An email from Peter prompted me to write this page about CBT and Insomnia for all of you who are struggling with sleep issues.
Dear Dr Purves
I’ve never been a brilliant sleeper but when I started working at a cinema when I was 16 and quickly got used to working late nights. I worked there for four years often getting home between 1am and 2am and once home I found I needed time to unwind before I could get off to sleep. I didn’t find it a problem at the time because once asleep I managed to stay asleep for about eight hours.
When I left the cinema I took an office job where the hours were completely different. I needed to be at work by 9am as the hours were 9-5. I thought that I’d adjust and naturally need to go to bed earlier but no matter how I tried I couldn’t get to sleep before 2am which meant I was averaging about 5 hours sleep a night. It wasn’t great but I could just about cope.
I’ve been working in an office now for about eight years and my sleep hasn’t adjusted, in fact it’s worse. I play on my Xbox to try to relax before I turn in but these days when I finally go off to sleep I find myself waking randomly for at least an hour or so in the middle of the night. I feel wide awake for a while, get really frustrated that I’m awake, and then eventually I fall back to sleep. When the alarm goes off it’s agony to get up and I feel like a zombie all day. Usually I’m so tired on week days that I have a nap when I get in at 5. At weekends I often sleep in until midday.
My wife has suggested I cut back on caffeine as I drink a fair bit of coke throughout the day but I don’t know how I’d get through without it. I’m knackered at the best of times.
I wondered if I should see my doctor and ask for some sleeping tablets but I’m not keen to have medication really.
Do you have any suggestions?
CBT for Insomnia: Cognitive-Behavioural Therapy
If you have insomnia then you have problems getting to sleep, staying asleep or experiencing a restful sleep. CBT therapy is one way to treat insomnia. Yes, really. In fact, Peter has mentioned many things in his letter which can typically be addressed with CBT.
If you’re a regular visitor to the site you’ll already be familiar with cognitive behaviour therapy. CBT is a talking therapy which can be used to challenge and change thoughts, feelings and behaviours.
I would recommend that Paul and anyone else suffering with persistent sleep issues seeks out a CBT therapist.
CBT for Insomnia: How can CBT help with sleep issues?
So how can CBT help with sleep issues? Well, CBT will help you by identifying the causes of your sleep issues with the aim of changing at your sleeping habits and attitudes to sleep.
CBT for Insomnia: Treatment
If I was Peter’s CBT therapist I would suggest that the first thing he needs to do is keep a sleep diary for one to two weeks, recording how many hours sleep he manages to get a night, when he goes to sleep, when he wakes up and the amount of times he wakes up during the night and for how long.
As his therapist I would then need to review the diary and would suggest restricting sleep which would involve cutting out the naps Peter takes and making sure he gets up early, even on weekends for around six weeks. Yes, if you try this you will feel worse to start with. But the goal is that Peter will begin to feel tired earlier and will then be able to work his bed time backwards, under supervision.
CBT for Insomnia: Education and Lifestyle changes
Peter states that he drinks caffeine. He needs to restrict this to mornings. Alcohol and cigarettes also need to be cut out at bedtime. If I was treating Peter I would take a wider look at his habits and identify anything which may be interfering with his sleep.
Playing computer games right up until bedtime can interfere with sleep because it’s stimulating. Peter really needs to be relaxing before he goes to bed.
In order to make these changes you need to understand why you’re doing so, so treatment would include an element of education where we would look at sleep cycles and how your sleep is affected by a range of things.
CBT for Insomnia: Relaxation
Peter doesn’t say if he’s particularly stressed at the moment or if he generally has problems relaxing but learning to actively relax is important. I work through muscle relaxation exercises with my clients and many have also felt the benefit of mediation and hypnosis.
CBT for Insomnia: Worrying
Another thing I look at with my clients and would focus on with Peter is his thoughts, in particular negative thoughts, and things that might be worrying him and stopping him from falling asleep.
CBT therapy is great at helping you to identify, challenge and change negative beliefs.
CBT for Insomnia: Condition the mind
The bedroom should only be used for sleep and sex. Peter doesn’t say if he’s playing the Xbox in bed at night or in another room but as part of CBT I work with my clients so that they are not using the bedroom for any other activities. This helps to condition the mind to expect rest upon entering the bedroom.
I hope this gives you some ideas of how CBT can be used to treat insomnia. It’s not meant to be an exhaustive list. If you’re having trouble with insomnia I am available for Skype consultations.
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