Cognitive and behavioural therapies1975479
The aim of CBT for insomnia is to change unhelpful thoughts and behaviours that may contribute to the insomnia. This may be recommended if the patient has had sleep problems for more than 4 weeks.
Common faulty beliefs and expectations that can be modified1
- Unrealistic sleep expectations (e.g., “I need to have 9 hours of sleep each night”)
- Misconceptions about the causes of insomnia (e.g., “I have a chemical imbalance causing my insomnia”)
- Amplifying the consequences (e.g., “I cannot do anything after a bad night’s sleep”)
- Performance anxiety and loss of control over ability to sleep (e.g., “I am afraid of losing control over my ability to sleep”)
CBT for insomnia is sometimes performed by a specially trained GP or the patient is referred to a clinical psychologist. Patients usually have 4–5 sessions of CBT, each lasting about 1 hour. As part of the treatment, patients may be asked to keep a sleep diary.
Stimulus control is designed to re-associate the bed/bedroom with sleep and to re-establish a consistent sleep–wake schedule. This is achieved by limiting activities that act as cues for staying awake. The treatment consists of the following behavioural instructions:
- Eliminate non-sleep activities in the bedroom. Remove the TV and computer from the bedroom.
- Use the bed and bedroom only for sleep and sex.
- Go to bed only when sleepy, even if later than prescribed sleep schedule.
- Get out of bed if not able to sleep within 15–20 minutes – go to another room and relax. Return to bed only when sleepy.
- Set alarm for agreed upon wake time.
- Avoid excessive napping during the day – a brief nap (15–30 minutes) during the mid-afternoon can be refreshing and is unlikely to disrupt nocturnal sleep82.
Anxiety reducing strategies and relaxation therapies1
Relaxation therapy is designed to reduce physiological and psychological arousal to promote sleep.
Recommended relaxation therapies should be individualised for each patient.
- Avoid arousing activities before bed (late-night phone calls, work, watching TV).
- Designate at least one hour before bedtime to help unwind from the day’s stresses – dim light exposure and engage in relaxing activities.
- Relaxation techniques such as deep breathing, light exercise, stretching, yoga and relaxation CDs can help promote sleep.
- Stress management skills training and relaxation therapies such as progressive muscle relaxation, biofeedback, hypnosis, meditation, imagery training, can be provided by a trained professional (through books, videos, or face-to-face sessions).
- Techniques for managing worry can be useful for some patients. This may include keeping a worry journal, scheduling worry time, challenging worried thinking, or seeking professional help