After a very long day, you cannot wait until you can snuggle into bed and enjoy a good night’s rest, but instead of snoozing off into your dreams, you lie awake unable to sleep, frustrated and defeated by insomnia. According to the Center for Disease Control (CDC), adults need seven or more hours of sleep per night for health and wellbeing. A 2014 study conducted by the CDC indicates that 35.2% of adults report less than seven hours of sleep per night. Lacking adequate sleep negatively influences your health and behavioral risk factors to include obesity, lack of motivation and energy impacting the desire to exercise, mood changes, irritability, and increased alcohol use.
There are various factors that can impact sleep including anxiety, depression, or other medical conditions. Insomnia is a sleep disorder lasting three or more months related to difficulty initiating sleep, staying asleep, sleeping for a healthy amount of time, or returning to sleep when a person awakes at an unorthodox hour.
Cognitive Behavioral Therapy for insomnia or CBT-I is a non-pharmacological approach to sleep disorders. The purpose of CBT-I is to improve the quality of sleep by addressing underlying sleep habits impacting healthy sleep. CBT-I involves several approaches tailored to the individual to facilitate healthy sleep habits by altering unhealthy lifestyle patterns interfering with quality sleep.
Before implementing CBT-I approaches, it is important to identify your conditioned arousal learned through habits surrounding our sleep schedule. Establishing ground rules for the bed is crucial. You must avoid reading, writing, worrying, working, or laying in bed frustrated, in order to improve sleep hygiene. By laying in bed feeling restless or engaging in other activities other than sleep or sex, you are training your brain that although you physically go to bed, the bed is not a place you actually go straight to sleep. This conditioning interferes with healthy sleep and can lead to insomnia. In order to decondition your brain, you can only use your bed for sleep and sex, it is not a palce for reading, worrying, working, writing, or laying in bed awake for hours.
Sleep hygiene includes changing lifestyle habits that impact sleep routines. This includes avoiding caffeine, such as coffee or tea, eliminating naps, avoiding technology such as watching television, laptops, and cell phones, at least one to two hours before bedtime. Aforementioned, be disciplined and mindful by using your bed only for sleep or sex, not for other activities such as reading, writing, scrolling through facebook, or lying awake worrying about being unable to sleep, also called paradoxical insonmia. If you cannot fall asleep within 15-20 minutes, get out of bed and return when you feel tired again.
Relaxation techniques are advantageous either before bed or if you cannot fall asleep or stay asleep. If you get out of bed, try using a red light in your lamp for light to avoid fluorescent lighting which may interfere with creating a relaxing environment. If you cannot sleep, do something relaxing when you get out of bed, such as stretching, progressive muscle relaxation, meditation, guided imagery, reading, journaling, or listening to relaxing music. According to the National Sleep Foundation, “music has a direct effect on your parasympathetic nervous system, which helps your body relax and prepare for sleep.” In addition, they suggest, “listening to music 45 minutes before bedtime helps you fall asleep faster, sleep longer, wake up less, and feel more rested.”
Improving your sleep environment is also beneficial, so avoid watching television while in bed, use black out curtains over your windows to eliminate outside lighting or moonlight, create a cool sleep environment with a fan or air conditioning, or an open window in cooler states, and creating a quiet sleep environment or implement a white noise machine to eliminate background noises that interfere with your sleep.
Sleep restriction is a CBT-I approach which instructs you to attempt to sleep only during the length of time you current sleep. If you are sleeping three hours a night, sleep restriction encourages you to go to bed at the hour you usually fall asleep. For example, if you typically fall asleep at 1am and wake up at 4am, allowing you only three hours of sleep per night, then you would not lay down in bed until 1am and get up at 4am. The purpose of sleep restriction is to cause the body to feel deprived of sleep and increase how tired a person feels the next night. Through sleep restriction, you can slowly increase the length of time in which you sleep.
Finally, another approach to sleep disorders may include bright light therapy. Bright light therapy may be utilized simultaneously with CBT-I to combat sleep disorders. This involves exposure to a minimum of 10,000 LUX bright light box to help reset your circadian rhythm. Side effects may vary, although minimal and short lasting, may negatively impact individuals with bipolar disorder (may cause mania) or degenerative eye disorders. It is important to visit with your primary care provider or mental health provider about these risks of bright light therapy and how to successfully and safely use the light box.
The United States Department of Veterans Affairs created an application called CBT-I Coach to be utilized in conjunction with a mental health provider. The mobile app is designed to help track your sleep habits, hygiene, offer tools such as relaxation techniques, sleep diary, and tracking. CBT-I interventions demand consistency and dedication in order to be efficacious. There may be underlying mental health concerns such as anxiety or depression, or medical conditions that may need to be addressed in order for CBT-I to be successful.