Insomnia: Cognitive Behavioral Therapy for Insomnia (CBT-I) may help
It’s 3am. You’re awake again. Instead of sleeping soundly, you groan inwardly. Rest feels so elusive. Breathing exercises. Visualizations. Didn’t I take melatonin earlier? Anxiety, dread, and despair set in. You think about checking emails for work. But your brain is so tired. Just as you almost fall asleep, a jolt of fear tightens your chest. The next day, you wake exhausted and hopeless that this cycle repeats, night after night.
You crave that sweet spot where you wake happy. You want control over your sleep, so that you don’t have to revolve your work and relationships around bizarre hours. You want peace and a natural rhythm to your body, mind, and emotional energy throughout the day.
Cognitive Behavioral Therapy for Insomnia (CBT-I) is considered the gold standard and first-line treatment for chronic insomnia. Endorsed by the American College of Physicians (the largest medical specialty organization), American Academy of Sleep Medicine, American Psychological Association Division 12 (Society for Clinical Psychology), and numerous international sleep and behavioral medicine organizations, CBT-I is a 5-8 week psychotherapy treatment program.
Wait, what about medication, like melatonin, trazadone, or benadryl?
Every year, the American Academy of Sleep Medicine (AASM) conducts an independent review of major sleep medications available the market. Anonymous sleep clinicians, who report no pharmaceutical conflicts of interests, analyze peer-reviewed journal articles and clinical trials on outcomes for patients who use prescribed and over-the-counter medications as sleep aid. Year-over-year, all medications reviewed report “weak” recommendations. The American College of Physicians is the largest organization for medical doctors in the nation, and they recommend that medications for insomnia are only used for 4-5 weeks for short-term sleep issues.
Instead, clinicians across organizations agree that CBT-I is a non-invasive and effective first-line treatment for chronic insomnia, garnering “strong” recommendation from the AASM.
What is CBT-I?
CBT-I is a 5-8 session program that addresses underlying causes of chronic insomnia. CBT-I was originally developed through research with over 10,000 patients through a collaboration at Harvard Medical School and the University of Massachusetts. In their study, over 90% of participants showed significant improvements in sleep over the course of five sessions.
Since their first study in 1996, researchers and clinicians across longitudinal studies have shown the efficacy of CBT-I, for patients who adhere to program recommendations[1].
Why haven’t I ever heard about CBT-I for insomnia?
Most people seek medication or over-the-counter sleep aids for insomnia. However, CBT-I is considered the first-line treatment for chronic insomnia.
I have already tried EVERYTHING. Isn’t this just more sleep hygiene basics?
No. CBT-I is not simply sleep hygiene. The 5-session program addresses insomnia in multiple ways. But clients must take action and adhere to the program.
What are the risks?
Unlike medication, CBT-I has no side-effects as a form of psychotherapy.
I already have a therapist. Do I need to leave my current therapist to do CBT-I?
No, CBT-I is designed as an adjunct program, similar to EMDR or other briefer therapies. You do not have to leave your individual therapist. However, your CBT-I therapist may redirect you to speak with your individual therapist if other issues get in the way of the sleep program. Likewise, a physician may be recommended to screen for underlying health issues that impact sleep, such as sleep apnea, restless leg syndrome, or hormonal imbalances.
What can I do next?
A therapist trained and certified in CBT-I may help guide you through sleep challenges and give you tools to continue to maintain better sleep. There are only less than 1,000 certified CBT-I therapists in the United States who are qualified to deliver CBT-I. You may find someone you like through directories such as the University of Pennsylvania Perelman School of Medicine. Nat Newton, AMFT, PhD, RPS is an in-house clinician at Silver Lake Psychotherapy who is available to assist you today.
Contact therapy@silverlakepsych.com for more information.
Written by Nat Newton AMFT, PhD, RPS
Associate Marriage & Family Therapist
[1] Jacobs, G. D., Benson, H., & Friedman, R. (1996). Perceived benefits in a behavioral-medicine insomnia program: A clinical report. The American Journal of Medicine, 100(2), 212–216.