants and technology a few hours before bed. This might mean exercising during the day. Answering these questions will help you when you feel drowsy. This makes the transition from daytime activity to a nighttime routine easier.

Build a Routine. It can be useful to set sleep-wake times and avoid naps. The Sleep & CBT-I Workbook helps you implement a schedule and complete goals. By improving your need for sleep and using your bed for only sleep, you’ll strengthen what we refer to as your “sleep drive” and “sleep efficiency.” 

Sleep Restriction & Stimulus Control

Drs. Arthur J. Spielman, Paul Saskin, and Michael J. Thorpy understood that treating chronic insomnia includes adjusting the time spent in bed awake. The more you remain in bed awake, the more your brain links the bed and nighttime with being alert. To counteract this association, the three researched Sleep Restriction Therapy (SRT), in which you only associate bed with sleep and calculate your sleep efficiency (total sleep time divided by time in bed) and sleep drive (your increased drowsiness and need for sleep). 

Drs. Richard R. Bootzin and Michael L. Perlis studied Stimulus Control Therapy (SCT) to reinforce new and sustained behavior for alleviating acute and chronic insomnia. Stimulus control is a way to reduce the things that keep you up at night: electronics, noise, bright lights. Our product allows you to put these concepts to practice. 

Cognitive Reframing 

When we’re experiencing sleep difficulties, our minds might develop automatic unhelpful thoughts. These specific thoughts grow and multiply, their intensity preventing us from relaxing and falling asleep. Remember that we can test these thoughts and determine to what extent we’d like to believe them. We can also set aside structured time to worry, ensuring the time right before bed supports a mindset for quality sleep.  Know that a subtle shift in thinking can loosen the grip on particular “rules” we set for ourselves. We can practice thinking that is realistic and flexible. We can develop the habit of changing our minds, refining thoughts as we go. 

Reflection

Improving our mental health includes noticing small changes over time. You might do this by acknowledging what’s working well. If there’s something you’ve tried that isn’t effective, try getting curious about why this might be. Remember that change is possible and also takes time.

NEXT STEPS: BETTER SLEEP 

Therapists designed a six-week guided program for you to integrate the tools and strategies of CBT-I into your life for better sleep. Our product helps you capture your current habits around sleep, learn the principles of sleep and CBT-I, and name and plan for any barriers to achieving good sleep. Our hope is that you’ll feel capable of achieving consistent, lasting sleep.

The workbook begins by gathering information on your current relationship with sleep. You’ll log sleep time and wake time. As you notice patterns, you’ll adjust your sleep schedule to improve your need for sleep. You’ll associate objects and environments with rest and sleep (think: bedroom and relax, bed and sleep). You’ll determine what is most helpful to you: What thoughts or techniques are needed to relax my body? Is this thought helpful or how can I challenge it? As you note what isn't helpful, you’ll decide what is needed to transition your mind and body for periods of rest. You’ll receive notes from therapists along the way, acknowledging the courage and effort of trying something new. 

We understand that recognizing the need for change, implementing new habits, and falling back on old habits is an ongoing process. We’re here to help guide you through this change. 

Learn more about how you can use The Sleep & CBT-I Workbook here

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