How Cognitive Behavioural Therapy Can Help With Insomnia
A short guide to the links between anxiety and insomnia.
Therapy 25th Jan, 2021
There are a growing number of clinics offering Cognitive Behavioural Therapy (CBT) directly targeted at helping people with insomnia. The links between anxiety, stress, depression and problems sleeping have been established for a long time. However, the viewpoint that looking for the cause and finding ways to manage that, will end issues with sleep, does not work for everyone. In addition, often, if you are an insomniac you have been told to stick to a sleep routine. While this can be helpful, particularly if you have struggled with your sleep for less than 3 months, a long-term insomniac may have already tried all the recommendations. Therefore, CBT targeted at insomnia uses a different approach. This type of CBT treats insomnia as a problem in it’s own right, that needs to be cured, rather than as a symptom of another issue.
There are many different aspects that may be covered to help reduce anxiety around sleep. One is to banish the myth that everyone should get 8 hours of sleep. Most medical professionals would now agree that the amount of sleep you need is as individual as your personality. Some people need 5 hours, others 9 and a half. Aiming for 8, if that is not what you need, can cause more harm than good. What an insomniac clinic may do is get you to keep a sleep diary. You record the time you go to bed, how long it takes to fall asleep (if you do), how many times you wake up and what time you get up. They will then work with you to see how many hours of sleep you need. This can help reduce your anxiety around how much sleep you believe you should get, leading to a less stressful approach to going to bed.
Another aspect that insomnia CBT looks at could be the idea of a set bedtime. If you suffer from insomnia, you may relate to going to bed earlier, or staying in bed later, to increase your chances of getting some sleep. However, when you suffer from sleep anxiety, you are increasing the amount of time you lie awake worrying and suffering. CBT flips this and sets a time to get up, rather than a bedtime. The advice may be no matter how much sleep you have had, what time you went to bed, or your schedule, to get up at the same time every day. The idea behind this is, although it can be difficult for the first few days, or weeks, gradually you will begin to feel tired at the same time every day. Then, over time you will start to have a more consistent bedtime as well. While you are establishing this new routine, your time in bed is also reduced, if you have worked out you need 7 hours of sleep and you get up at 7.30am, then the earliest you can go to bed is 12.30am. With the specialist help you are receiving, once you are managing to sleep for 90% of the time you can move your earliest bedtime, under their advice.
CBT also works to end the negative feelings and associations you could have with your bedroom. As you may have experienced, the decision to go to bed can actually wake you up, as you worry about lying awake and getting frustrated at your inability to sleep. This, in turn, leads to more anxiety and potentially actually disliking your bedroom. What an insomniac clinic using CBT might do, is ask you to not to do anything other than sleep or have sex in your bedroom and leave it after 15 minutes if you are not asleep. Go into another room and do what you have agreed with your therapist (read, meditation etc), then try again. This can be difficult, requiring the support given by the clinic and may result in your initially sleeping less. However, over time, you can retrain your brain and change the negative associations between your bedroom and sleep.
Overall, if you have suffered from insomnia for more than 3 months, it may be worth looking into sleep clinics. Take care, particularly if you suffer from anxiety, do not pay for anything until you have researched the company and looked at reviews that are not on their website. A good test to ask yourself is would you recommend the place you have found to an elderly family member, who can not use the internet? If possible try a free taster session before looking at the paid options. Places like The Insomnia Clinic https://www.theinsomniaclinic.co.uk/ offer a limited amount of free advice and a free webinar. Above all, treat your insomnia like any other illness and take the time and space you need to find the right treatment for your circumstances.