Managing insomnia with CBT: a guide to treating sleep difficulties

“I lie in bed, tossing and turning, mind racing, knowing I’ve got another day tomorrow where I will feel exhausted all day and be unproductive, irritable and snappy with everyone around me”.  Sound familiar?  You, like 30-48% (NICE, 2004) of the UK population may be experiencing symptoms of insomnia.

What is insomnia?

Insomnia by definition is disturbance of normal sleep pattern with either difficulties initiating or maintaining sleep.  It is actually really normal to have the occasional bad night’s sleep.  Most of us would expect not to sleep well if there was something big happening, such as a relative being unwell or having an interview the next day.  However, for some people these sleep issues persist and develop into what we would call insomnia.

Sleep Myths & Facts

• We don’t all need 8 hours of sleep – everyone is different and the amounts we need can change over time.

• Sleep medication is not a magic cure, the evidence is mixed and they should only be used short-term

• CBT for insomnia is recommended by NICE over hypnotic drugs (https://cks.nice.org.uk/topics/insomnia/ )

• We don’t NEED lavender, chamomile tea, meditation, kiwi fruit or any of the other “sleep cures” you may have read about.

So, what can I do to improve my sleep?

Firstly, relax.  The excess focus that we put on sleep and sleep difficulties can actually make the problem worse.  Trying “too hard” to fix it, doesn’t work. If you look to times you have slept well or speak with others who have minimal issues with sleep; they don’t have a set of things they must do to sleep.  They don’t always follow the rules and can still sleep well.  Sleep hygiene can play a part but can we get too caught up in the Dos and Don’ts, this can lead to a cycle like below.

https://brooksidetherapy.com/wp-content/uploads/CBT-Model-of-Insomnia.jpg

The good news is there are 3 basic things we can do to help:

1.      Work with our own body clock – this means going to bed at the right time for you (are you a night owl, or an early riser – go with what works for you).  A regular bedtime and wake up time, 7 days a week is really important.

2.      Generate sufficient sleep drive Sleep drive is like an appetite for sleep, it builds up through the day.  Naps can erode some of this so we have to start to build it up again (if you have children you may identify with the 5 minute nap in the car that means your toddler won’t sleep until late!).  Avoid too much time in bed!

3.      Maintain a positive association between bed and sleep Bed should be the place we sleep, not where we watch TV, chat, play on our phone etc.  This also means finding strategies to manage worry so we aren’t spending our nights lying awake thinking.  As a basic rule if you are still awake after about 30 minutes (around when you will start to toss and turn and feel frustrated – avoid clock-watching) get up, go to another room for a while and go back to bed when you start to feel sleepy. 

It helps to actually shorten the time we spend in bed to minimise time awake; if you are sleeping for 6 hours start by just going to bed for 6 hours and as your sleep improves you can work to slowly add time to this (this is called sleep restriction and works to improve your “sleep efficiency”).

We may also need to address worries and challenge the thoughts we have about sleep that are keeping this stuck.  CBT can be really useful for this.

Poor sleep is often a symptom of depression, anxiety and other psychological difficulties and we can help with all of these at the Condition Management Company. You can book a telephone consultation to find out more, or arrange a clinical assessment with one of our skilled therapists.