A Guide to Cognitive Behavioural Therapy for Insomnia (CBT-I)

In this guide, we will explore what CBT-I is, its components, how it works, and the many benefits it offers to those struggling with insomnia.

What is Cognitive Behavioural Therapy for Insomnia (CBT-I)?

Short-term or ‘acute’ insomnia is often triggered by a one-off stressful event, a combination of smaller stressful events or an underlying stress on the body (such as pregnancy or menopause). It is completely normal that stress can trigger a sleepless night. However, if we have night after night of poor sleep, then we start to make subtle changes to our sleeping habits as well as how we think and feel about our sleep and it is those changes that often cause your insomnia to stick around. Your brain also starts to learn or associate the bed as a place of worry and wakefulness and this can become triggered when a sleepy patient gets into bed, finding it difficult to fall or stay asleep. These ongoing thoughts and behaviours are the root cause of most cases of chronic insomnia.

Cognitive Behavioural Therapy for Insomnia (CBT-I) is a structured, evidence-based treatment for insomnia that helps individuals change the thoughts and behaviours that contribute to their sleep problems. Unlike medication, CBT-I addresses the underlying causes of sleep disorders by focusing on cognitive and behavioural techniques to improve sleep patterns.

What are the components of CBT-I?

CBT-I typically includes several key components:

1. Sleep Restriction/Consolidation: Limiting the time spent in bed to match the actual amount of sleep, which helps to consolidate sleep and improve sleep efficiency.
2. Stimulus Control: Creating a strong association between the bed and sleep at the same time as removing the triggered wakefulness bed can bring.
3. Sleep Hygiene: Adopting healthy habits both in the morning, day time , evening and night that positively influence sleep. These include but are not limited to maintaining a consistent sleep schedule and optimising the sleep environment.
4. Cognitive Therapy/Restructuring: Identifying and challenging negative thoughts and beliefs about sleep that contribute to insomnia symptoms. CBT-I also explores methods to remove stress from the bedroom in the first place.
5. Relaxation Techniques: Learning methods like muscle relaxation, deep breathing, and visualisation to reduce stress and anxiety before bedtime.
6. Sleep Diary: Keeping a detailed record of sleep patterns, including time spent in bed, time taken to fall asleep, and frequency of awakenings. Sleep diaries are used to monitor progress and results.

At TM Insomnia Treatment, we will further explore insomnia treatment by addressing diet, exercise, learning to switch your brain off in bed, stress management, sleep education and relapse prevention.

How does CBT-I work?

Cognitive Behavioural Therapy for Insomnia (CBT-I) works by addressing the cognitive (the way we think) and behavioural (the things we do) factors that perpetuate insomnia. By identifying and altering negative thoughts and behaviours related to sleep, individuals can develop healthier sleep patterns. CBT-I also works at re-teaching your brain to associate your bed with a place to fall asleep quickly at the same time as disassociating the negative triggers it may currently have. Techniques like sleep restriction and stimulus control help improve sleep efficiency, while cognitive therapy and relaxation techniques reduce anxiety and stress associated with sleep. CBT-I will help reset your current sleep drivers back in line with normal awake/sleep cycles.

What are the benefits of Cognitive Behavioural Therapy for Insomnia (CBT-I)?

The benefits of CBT-I:

• Long-Term Improvement: Unlike medication, which may only provide temporary relief, CBT-I offers long-lasting improvements in sleep quality.
• Reduced Sleep Anxiety. Reduces the worry that comes with a poor night sleep and lessens the focus on poor sleep outcomes.
• Improved Mental and Physical Health: Better sleep can lead to improvements in overall mental health and well-being as well as reduce the risk of developing chronic physical health conditions such as cardiovascular disease and dementia.
• Reduced Dependence on Medication: Many individuals are able to reduce or eliminate their use of sleep medications after completing CBT-I. No more constant appointments with your GP to get repeat prescriptions.
• Gives you the Tools for Life. Through CBT-I you learn the methods on how to control your sleep and avoid a relapse into sleeping problems. If you do start to experience poor sleep after the course, you have the ability to self-treat and get your sleep back on track yourself.
• Cost Effective. Compared with potential life time use of expensive sleeping medications and the cost of doctors appointments, CBT-I is a one time payment for continual and effective sleep treatment. Add into it the costs of less sick leave days needed due to your poor sleep effecting your health.

How long does it take for CBT-I to work?

The duration of CBT-I varies depending on the individual and the severity of their insomnia symptoms. Typically, small improvements start within the first few sessions and significant improvements can be seen within 6-8 sessions over a period of 6-12 weeks. Some individuals may experience relief sooner, while others may require additional sessions for optimal results.

Is Cognitive Behavioural Therapy for Insomnia effective?

Numerous clinical studies have demonstrated the effectiveness of CBT-I in treating insomnia in adults. Research indicates that CBT-I can significantly improve sleep quality, reduce the time taken to fall asleep and increase the total time spent asleep. CBT-I is often considered the gold standard treatment for insomnia due to its proven efficacy and long-lasting benefits. When CBT-I is compared to the often commonly prescribed sleeping pill, results for long term success always side with the CBT-I and also have the added benefit of not relying on medication that often has further health complications and dependency issues.

Who is CBT-I for?

CBT-I is suitable for individuals experiencing chronic insomnia, including those who:

• Have difficulty falling asleep or staying asleep for 30 minutes or more.
• If you have had difficulties sleeping for more than three nights a week for over three months.
• Experience poor sleep quality or wake up feeling unrefreshed.
• Suffer from insomnia symptoms that impact daily functioning and overall quality of life
• If you are looking for a long-term, medication free solution to your insomnia.
• If your GP/Family doctor has excluded any underlying causes to your insomnia.
• If you are looking for a structured, science backed program that helps you learn to sleep again.

Who is CBT-I not for?

CBT-I may not be appropriate for individuals with certain conditions, such as:

• Severe mental health disorders that require immediate psychiatric intervention.
• Untreated sleep apnea or other medical conditions that better explain your sleep problems.
• Individuals who are not motivated to actively participate in therapy or make changes to their sleep habits.
• You are under the age of 18.
• You are looking for a quick-fix or drug based solution
• If your insomnia is caused by being currently pregnant, or a new parent of an infant child, as the needs of your new born as well as hormonal changes can affect sleep, some of the recommendations in this program are not suitable.

If you suspect you might fall into the above category, speak to your CBT-I therapist as they may be able to give you some valuable sleep advise that benefits you without having to do a full CBT-I course.

Who provides CBT-I?

CBT-I is typically provided by qualified medical or mental health professionals, including psychologists, psychiatrists, sleep coaches and trained therapists with specialised expertise in cognitive behavioural therapy for insomnia. It is important to seek a qualified professional who has specific training and experience in CBT-I for optimal treatment of sleeping complaints. Tracey, our expert sleep specialist in Australia, offers personalised CBT-I treatment online, accessible quickly and without the need for referrals. This ensures you can start your journey to better sleep as soon as possible.

Where do I find a CBT-I Specialist in Australia?

To find a CBT-I specialist, you can:

• Ask for a referral from your general practitioner or a mental health professional.
• Search online directories of licensed therapists and psychologists who specialise in CBT-I within your area.
• Contact local sleep clinics or mental health centres that offer treatment for insomnia.
• Check with professional organisations, such as the Australasian Sleep Association or the Association for Behavioural and Cognitive Therapies, for a list of certified CBT-I providers.

Most major cities and towns in Australia may have sleep clinics, but that doesn’t necessarily mean someone there practices CBT-I. At TM Insomnia treatment, we conduct all of our insomnia therapy sessions online via video conferencing. Since it is very difficult to find local providers, this way you can reduce travel times as well as conduct the treatment in the comfort of your own home. 

Unlock Better Sleep with CBT-I

Effective treatment for insomnia, particularly through Cognitive Behavioural Therapy for Insomnia (CBT-I), brings profound benefits that extend far beyond improved sleep. On a personal level, CBT-I can enhance both physical and mental health by reducing the risk of chronic conditions like cardiovascular disease, boosting immune function, and alleviating symptoms of depression and anxiety. The resulting increase in cognitive function and overall quality of life is invaluable.

However, the impacts of insomnia and its treatment ripple outward, affecting social, financial, and global domains. Socially, individuals who sleep better are more likely to engage positively with their communities, maintain healthy relationships, and contribute to a supportive social environment. Financially, reducing insomnia can lead to increased productivity and reduced healthcare costs, as well-rested individuals are less likely to suffer from work-related accidents, absenteeism, and reliance on medical interventions. On a larger scale, the global market bears a significant burden due to insomnia, with billions lost annually in productivity and healthcare expenditures.

Given these extensive impacts, seeking treatment for insomnia should be a priority. Addressing sleep issues sooner rather than later can prevent the cascading effects of chronic insomnia and promote a healthier, more productive life. Cognitive Behavioural Therapy for Insomnia (CBT-I) stands out as an effective, long-lasting solution, making it an essential tool in combating the widespread issue of insomnia. By taking proactive steps to address insomnia through CBT-I, individuals can reclaim their sleep, health, and overall well-being, contributing positively to their personal lives and the world around them.

 

Frequently Asked Questions (FAQ):

I have had insomnia for less than 3 months, is CBT-I for me?

CBT-I is aimed at helping patients who have chronic (or long term) insomnia. Insomnia is considered chronic when it has been ongoing for more than 3 months. That being said, having an appointment with a CBT-I therapist can be vastly beneficial to understand insomnia and devise a plan to help get your sleep back on track. It is important in this situation to learn what ‘not to do’ in coping with insomnia, as many coping strategies patients adopt can end up being counter-productive in curing the condition.

How often should I see the CBT-I therapist?

Ideally you should be making frequent contact with your therapist to closely monitor your progress and guide you through the more difficult stages of it. At TM Insomnia Treatment, appointments are conducted weekly for 1 hour. The initial appointment is a 2 hour intake.

I’m currently taking sleeping pills, should I stop them before starting Cognitive Behavioural Therapy for Insomnia?

It depends, this should be discussed with your prescribing practitioner as well as your CBT-I therapist. There are different methods that can be adopted and it depends on the individual patients situation.

Should I sleep separately from my partner whilst I do CBT-I?

Ideally not. You should conduct CBT-I in the sleep environment you want to sleep in, so you become accustomed to it. If you sleep in a different bedroom, then you are training yourself to sleep in that room, not the main bedroom. Even though parts of the program can disrupt a partners sleep marginally, it is temporary and beneficial for your training if you sleep together. If you feel this might be an issue, speak to your sleep therapist to make a plan.

I hear CBT-I can be difficult, should I take annual leave before commencing Cognitive Behavioural Therapy for Insomnia?

If you’re worried about your job performance then voice these concerns to your sleep therapist to explain the program in more detail. If you have a job that involves constant concentration (such as a pilot or driver), then it’s best to discuss a plan with your sleep therapist.

I am a shift worker, can I do CBT-I?

Shift work makes it difficult to conduct parts of the CBT-I training. Speak to your sleep therapist about ways to work around this, or ask your employer for an extended exclusion from night shift for a few weeks.

I travel a lot for work, is CBT-I still possible?

Yes it is still possible, your sleep therapist will talk about different ways to cope with a change of sleeping environments. If you travel internationally and cross time zones often, then this can be a little difficult for the early stages of the program. Speak to your CBT-I therapist about how to work around this.

What is the minimum amount of sleep I’ll get per night with CBT-I?

The amount of time spent in the bed during the program is completely individualised. This will be explained fully by your CBT-I therapist who will continue to guide you through the process. As sleep improves the amount of time spent in bed will increase until you are achieving the desired amount of sleep.

Do I need to do a sleep test / sleep study before starting Cognitive Behavioural Therapy for Insomnia?

Not necessarily. A sleep study is only needed if there is a suspicion that you also have an underlying sleep disorder such as restless leg syndrome or sleep apnea. During your initial consultation, you will be asked certain questions to see if you have symptoms of other sleep disorders.

What do I do if CBT-I doesn’t work?

Even though CBT-I is considered the gold standard of chronic insomnia treatment and outperforms anything else around, it does not have a success rate of 100%. If you reach the end of your therapy and sleep hasn’t improved at all, then discuss the possible reasons for this with your CBT-I therapist or medical practitioner.

What is the difference between CBT and CBT-I?

Cognitive Behavioural Therapy has a lot of different types that might target specific psychological conditions such as anxiety or depression. Cognitive Behavioural Therapy for Insomnia (CBT-I) targets insomnia specifically and focuses mostly on improving sleep.

Can I do Cognitive Behavioural Therapy for Insomnia on my own?

In principle yes, however, results improve dramatically when you are guided through the process by a trained professional. Most free CBT-I apps are a standard guide and aren’t tailored to a specific individual. Quite often a patient will need individualised guidance as their particular sleeping problem is outside the normal, and free online apps aren’t the best method to treat their sleep disorder.