Herbie Murray
Sleep therapy is a treatment option for people who have trouble falling or staying asleep, or who feel tired during the day despite getting enough hours of sleep. Sleep disorders can be caused by or trigger emotional health problems such as anxiety, stress, and depression. Cognitive behavioural therapy (CBT) is the most widely used therapy for sleep disorders and can be more effective than sleeping pills in the long term. CBT can help to improve sleep by changing pre-bedtime behaviour and addressing the negative thoughts that keep you from falling asleep. It also focuses on improving relaxation skills and changing lifestyle habits that impact sleep patterns.
| Characteristics | Values |
|---|---|
| Purpose | Improve sleep quality |
| Effectiveness | More effective than sleeping pills |
| Therapy Type | Cognitive-behavioral therapy (CBT) |
| Therapy Focus | Changing pre-sleep behavior and thoughts; improving relaxation skills; changing lifestyle habits |
| Underlying Issues | Emotional health problems such as anxiety, stress, and depression |
| Therapy Benefits | Relaxing the mind; changing outlook; improving daytime habits |
| Sleep Disorders | Insomnia, sleep apnea, narcolepsy, restless legs syndrome, circadian rhythm sleep disorders |
| CBT Types | Individual, group, online |
| CBT Length | Depends on type and severity of sleep disorder; short-term |
| CBT Techniques | Thought challenging, behavioral techniques, stimulus control therapy, sleep restriction therapy, relaxation training, biofeedback, hypnosis |
| Sleep Hygiene | Regular exercise, avoiding nicotine and caffeine, unwinding at night |
| Online Therapy | Convenient, effective, accessible |
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What You'll Learn
Cognitive behavioural therapy (CBT) for insomnia
Cognitive behavioural therapy (CBT) is the most widely used therapy for sleep disorders and problems. CBT can improve your sleep by changing your behaviour before bedtime, as well as changing the ways of thinking that keep you from falling asleep. It also focuses on improving relaxation skills and changing lifestyle habits that impact your sleeping patterns.
CBT for insomnia (CBT-I) is a short, structured, and evidence-based approach to combating the frustrating symptoms of insomnia. CBT-I focuses on restructuring the thoughts, feelings, and behaviours that are contributing to insomnia.
Therapy techniques involve stimulus control, sleep restriction, and relaxation training. Stimulus control therapy helps to identify and change sleep habits that prevent you from sleeping well. This means training yourself to use your bedroom for just sleep and sex, rather than working or watching TV, and maintaining consistent sleep-wake times, even on weekends. Sleep restriction therapy (SRT) reduces the time you spend lying in bed awake by eliminating naps and forcing you to stay up beyond your normal bedtime. This method of sleep deprivation can be especially effective for insomnia as it builds a stronger association between bed and sleep rather than bed and lying awake.
Most individuals who try CBT-I experience improvements to their insomnia and better quality sleep. CBT-I is considered effective for both short-term insomnia and chronic insomnia. The American College of Physicians recommends that all adult patients receive CBT-I as a first-line approach.
The length of therapy depends on the type and severity of your sleep disorder. While CBT is rarely an immediate or easy cure, it is relatively short-term. Many CBT treatment programs for insomnia report significant improvement in sleep patterns following a course of 5 to 8 weekly sessions. The majority of patients respond to this treatment fairly quickly. Some experience significant changes after only two therapy sessions, and most improve after four to six sessions.
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Sleep and mental health
Cognitive-behavioral therapy (CBT) is the most widely used therapy for sleep disorders and problems. CBT can improve your sleep by changing your behavior before bedtime as well as changing the ways of thinking that keep you from falling asleep. It also focuses on improving relaxation skills and changing lifestyle habits that impact your sleeping patterns.
During CBT, a trained CBT provider helps to identify thoughts, feelings, and behaviors that are contributing to the symptoms of insomnia. Thoughts and feelings about sleep are examined and tested to see if they're accurate, while behaviors are examined to determine if they promote sleep. A provider will then clarify or reframe misconceptions and challenges in a way that is more conducive to restful sleep.
CBT addresses negative thoughts and behavior patterns that contribute to insomnia or other sleeping problems. It involves two main components: cognitive therapy and behavioral therapy.
Cognitive therapy teaches you to recognize and change negative beliefs and thoughts (cognitive distortions) that contribute to your sleep problems. It involves thought challenging or cognitive restructuring, in which you challenge the negative thinking patterns that contribute to your sleep problems, replacing them with more positive, realistic thoughts.
Behavioral therapy teaches you how to avoid behaviors that keep you awake at night and replace them with better sleep habits. This includes stimulus control therapy, which helps to identify and change sleep habits that prevent you from sleeping well, and sleep restriction therapy (SRT), which reduces the time you spend lying in bed awake.
Relaxation training is another important component of CBT, teaching you how to relax both your mind and body to reduce any anxiety or tension that keeps you awake. This can include mindfulness meditation, progressive muscle relaxation, and breathing exercises.
Sleep therapy can be conducted individually, in a group, or via an online therapy platform. It is often not an immediate or easy cure, but rather a short-term process that requires commitment and practice. However, it can be highly effective, with many people experiencing significant improvements in their sleep patterns.
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Sleep therapy vs. sleeping pills
Sleep therapy and sleeping pills are two different approaches to treating sleep disorders such as insomnia. Sleep therapy, specifically Cognitive Behavioural Therapy (CBT), is a type of therapy used to improve sleep quality by changing negative thought patterns and behaviours that affect sleep. Sleeping pills, on the other hand, are medications that induce drowsiness and relaxation to help with sleep. While sleeping pills can provide short-term relief, sleep therapy is often a more effective long-term solution without the side effects associated with sleeping pills.
Sleep therapy, particularly CBT, is a widely used and effective approach to treating sleep disorders such as insomnia, sleep apnea, narcolepsy, and restless leg syndrome. CBT helps individuals identify and change negative thoughts and behaviours that contribute to sleep problems. It involves cognitive interventions, such as cognitive restructuring, which aims to replace negative thoughts with more positive and realistic ones. For example, instead of thinking, "I'm never going to be able to sleep well", an individual would be encouraged to think, "Sleep problems can be cured. If I stop worrying and focus on positive solutions, I can beat it". Behavioural interventions, such as stimulus control therapy, sleep restriction therapy, and relaxation techniques, are also used to establish healthy sleep habits and improve sleep hygiene. Sleep therapy typically requires a trained therapist and may take several sessions to see significant improvement. However, it addresses the underlying causes of sleep disorders and helps develop healthy sleeping patterns for the long term.
Sleeping pills, on the other hand, are medications that can be obtained over the counter or through a prescription to help with sleep. Over-the-counter sleeping pills often contain antihistamines, which cause drowsiness. Prescription sleeping pills, such as benzodiazepines and Z-drugs, are stronger and work by stimulating chemicals in the brain that induce sedation and muscle relaxation. While sleeping pills can help individuals fall asleep faster, they do not address the underlying causes of sleep disorders. Sleeping pills are associated with several side effects, including daytime drowsiness, cognitive impairment, dependence, withdrawal symptoms, and abnormal thinking and behaviour. They are typically recommended for short-term relief and not as a long-term solution due to the risk of dependence and addiction.
While sleeping pills can provide temporary relief for sleep disorders, sleep therapy, such as CBT, is often a more effective and sustainable solution. Sleep therapy addresses the underlying causes of sleep problems and helps individuals develop healthy sleeping patterns and improve sleep hygiene. Sleeping pills, on the other hand, may provide short-term relief but do not address the root causes and can lead to dependence and side effects. For those struggling with sleep disorders, sleep therapy is a recommended first-line approach, and even if prescription medication is required, it is often combined with therapy and lifestyle changes for optimal results.
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Sleep restriction therapy
SRT is a behavioural treatment that addresses the pattern of worrying that can develop alongside insomnia. It is a method that forms part of cognitive behavioural therapy for insomnia (CBT-I).
Step 1: Identify Average Total Sleep Time Using a Sleep Diary
A person will work with a sleep therapist who will ask them to keep a sleep diary for 1-2 weeks. In the diary, they should record how long they spend in bed and estimate the length of time they sleep each day. They should also take note of factors that can disturb their sleep, including needing to use the bathroom and other sleep disturbances.
Step 2: Determine the Sleep Window
The sleep specialist will determine the maximum time that a person can spend in bed based on their average total sleep time, or sleep window, per week. For example, a person who sleeps on average for 6 hours per night should restrict their sleep window to 6 hours. However, practitioners advise that people do not restrict their time in bed to less than 5 hours, regardless of their average sleep time.
Step 3: Set a Waking Up Time
A person should select a time to wake up every morning—the same time each day—and stick to it regardless of how much sleep they had the night before.
Step 4: Set a Bedtime
Individuals can determine their bedtime by counting backward from their wake time to fit in their sleep window. For example, if a person has decided to wake up every day at 7 a.m. and has a 6-hour window, they should go to bed at 1 a.m.
Step 5: Stick to the Schedule for About 2 Weeks
A person should commit to following their schedule for about 2 weeks while continually tracking their time in bed and asleep.
Step 6: Calculate the Average Efficiency Score
A person can calculate their sleep efficiency (SE) score by dividing the time they spend asleep by their time in bed and multiplying it by 100 to get a percentage. Both of these times should be in minutes.
Step 7: Adjust the Sleep Window
A sleep specialist then uses a person’s weekly average SE score to determine the need to adjust their sleep window. When a person’s sleep efficiency is higher than 90%, or 85% in older adults, the sleep specialist can increase their time in bed by 15–30 minutes. A person’s permitted time in bed becomes 15–30 minutes shorter when their SE score is 80–85%. Sleep specialists will follow each change for at least a week before making another adjustment. This continues until no further change is necessary because the person has already reached their recommended amount of sleep, or the amount of sleep they are getting is enough for optimal functioning during the day.
Tips for Sleep Restriction Therapy
- Avoiding napping: Taking naps during waking hours will decrease the sleep drive, making it difficult to sleep at bedtime.
- Using light: Light is a powerful controller of the body clock. A person can use bright light in the morning and dim light or no light in the evening to help reset the sleep-wake cycle.
- Practicing good sleep hygiene: A person should aim to adopt habits and practices that can help promote sleep, including regular exercise, eliminating nicotine and caffeine, and avoiding eating heavy meals too close to bedtime.
- Embracing a routine: Adopting a consistent routine can help prepare the body for bed. A person can begin by adding habits that signal to their body that it is the morning, such as showering and walking outdoors.
- Using the bed only for sleeping and sex: A person should avoid working, watching movies, or spending time on social media while lying in bed.
- Creating a cosy sleeping environment: Sleeping in a cool, quiet, and dark room can help signal to the body that it is time to sleep by triggering the release of melatonin, the hormone that promotes sleep.
- Expecting an increase in daytime sleepiness, especially early in the SRT treatment: It is best not to operate heavy machinery or drive when this occurs.
SRT is widely prescribed to people with chronic insomnia and is generally considered safe. However, because it may cause sleepiness, it may not be appropriate for everyone. For example, people in certain occupations, such as transportation or construction, may put themselves or others in danger if they attempt to work while sleep-deprived.
Additionally, sleep experts generally do not prescribe SRT to individuals with:
- Major illness or recent surgery
- Untreated sleep apnea
- Seizure disorders that are not under control
- Untreated bipolar disorder
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Relaxation techniques
Sleep therapy is a type of therapy used to improve the quality of your sleep at night. Cognitive-behavioural therapy (CBT) is the most widely used therapy for sleep disorders and problems. CBT can help you develop healthy sleeping patterns for life and improve your daytime habits.
Diaphragmatic Breathing
Also known as belly breathing, this technique involves engaging the large muscle at the base of the lungs. Diaphragmatic breathing can reduce stress and increase relaxation, as well as strengthen the diaphragm and improve breathing efficiency. To try this technique, place one hand on your upper chest and the other hand on your belly, just below your rib cage. Breathe in through your nose, pushing your belly against your hand. Keep your chest as still as possible, then tighten your stomach muscles and exhale. Repeat this process, gradually increasing the time to maximise the benefits.
4-7-8 Breathing
This technique helps control the speed of your breath. To try it, inhale through your nose for 4 seconds, hold your breath for 7 seconds, then exhale through your mouth for 8 seconds, making a natural sound as if blowing out a candle. As you get used to the pace, increase the amount of time you spend on this exercise.
Body Scans
Body scans are a type of meditation that involves slow, focused attention to different parts of the body. Lie comfortably in bed and take a few deep breaths to relax your body. Bring your attention to your feet, noticing any sensations and tension. Acknowledge any discomfort and visualise it leaving your body through your breath. Move your focus to your calf muscles and repeat the process. Continue moving your attention up your body, one part at a time, until you've scanned your entire body.
Yoga Nidra
Yoga nidra is a form of meditative yoga intended to induce calmness and improve sleep. Lie flat on your back with your hands apart. Think of a short, positive phrase or mantra, then increase your body awareness by visualising different parts of your body in succession. Focus on each breath and imagine the air flowing in and out of your body. Recall personal experiences, feelings, and sensations, both positive and negative. Visualise each scene and emotion as if it's happening in the present moment. Repeat your positive phrase and return your awareness to your body and the room. Continue this process until you reach a deep state of relaxation.
Progressive Muscle Relaxation
This technique is based on the idea that it's hard to feel tense when your muscles are relaxed. It involves tensing and relaxing different muscle groups one by one. Lie down in bed and inhale, tensing the first group of muscles for 5-10 seconds. Exhale and quickly relax the muscles in that group. Stay relaxed for 10-20 seconds before moving on to the next muscle group.
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Frequently asked questions
Sleep therapy is a type of therapy used to improve the quality of your sleep at night. Cognitive-behavioural therapy (CBT) is the most widely used therapy for sleep disorders and problems. CBT can improve your sleep by changing your behaviour before bedtime, as well as changing the ways of thinking that keep you from falling asleep.
Sleep therapy can help you develop healthy sleeping patterns for life and address the underlying causes of your sleep disorder, such as anxiety, stress, and depression. It can also be more effective than sleeping pills in the long term, without the same side effects.
During sleep therapy, a trained CBT provider will help to identify thoughts, feelings, and behaviours that are contributing to the symptoms of insomnia. They will then work with you to clarify or reframe misconceptions and challenges in a way that is more conducive to restful sleep.
If you have been experiencing insomnia or other sleep difficulties for at least three months, sleep therapy may be a good option for you. Signs that you may need sleep therapy include regularly struggling to fall or stay asleep, feeling tired during the day despite getting enough hours of sleep, and having broken or restless sleep.
