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5 Ways Cognitive Behavioral Therapy Can Help Your Insomnia

As anyone who’s ever tossed and turned for hours in the middle of the night can attest, getting to sleep isn’t always as simple as counting sheep or reading a book. For some, insomnia is a recurring struggle that can make the following day a challenge, to say the least. But there’s hope, in the form of cognitive behavioral therapy for insomnia (CBT-I). Think of CBT-I like a toolkit for reshaping your thoughts and actions for better sleep.

CBT-I explores the connections between the way you think, the things you do, and how you sleep. A trained CBT-I provider will help point out thoughts, feelings, and behaviors that contribute to your sleeplessness. Then, with its set of methods and specific techniques, CBT-I can help you shift your choices around sleep and improve your sleep schedule.

Sleep Restriction. CBT-I helps fix your sleep patterns by limiting the time spent in bed when not sleeping. Spending too much time in bed awake can make your insomnia worse. CBT-I may involve temporarily restricting your time in bed. Then you'll gradually extend it as your sleep improves. For example, maybe you typically spend 10 p.m. to 8 a.m. in bed but only end up sleeping for six hours total. With CBT-I, you might try going to bed at midnight and getting up at 6 a.m. Your body will start to adjust. You'll crave more sleep. As that happens, you'll spend more time in bed—and more time asleep.
Stimulus control. This technique involves using the bed and bedroom only for sleep. Anything other than sleep and sex—even reading or watching TV—is done outside of the bedroom. The goal is to connect the bed with sleep more strongly in your mind. If you turn out the light and can’t fall asleep within 10 minutes, get up. Go into another room. Read or do another relaxing activity. Then go back to bed once you feel sleepy.
Sleep hygiene. CBT-I encourages good sleep hygiene, or behaviors around sleep that contribute to a more restful night. That includes a consistent sleep schedule, a relaxation routine, and a peaceful environment. A regular sleep schedule helps set your internal sleep clock. That signals to your body and mind that it’s time to wind down. Plan to go to sleep and wake up at the same time every day, including on weekends. Schedule a relaxation routine for yourself in a peaceful environment. Your room should be quiet, cool, and dark. Your mattress and pillow should be comfortable and supportive. You might try deep breathing and progressive muscle relaxation (PMR) or listening to some guided sleep meditations. Put your phone down, ideally outside the bedroom. Avoid caffeine after 2 p.m. A relaxed mind and a relaxed body set the stage for better sleep.
Cognitive restructuring. Negative thoughts and worries can fuel anxiety and add to sleeplessness. In the sessions you have, your CBT-I therapist can help you learn to spot and challenge these unhelpful thoughts. These can range from concerns about health and money to worrying about your insomnia itself and its consequences. Identifying these thoughts is key to doing something about them. By challenging and changing these thoughts, you can reduce your anxiety and promote relaxation at bedtime.
Relaxation Techniques. CBT-I teaches a few relaxation methods to help with insomnia. These include deep breathing, PMR, and meditation. These techniques can reduce physical tension, quiet your mind, and help you to let go and ease into sleep. Slow, deep breathing and progressive relaxation help slow down your nervous system. Mindfulness practices, including mindfulness meditation, help you learn to observe and let go of your thoughts. These skills can set the stage for sleep.

CBT-I is not a quick fix. It's about building lasting habits for better sleep. It provides tools for long-term self-management. That way, you can ensure that benefits extend far beyond the initial treatment period. Incorporating CBT-I into your insomnia-fighting toolkit might be the change you need for restful nights. It's not just about tonight. It's about building a foundation for a lifetime of better sleep.

To find a CBT-I practitioner, try searching reputable online databases like the Society of Behavioral Sleep Medicine. You can also call the number on the back of your insurance card, if you have one, or ask for a referral from a doctor. If you don’t have insurance, you may find help at organizations like Mental Health America or the National Alliance on Mental Illness. Both help to find affordable therapy options for anyone who needs them.