Cognitive Behavior Therapy (CBT) is an important part of treatment for chronic insomnia. Studies show that in 75-80% of insomnia patients it improves sleep. In nearly half the patients the use of sleeping pills is eliminated. These effects are maintained long-term. CBT has no negative side effects that I am aware of.

In contrast, sleeping pills have performed less successfully in improving sleep. They are found to increase total sleep time, and reduce sleep onset by 10 minutes. Overweighing these mild to moderate short-term improvements are significant side effects, especially in adults older than 60, including dependency, daytime sleepiness, amnesia (no memory of driving, eating, even being awake while under the influence of sleeping pills). Those who are dependent on sleeping pills can suffer rebound insomnia after stopping the pills. They may feel groggy in the morning as well, and there are many other well documented side effects of prescription sleeping pills. These side effects help establish CBT as the better treatment for insomnia. A study reported in the American Journal of Psychiatry, January, 2002, revealed that CBT sent people to sleep faster than sleeping pills.

Why does CBT work so well? Because the principal cause of insomnia is over-arousal, a “too-active” awake system in the brain. CBT helps to reduce the arousal, which is associated with stressors that cause and maintain insomnia, thus restoring normal sleep. It helps reduce fear, anxiety, and worry by providing important information about sleep, such as:

You may need less sleep than you think. To maintain alertness in most people, the minimum amount of sleep necessary is 5.5 hours. Known as “core sleep,” this is less than most people need to feel fully alert and refreshed the next day (or night), but may be enough for normal functioning. CBT techniques help people replace nagging thoughts like “I won’t be able to function tomorrow if I don’t get to sleep soon” and “I didn’t sleep well last night, so I’m sure to have a bad day at work” with positive thoughts such as “I’m not going to get enough sleep tonight, but this has happened before without harming my performance.”

You may be getting more sleep than you think. Periods of light sleep you may experience as “being awake.”

Other behavioral techniques can be used as part of CBT. For example, if you are actually sleeping six hours a night, but spending eight hours in bed, sleep restriction (starting with only a few hours of sleep per night, then working gradually up to a normal sleep period), and sleep scheduling may be necessary. With this method, you will have no time to worry and fret over how much sleep you have to get in order to function, and you will find that the awful sense of being awake “all night” has been reduced. The less time you spend in bed thinking you are awake when you are actually in light sleep, the better. Sleep drive, which helps you to quickly enter a deeper sleep, will be increased.

Other techniques, such as sleep hygiene, stress management, avoiding daytime naps (which reduce the drive to sleep at night), and stimulus control can help. Stimulus control works on the “associated learning” response, meaning that over time, you adopt the habit of expecting to be awake and alert instead of being asleep. CBT will show you that in order to break this habit, you should wait about 20-30 minutes to see if you can get to sleep. If that does not occur, get up and go to a quiet, comfortable place and try to relax until you feel drowsy (relaxation techniques might help also). When you feel sleepy, go back to bed and wait another 20-30 minutes. If you don’t get to sleep, repeat the process, as many times as necessary. Over time, this results in stopping the association of the bed with wakefulness.

CBT also helps with psychological and physical disorders like chronic pain and anxiety.