Cognitive behavioral therapy is a first-line treatment for insomnia. But how can you tell whether it’s right for you?
Sleep and mental health often go hand-in-hand. Poor sleep hygiene can impact your mental health. In turn, mental health conditions can affect your sleep patterns.
Sleep therapy may be one option to help you overcome any sleep challenges. It typically involves working with a trained sleep therapist to develop specific skills and habits.
Sleep therapy can also explore potential reasons why you may not be sleeping as well as you would like. For example, are you developing symptoms of anxiety or depression?
“Sleep therapy” is an umbrella term that includes different approaches and techniques.
Sleep therapy is any method designed to help you overcome sleep challenges or improve the quality of your sleep.
Some forms of sleep therapy focus on specific techniques to improve sleep. Others, such as cognitive behavioral therapy (CBT), combine these strategies with the exploration of mental health barriers to good sleep.
It can take several CBT sessions to achieve the best results for you, though everyone’s different and it depends on the root causes of your sleep challenges.
CBT for insomnia might be best suited for someone who has had difficulty getting a good night’s sleep for some time, despite trying a few remedies or lifestyle adjustments.
Many people turn to sleep therapy after other self-help strategies, like stress reduction, have not worked on their own.
Common causes of poor sleep
Depression and anxiety are two common causes of disturbed sleep patterns, including insomnia, per 2021 research.
Sometimes medications, like benzodiazepines and antidepressants, can also play a role in preventing you from sleeping 7 to 9 hours per night.
When insomnia has another root cause, like a medical condition, your health professional may want to focus on that cause first. They may also recommend sleep therapy to help you achieve optimal rest.
Cognitive behavioral therapy for insomnia (CBT-I) is the American College of Physicians’ first recommended treatment for insomnia.
Dr. Smita N. Naidoo, a child and adolescent psychiatrist with a focus on sleep health and co-founder of PaperClouds.ca, says CBT-I combines teaching and review components.
“Sleep therapy creates awareness into your own current habits and teaches you how to optimize your patterns for better sleep quality,” she explains.
Sessions of CBT-I might include reviewing sleep logs to identify reasons behind insufficient or poor sleep. This type of therapy can also include elements of other sleep techniques, like:
- sleep education
- stimulus control
Naidoo calls CBT-I the gold standard for insomnia, but notes that success often depends on the person.
“It will depend on how much effort and consistency you put into it. It is as promising and often the more sustainable treatment compared to prescription medications,” Naidoo says.
Erica Alter, a licensed therapist specializing in insomnia, says CBT-I can be highly effective. The therapy offers tools to improve sleep quality and address other challenges a person might experience that could make it difficult to get adequate sleep.
“The crux of the treatment is addressing your sleep anxiety and working with your therapist to explore your perceptions about your insomnia and to make it seem less scary overall,” says Alter.
Research from 2020 suggests CBT for insomnia really works, particularly for people living with depression.
Sleep therapy refers to working with a medical professional to improve the quality of your sleep. That professional isn’t always a mental health specialist.
Sleep hygiene education (SHE)
SHE aims to provide greater awareness about behaviors that can promote restful sleep, such as:
- avoiding naps
- limiting alcohol and caffeine consumption
- reducing the use of electronics
SHE is most effective when combined with other methods like CBT-I.
Sleep restriction therapy (SRT)
SRT encourages you to limit habits and activities that could contribute to your insomnia, according to a 2018 research review.
Specifically, SRT recommends not staying in bed while you’re awake. By focusing on a specific sleep time, you could experience more consolidated sleep.
Stimulus control therapy (SCT)
SCT is similar to SHE in that it recommends not doing things that can make it hard to fall asleep.
This might include not eating in bed or using tablets, smartphones, or other digital devices in the bedroom.
SCT also encourages you to go to bed only when you’re feeling sleepy — and get up if you don’t feel tired.
The practice of relaxation techniques, such as deep breathing and visualization, can help you reduce stress and improve sleep.
Some common relaxation therapies include:
- belly breathing
- mental imagery
- progressive muscle relaxation
Relaxation therapy helps the body to wind down. It can help also help you manage anxiety about not being able to sleep, which can sometimes make insomnia worse.
You can take other steps to improve sleep quality if you’re living with poor sleep hygiene or sleep-related challenges.
You may want to consider some of the following practices, once your healthcare team gives you the green light.
Trying to get regular physical exercise
Exercise can reduce stress and relieve anxiety. This may make it easier for you to sleep more soundly at night and contribute to better overall health.
Physical activity like yoga can release endorphins that also enhance mood and may impact your sleep patterns, according to the Anxiety & Depression Association of America.
Practicing relaxation exercises before bed
Listening to relaxing music, practicing gentle stretching, or engaging in mindfulness techniques can help set your mind and body to sleep. This may help reduce some of the barriers to rest that cause insomnia.
Writing down your thoughts
It’s natural to spend time planning for tomorrow or thinking back on your day. But if this is keeping you from getting a good night’s sleep, you might want to avoid it.
Keeping a journal to set an agenda for tomorrow and to get out any unresolved feelings from the day can free up your mind to focus on rest.
You might want to save 10 to 20 minutes every evening for this practice.
There are a few over-the-counter (OTC) and prescription medications available for insomnia.
Your healthcare professional may prescribe medications to offer temporary relief for insomnia. But these aren’t usually for long-term use.
They also don’t cure insomnia, and in some cases could lead to rebound sleeplessness when you stop using them.
Some common prescription sleep aids include:
- eszopiclone (Lunesta)
- zolpidem (Ambien)
- zaleplon (Sonata)
It might be a good idea to discuss your options, whether OTC or prescription, with a health professional. In most cases, they may want to explore the causes of your sleep disturbances and address those directly.
Good sleep hygiene is important for mental health.
Sleep therapy like CBT-I can help you improve your sleep times and quality. Relaxation techniques and medications can also help in some cases.
It may be useful to discuss your sleep challenges with a healthcare professional. They can help you explore possible reasons why you’re not sleeping as much or as well as you need to.
If you’d like to find a sleep therapist, these resources can help: