by Joanna Fishman

There are more than 70 medically recognised sleep disorders, but insomnia is one of the most common. As many as 90% of people will suffer from some kind of sleep disturbance during their lifetime, with 30% of people suffering from a severe form. Insomnia, in its simplest incarnation, is the inability to get enough sleep, either because of being unable to get to sleep, or because of waking too soon. Naturally insomnia can lead to tiredness during the day and a lack of concentration, but it is also associated with anxiety and depression, especially when it is longstanding.

Treatment

Insomnia can be caused by a large number of factors, both physical and psychological. Medication can be prescribed by health professionals, but sleeping tablets can become addictive and are not a long-term solution, especially if there is no underlying medical cause for the insomnia. Cognitive Behavioural Therapy (CBT) conducted by a psychologist or psychotherapist can offer a drug-free solution to insomnia.

CBT is a psychotherapeutic treatment/taling therapy for many different emotional and psychological conditions. It works on the basis of helping to reprogramme the mind to prevent it from falling into timeworn patterns. By helping the sufferer to see the cycle that they are in, it provides alternative pathways to break the cycle. The therapy is goal-orientated and follows systemic patterns to break the bad habits that the insomnia sufferer has unwittingly fallen into. [1]

How it works

When an insomnia sufferer begins a CBT programme [3], their attitudes towards sleep will be assessed and the main issue relating to sleep problems will be focussed on. There are then three stages that are worked through to try and rebalance the body’s need for sleep.

Stimulus control

In the same way that a baby is taught to associate its cot with sleeping, so an insomniac must learn to associate the bed with only sleep. The bed should only be used for sleeping in; not reading, working or watching the TV. The sufferer must go to bed only when tired, and if they don’t fall asleep within ten minutes of getting into bed, they must get up and move to another room, to prevent falling into the pattern of trying to sleep and not managing to. They must also get out of bed at the same time every day, regardless of how much sleep they have had.

Sleep hygiene

Sleep hygiene does not actually relate to physical cleanliness but to the clean and undisturbed rituals surrounding going to bed. Things that could cause one’s sleep environment to become unhygienic include noise pollution from television, light pollution from video games or stimulant pollution from caffeine, tobacco or alcohol. During CBT, the insomnia sufferer is asked to focus particularly on the 4-6 hours prior to bed and must keep these hours clean of things that could interrupt their sleep. They are encouraged to do something calming such as reading or having a bath, in order to prepare their body for sleep.

Sleep restriction

Restricting the amount of sleep that an insomnia sufferer is allowed to have may seem like a contradiction at first, however, CBT aims to balance out the person’s need for sleep and their desire to sleep with the amount of sleep that they get. Much of the anxiety surrounding insomnia is down to the stress from knowing that you are not getting enough sleep in order to function properly. Lying awake for hours worrying about not sleeping only makes matters worse. In order to get the balance right, CBT looks at the ratio of sleep efficiency. Sleep efficiency (SE) is calculated using the following formula:

SE = Total Sleep Time/Time in Bed

Therefore, in order to increase a person’s sleep efficiency, their time in bed must be reduced. A person undergoing CBT will be instructed to alter their time in bed by 20-minute increments until they reach the desired goal of a Sleep Efficiency value of more than 90%. This can lead to the person being very tired when they first start out, and it can take weeks or months for the goal to be achieved, but by reducing the amount of time that they are in bed, when they do get to bed, they will fall asleep quickly and sleep well, rather than being in bed for a longer time, without sleeping as long.

CBT has been shown to have between an 80% and 90% success rate [2] for insomnia sufferers. Although the patient must be committed to the therapy and may find some of the stages hard, particularly the restricting sleep stage, the steps are relatively uncomplicated and easy to understand. By addressing the issue of insomnia as a whole body issue rather than just a medical one, CBT often gets to the bottom of the sleep issues, rather than just masking them with medication. Because of this, CBT has become a very popular way to treat insomnia, and its success rate is conclusive evidence that it is a viable and effective treatment.

References:

[1] http://www.sleepfoundation.org/article/hot-topics/cognitive-behavioral-therapy-insomnia

[2] http://sleephealthcme.com/pictures/1030_CBT-I%20eD%20gLAUSERfor%20Sleep%20Health%202012%20Conference.pdf

[3] http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy_for_insomnia