What is Cognitive-Behavioral Therapy for Insomnia (CBT-I)? Frequently Asked Questions for Skeptical Patients
What is Cognitive-Behavioral Therapy for Insomnia (CBT-I)?
CBT-I addresses behaviors and thinking patterns that interfere with sleep (Manber et al., 2014). In treatment, you can expect a thorough examination of your sleep patterns and habits followed by a structured and brief treatment (typically 6-8 sessions) that assists in creating new patterns.
Does it really work?
According to many studies, CBT-I is as effective as medication in the short term and more effective than medication in the long term (as cited in Muench et al., 2022). Why? Because we may become tolerant of medications but behavioral and cognitive changes can be maintained over time.
What does good sleep even look like?
‘Good’ or ‘healthy sleepers’ take on average 30 minutes to fall asleep (as cited in Manber et al., 2014). They also wake up two times or less in the night and are awake for 30 minutes or less once awake. If your sleep difficulties extend beyond this range, you may benefit from treatment.
What does CBT-I entail?
You can expect the first few weeks to entail data collection (as cited in Manber et al., 2014). We will ask you many questions about your sleep habits and routine. In CBT-I, we generally will collect 2 weeks of sleep data, in what is often called a sleep diary, to identify averages. We will then calculate what is called your sleep efficiency. Sleep efficiency is defined as follows:
Total Sleep Time/ Time in bed x 100.
This number should be more than 85% for a healthy sleeper.
What is the goal of treatment?
In short, the goal is to sleep in your bed and to stop wasting time tossing and turning! How will we help you do that? We will recommend, if indicated, what is called sleep restriction or a structured way to restrict time in bed. This may not make sense at first. Why would we recommend you sleep less to sleep more? Because this will help you reset and create new sleep rhythms and habits. Essentially, we will calculate, on average, how long you are actually sleeping in your bed. We will encourage you to only be in your bed for that amount of time for a short period of time (days or weeks, at most) by setting a consistent rise time and changing your bedtime over the duration of treatment (as cited in Manber et al., 2014). Once sleep efficiency improves, we will assist with expanding more time in bed slowly so that your body can adjust to sleeping more when you are supposed to when in bed. For example, if on average you are only sleeping 5/ 8 hours in bed, we will encourage a bed time and rise time that only allows for 5 hours in bed. Once you start sleeping during the majority of that time in bed, we will assist with slowly expanding time in bed. We will do so by recommending an earlier and earlier bed time while maintaining the same wake time and ensuring you are still sleeping the majority of that time in bed.
Can I do anything before I get started to help improve sleep?
Yes! Follow some general sleep guidelines as follows (as cited in Manber et al., 2014):
How will my sleep anxiety be addressed in treatment?
Many people have anxiety-provoking thoughts about sleep. For instance, some people think, if they wake up, they won’t be able to go back to sleep, or they may think they will not fall asleep and oversleep and miss work and and and! Unfortunately, sometimes these anxiety-provoking thoughts end up creating a self-fulfilling prophecy… if you wake up and have the thought “it’s 2am, now I’m never going to get enough sleep and my day will be horrible,” that thought will trigger anxiety which will then make falling back asleep even more difficult.
We will help you challenge your thoughts about sleep by helping you become a scientist. We will encourage you to ask yourself “is this really accurate?” We can also assist by helping you learn how to tolerate anxiety and uncertainty, in general. Most of our thoughts are not really accurate. Also, I bet you have gone to work exhausted many days and somehow got through it. That is the goal: To learn that you will get through the next day even if sleep deprivation occurs!
Manber, R., Friedman, L., Siebern, A.T., Carney, C., Edinger, J., Epstein, D., Haynes, P., Pigeon, W., & Karlin, B. E., (2014). Cognitive behavioral therapy for insomnia in veterans: Therapist manual. Washington, DC: U.S. Department of Veterans Affairs.