Sleep is an incredibly important aspect of peoples’ lives. You may know what it feels like to have a restless night sleep and how difficult it can be to function the following day on only a couple of hours of sleep. Most people experience a poor night sleep every now and again or during periods of heightened stress. However, insomnia differs from typical sleep disruptions due to its longer lasting nature.
Insomnia often begins with a specific stressor (e.g., death of a loved one, divorce/breakup, sleep changes due to having a baby, heightened levels of stress due to work or school). If the symptoms remain, the insomnia often becomes chronic in nature and can remain even after the stress of the initial trigger decreases. The typical sleep problems related to insomnia include any combination of the following conditions:
– Difficulty falling asleep
– Waking up in the middle of the night one or more times and having trouble falling back to sleep
– Waking up earlier than necessary or desired and being unable to fall back to sleep
Due to the decreased quality of sleep, people often worry about going to bed and they typically have thoughts such as “what if I don’t sleep well again” or “how will I manage again tomorrow on so little sleep.” Unfortunately these worries make the insomnia even worse.
Effective treatment for insomnia does exist; cognitive behavioral therapy for insomnia (CBT-I) has received extensive research support and is recommended by the National Sleep Foundation as the treatment of choice for insomnia. The major components of CBT-I consist of the following:
Sleep hygiene education refers to providing individuals with information to help decrease sleep interfering behaviors and increase sleep promoting behaviors. Areas covered include information regarding food and beverages, napping, exercise, and bedtime routines.
Stimulus control is the aspect of treatment which limits one’s bed to only sleep and sexual activity. Due to difficulty sleeping and long periods of lying awake in bed individuals with insomnia often develop a dread and anxiety about going to sleep. The goal of stimulus control is to help individuals learn to once again associate bed with sleep.
Sleep restriction is a technique which systematically adjusts one’s sleep habits to increase the individual’s sleep efficacy which simultaneously decreases the amount of time lying awake in bed. Sleep efficacy is the total amount of sleep in a night divided by the total time in bed for that night.
Cognitive restructuring is another important aspect of treatment and focuses on addressing and alleviating common unhelpful thinking patterns that lead to increased worry and difficulty sleeping.