CBT for Insomnia
Cognitive-behavioral therapy for insomnia (i.e., CBT-I) targets the beliefs and behaviors that keep you from solid, restorative sleep. CBT-I can help you cope with the thoughts, worries, and ideas that make it harder to sleep. The goal is to learn behavioral strategies, skills, and habits that make it easier to sleep. At Sleep and Brain, we cover the six CBT-I elements in an accelerated, intensive four-week program.
CBT-I Elements
Sleep Education
We will provide you an overview of normal sleep physiology.
Sleep Hygiene
Healthy sleep hygiene means having both a bedroom environment and daily routines that promote consistent, uninterrupted sleep. Crafting sustainable and beneficial practices makes healthy behaviors almost automatic, creating an ongoing positive reinforcement process. On the flip side, your bad habits can become engrained even as they cause negative consequences.
Stimulus Control
After a long time, your brain and body have learned to be awake during the times we want and need to be asleep. Stimulus control retrains your brain that nighttime and your bedroom are for sleep.
Changing Thoughts and Behaviors
CBT-I can help you identify, challenge, and work skillfully with thoughts and beliefs that may be contributing to your insomnia. It also targets the behaviors that make it difficult to get deep, uninterrupted sleep.
Sleep Restriction
Sometimes reducing the number of hours you are in bed helps to consolidate sleep to be less fitful and more refreshing. As your sleep quality and efficiency improve, you will slowly increase the amount of time you spend in bed until you reach your goal.
Relaxation Training
Relaxation training focuses on becoming aware of tension within the mind and body. Then, we use systematic relaxation methods (such as diaphragmatic breathing, progressive muscle relaxation, and guided imagery) to reduce the tension.
Four Week CBT-I Outline
Week 1
Complete pre-course sleep measures
Sleep education
Sleep hygiene
Stimulus control
Introduce sleep diary
Set goals and provide weekly assignment
Week 2
Review of session 1 and homework
Review sleep diary
Relaxation techniques
Sleep restriction
Development of new sleep schedule
Set goals and provide weekly assignment
Week 3
Review of session 2 and homework
Review sleep diary
Adjust sleep schedule
Calculate sleep efficiency
Cognitive restructuring
Set goals and provide weekly assignment
Week 4
Review of sessions 1 - 3 and homework
Review of sleep diary
Review and adjust sleep schedule as needed
Discuss sleep medications side effects and tapering strategy
Relapse prevention.
Complete post-course sleep measures
The CBT-I program evaluates the sleep and brain health issues that may contribute to insomnia. We additionally use validated sleep measures to assess improvement.
Sleep Disorders Screening
Sleep Disorders Questionnaire
The Sleep Disorders Questionnaire includes 18 questions designed to identify whether you meet the criteria for a sleep disorder and report problems with sleep.
Structured Clinical Interview
The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Sleep Disorders
The clinical interview includes 20 to 51 questions and takes 10 to 20 minutes to administer. The interview assesses nine major sleep disorders, including insomnia.
Sleep Measures
Insomnia Severity Index
Seven questions comprise the Insomnia Severity Index, which measures your subjective sleep complaints and associated distress. Specifically, it examines your severity of insomnia based on difficulty initiating or maintaining sleep and the degree of dissatisfaction and daytime impairment associated with insomnia.
Pittsburgh Sleep Quality Index
The Pittsburgh Sleep Quality Index consists of 19 questions and measures seven component scores (subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction) and a global score.
Dysfunctional Beliefs and Attitudes about Sleep Scale
The Dysfunctional Beliefs and Attitudes about Sleep Scale assesses the disrupted cognition seen in those with sleep disturbance. You will indicate the extent to which you agree with a particular statement. High scores suggest unrealistic expectations for sleep or that dysfunctional thought about sleep has become a factor in your sleep problem.
Sleep Diary
Sleep diaries are a reliable and valid measure of insomnia symptoms. The sleep diary provides a night-by-night account of your sleep patterns and quality of sleep. We will use the sleep diary to calculate a subjective report of sleep efficiency throughout the course
Psychological Variables
Fatigue Symptom Inventory
The Fatigue Symptom Inventory is a 14-question measure that assesses fatigue's physical and psychological aspects, including perceived severity, frequency, daily pattern of fatigue, and perceived interference with quality of life.