CBT-i for Insomnia
Dr. Lauren Gorog is a psychologist practicing in Denver, CO. Dr. Gorog specializes in the treatment of health mental problems, and helps people to cope with their mental illnesses. As a psychologist, Dr. Gorog evaluates and treats patients through a variety of methods, most typically being psychotherapy or talk therapy.... more
CBT-I for Insomnia: A Comprehensive Treatment Approach
Primary Insomnia, also known as “psychophysiological insomnia,” in the International Classification of Sleep Disorders Revised (ICSD-R), is characterized by its etiological underpinnings (nature of origin) and is described as “a disorder of somatized tension and learned sleep-preventing associations that results in a complaint of insomnia and associated decreased functioning during wakefulness”1.
Like any effective treatment, the behavioral treatment for insomnia must target both plausible causes and maintaining factors responsible for prolonged sleep loss.
So before I explain how I use CBT-I to treat insomnia, I will elaborate upon how insomnia develops.
In the above definition, “Somatized tension” is essentially tension in the body that is derived from an overactive peripheral nervous system, especially from within the somatic nervous system. For example, have you ever felt your heart racing, felt too hot or cold, experienced muscle tension, or became hyperaware of any noises or other aspects of your sleep environment during times of unrest?
Whether we are aware of it or not, our peripheral nervous system could be in overdrive, making it increasingly difficult to feel subjectively tired or allow our bodies to relax and fall asleep. More so, if you have developed a pattern of difficulty with sleep, your body might be conditioned to arousal at bedtime. In effect, our bodies “remember” how frustrated we get when we get into bed and cannot fall asleep, and essentially prepares for a frustrating experience.
Additionally, “Learned sleep-preventing associations,” broadly identifies pre-sleep arousal maintained physiologically and psychologically through classical conditioning in the bedroom environment. Cognitions and expectations regarding sleep and racing thoughts are good indicators of this aspect of pre-sleep arousal.
Thus, based upon this brief explanation, insomnia is characterized by a reciprocal relationship between your nervous system, your cognitions (thoughts about sleep), and your behaviors related to your sleep environment (sleep hygiene).
CBT-I stands for Cognitive Behavioral Therapy for insomnia and it is designed to target and break this vicious cycle causing sleeplessness at night and sleepiness during the day.
CBT-I is considered the standard (demonstrating the highest clinical effectiveness) treatment for Chronic Primary Insomnia and Secondary Insomnia2. It has been shown to improve sleep quality, sleep quantity, and daytime related impairments and is effective for all ages, and should be used as a first-line treatment. Specific components considered first-line are stimulus control therapy or relaxation therapy, or a combination of cognitive therapy, stimulus control therapy, sleep restriction therapy with or without relaxation therapy. As a guideline in the field of sleep medicine, sleep restriction, paradoxical intention, and biofeedback therapy are also effective adjunct therapies.
How I use CBT-I to treat Insomnia
My initial evaluation is specially targeted towards improving all aspects of your sleep and daytime performance. My sleep intake is a diagnostic clinical interview that will help me evaluate your sleep history, medical history, psychiatric history, and substance use history in order to first determine that you will benefit from CBT-I treatment. With the use of self-administered questionnaires, at-home sleep logs, symptom checklists, psychological screening tests, and bed partner interviews, I am able to make a correct diagnosis or provide you with a referral to obtain a sleep study if I suspect an organic sleep disorder is present.
Once a diagnosis of insomnia is made, I develop a specific treatment plan with you. I use outcome indicators to track and measure progress, as well as continually direct the path of treatment. Additionally, since patient engagement is very important in treating insomnia, I ask that my patients maintain a sleep diary outlining several important aspects of sleep associated with their identified disruption of sleep.
As a first-line intervention, you will practice stimulus-control methods and sleep restriction techniques to re-calibrate your circadian rhythm, and disrupt both cognitive and behavioral patterns maintaining your sleep problem. I implement several relaxation techniques and offer biofeedback to achieve enhanced relaxation. Cognitively, we will explore your beliefs about sleep or the lack thereof, and work on methods to restructure thoughts and beliefs that are paradoxically maintaining somatic tension.
Since insomnia has a high relapse rate, I believe it is important that I help you become your own sleep expert. Therefore, in addition to CBT-I, my treatment approach includes psychoeducation, biofeedback, relaxation therapies, and relapse-prevention sessions. I take a collaborative approach with other medical professionals, especially as it pertains to the use of pharmaceutical sleep aids and substance abuse.
The importance of sleep cannot be overstated as it is inextricably linked to all aspects of our healthy life. The longer we go without quality sleep, the more pervasive and damaging it can be. If you’d like to learn more information, please contact us to schedule a sleep evaluation.
