CBT FOR INSOMNIA
WHAT IS INSOMNIA?
Insomnia essentially refers to when sleep goes wrong, whether that be difficulty getting to sleep, sleep maintenance, or early waking.
Symptoms can include:
- lying awake for a long time at night before falling asleep
- waking up during the night
- waking up early in the morning and not being able to return to sleep
- feeling tired and not refreshed by sleep
- not being able to function properly during the day; finding it difficult to concentrate; irritability
- anxiety at the prospect of further sleeplessness
HOW COMMON IS INSOMNIA?
Around one third of people are estimated to have sleep difficulties. Research indicates around 10 per cent of people have persistent, severe insomnia – that is, difficulty sleeping for at least three nights per week for at least three months, resulting in negative consequences the following day. Insomnia is especially common among women and older people.
HOW MUCH SLEEP DO I NEED?
Everyone is different, and the amount of sleep you need can be influenced by your age, lifestyle, diet and environment. As a general rule, teenagers need around 9 hours’ sleep; young adults, 7.5 to 8.5 hours’ sleep; adults, 7—8 hours. Sleep is less consolidated at night in later life, with older people typically sleeping for 6 to 6.5 hours. Older people do, however, tend to use daytime naps to ‘top up’.
INSOMNIA'S NEGATIVE CONSEQUENCES
Insomnia is often referred to as a 24-hour disorder because it results in negative daytime as well as night-time effects.
- Sleep loss causes us to feel fatigued and drowsy the following day. It impairs concentration, memory and ability to read social cues. It drives irritability, low mood and anxiety, often to the detriment of interpersonal relationships. It is associated with higher rates of missed work days, greater work dissatisfaction, higher error rates and reduced productivity.
- Insomniacs are about twice as likely as non-insomniacs to report using alcohol to sleep. Self-medicating insomnia with alcohol ultimately worsens insomnia. Poor sleep quality has been linked to alcohol and drug abuse and to an increased vulnerability to physical disease.
- People with insomnia have higher rates of mental health problems. Insomnia often co-exists with other conditions such as depression. In such cases, insomnia was traditionally seen as a secondary factor, a symptom of the depression. This is often the case, although we now know that insomnia increases the risk that you will become depressed in the first place. Insomnia also increases the likelihood of relapse among people who are prone to depression.
Quite simply, poor sleep reduces quality of life.
CAUSES OF INSOMNIA
Insomnia can be driven by many factors, including stressful events, physical and mental health problems, drug misuse, certain medicines, a poor sleeping environment, and lifestyle factors. Genes can play a part – it can be inherited. Hormones may also play a role, as insomnia is more common in women, with pregnant women especially likely to report disturbed sleep patterns.
Perpetuating factors can keep the problem going once it has started. A vicious cycle often develops; people with insomniac tendencies will often worry about not sleeping properly. This frustration and anxiety then further compounds their sleeping problems.
TREATING INSOMNIA WITH CBT
The potential for side-effects and dependence means sleeping pills are generally viewed by doctors as a last resort, something that should be used for only a few days or weeks at a time. They don’t treat the cause of your insomnia – rebound insomnia occurs following discontinuation and this is characterised by a worsening of the original symptoms – and can become less effective over time.
Hundreds of scientific studies have shown cognitive behavioural therapy for insomnia (CBT-I) to be a very effective long-term treatment. Studies show as many as three-quarters of people with persistent insomnia obtain lasting benefits.
CBT-I is a modified form of CBT that has been tailored to deal with the problem of insomnia by helping people change their sleep-related behaviours and thoughts. Sleep-related anxiety is common in people with anxiety. There tends to be an excess focus on sleep itself: the thought ‘I won’t be able to sleep’ is an all-too-common one that triggers feelings of anxiety. This results in mental and physiological arousal, compounding your inability to sleep. CBT-I helps to break this vicious circle.
Cognitive skills help you tackle the mental factors associated with insomnia – the racing mind, stress, sleep-related anxiety – while we will also discuss how to develop good sleep habits and avoid certain behaviours. Sleep scheduling, stimulus control techniques, daytime and bedtime relaxation techniques, and lifestyle habits that aid sleep are all a part of therapy. The aim is to establish a ‘pro-sleep’ routine that cements a strong connection between bed and successful sleep.
The rich evidence base surrounding the effectiveness of these cognitive and behavioural techniques mean that international advisory bodies have recommended CBT-I as the first-line treatment for insomnia.