Behavior Therapy for Insomnia

By Jennifer Nelson

Forget sleeping pills and OTC products designed to help you sleep. What if a visit to a therapist could have you sleeping better in a few sessions?

The best-kept secret in sleep medicine may be a pill-free treatment for insomnia called cognitive-behavioral therapy for insomnia (CBT-I).

Sessions consist of talking with a therapist about the thoughts and behaviors that screw up your slumber. About 86 percent of insomniacs had significant improvement in their sleep after just three sessions, according to an article published in Psychology Research and Behavior Management.

CBT-I is not a single technique but a collection of complementary ideas and is a method approved by both the National Institutes of Health and the British Medical Association for treating insomnia by regular—often weekly—visits to a clinician. A therapist assesses your sleep, asks you to complete a sleep diary and discusses how you can modify your sleep routine, including teaching you to control or eliminate negative thoughts and worries that keep you awake.

However, CBT-I is not an easy fix. It takes time to implement the changes and includes components such as sleep restrictive therapy, in which naps and earlier bedtimes are stopped.

Dr. Michael Perlis, associate professor of Psychiatry and Psychology at the University of Rochester, told the National Sleep Foundation that during this phase of therapy patients may feel worse than usual during the day. “After a few days of being very sleepy at bedtime, you should find it easy to fall asleep, and that is our goal,” he said.

CBT-I also includes sleep hygiene education—the dos and don’ts of good sleep, such as a cool temperature and a dark room, plus stimulus control instruction, whereby clinicians look at a patient’s sleep habits and pinpoint changes, such as not using the bed for work or reading and getting up out of bed when you can’t sleep. The simple task of putting the alarm under the bed, for example, can halt clock-watching, which only fuels the fire of insomnia for most people.

CBT-I may be right for you if you’ve had insomnia for a long period of time, tried sleep medications with little success, and have ruled out a medical disorder. However, currently there are only about 75 practitioners in the country certified as CBT-I specialists.

The length of CBT-I treatment depends on a person’s insomnia issues, but typically is four to eight sessions at a cost of $100 to $200 each, depending on the therapist.

But unlike prescription sleeping pills, once you learn the skills you need to end your insomnia, you can fall back on them should your insomnia return. People who respond well to CBT-I do so in a few sessions, and it’s a fix that won’t break the bank.

The Veteran’s Administration launched an app for patients going through CBT-I called CBT-I Coach, for people undergoing therapy for insomnia and looking to improve their sleep habits.

If you’re having trouble sleeping, investigate whether getting on the couch might help you get a restful night’s sleep.