Many people believe the only treatments available for chronic insomnia require drugs. The truth is, there is a non-drug therapy for insomnia which has been around for a while that can be very effective in treating insomnia. CBTi stands for Cognitive Behavioral Therapy for Insomnia, and it is often used by psychotherapists who have training in sleep medicine to treat insomnia disorders. Sometimes it is used in conjunction with sleep aids, but it can also be used with patients who are trying to wean themselves off of hypnotic drugs in an effort to try to sleep better naturally.
Essentially, CBTi is a structured behavioral training approach which helps insomniacs to identify and replace thinking and actions which lead to or aggravate preexisting insomnia. This practical therapeutic training can help insomniacs discover, then overcome the root causes of their sleeplessness.
Some techniques for CBTi can include (this list is not exhaustive):
- Biofeedback. Observing your biological signs (heart rate, respiration, muscle tension, etc.) so you can see what needs to be adjusted, using a take-home device.
- Relaxation training. Mind and body helps, such as meditation, self-hypnosis, yogic breathing, muscle relaxation, etc.
- Sleep hygiene. What we talk about all the time in SHC: better lifestyle habits lead to better sleep habits!
- Sleep restriction. This is the strategic decrease of time in bed which helps to reset the sleep drive. Usually requires sticking to an odd schedule for a while.
- Sleep space improvement. It's not silly to rethink sensory comforts like bedding, lighting, even aromatherapy.
- Stimulus control therapy. This helps break down thought processes ("racing thoughts") that encourage resistance to sleep.
- Relapse prevention. Behaviors can return; a good CBTi therapist can offer tools to prevent this from happening.
CBTi may not work immediately as it requires behavioral modification, unlike a sleep aid like Ambien, which you just take at night and (with any luck) fall asleep. For people who are impatient to find sleep again, these are therapies that require time and earnest effort. If you are resistant to the notion of using therapy to fix your insomnia problems, consider this:
However, the problem with the vast majority of drugs used to facilitate sleep is that they have unsafe side effects, can negatively interact with other maintenance drugs and are often only meant for short-term use as they can be addicting or easily habituated to. For many insomniacs, drugs simply do not work because they are at best a temporary, Band-Aid solution, whereas the value in CBTi lies in the fact that this therapy can help address and conquer the underlying reasons for not sleeping.
CBTi also works for other kinds of sleep problems, such as adult acclimation to CPAP therapy, pediatric difficulties with falling or staying asleep and anyone suffering from recurrent nightmares.
Below is a quick list of excellent, in-depth resources on CBTi. If you have insomnia and have had no luck with prescription or over-the-counter sleep aids and your friends' home remedies aren't working either, please consider giving CBTi a try. Most insurance will cover it, and you can often meet with more than one practitioner in a free consult to determine if they are a good match for you. Ask them what kinds of therapies they support and get patient testimonials, whenever possible.
NATIONAL SLEEP FOUNDATION || Cognitive Behavior Therapy for Insomnia
SLEEPDEX || Cognitive Behavioral Therapy for Insomnia
STANFORD HEALTH CARE || Cognitive Behavioral Therapy for Insomnia (CBTi)
AMERICAN ACADEMY OF SLEEP MEDICINE || "Cognitive behavioral therapy is an effective treatment for chronic insomnia." Published June 9, 2009; accessed March 28, 2015.
“New Developments in Cognitive Behavioral Therapy as the First-Line Treatment of Insomnia.” Siebern, Allison T, and Rachel Manber. Psychology research and behavior management 4 (2011): 21–28. PMC. Web. 28 Mar. 2015. [PDF]