Insomnia is a serious disorder and effective insomnia treatment can be crucial to getting the sleep you need. Until now, there were few safe, effective, non-drug insomnia treatments.
By Mayo Clinic staff
By Mayo Clinic staff
Insomnia is a widespread condition that's characterized by a difficulty in falling asleep, staying asleep or getting restful sleep. Like many people who experience insomnia, you may have turned to sleeping pills for relief.
However, new research and sleep studies show that your attitudes about sleep and certain behaviors are often the root cause of insomnia. Changing those attitudes and behaviors can lead to better sleep.
What's so good about a good night's sleep?
Sleep is essential for good physical and mental well-being. Natural sleep restores your body and mind and provides enough dreaming time (REM sleep) to sustain learning, memory and mood.
If you're sleep deprived, you're more likely to develop infections, and have high blood pressure, cardiovascular disease and diabetes. You may also be more prone to make mistakes on the job, take longer to recover from stress, have problems with learning and memory, and experience depression and irritability.
Problems with sleeping pills
There are times — such as during periods of pain or grief — when sleeping pills may help those who experience sleep deprivation. In addition, several hypnotics are now approved by the Food and Drug Administration for indefinite use.
However, many sleeping pills shouldn't be taken for more than a few days to a few weeks. Because they can be habit-forming, some people take these drugs far longer. Others may increase their dosage as the pills become less effective over time. Sleeping pills can also:
Cognitive behavioral therapy (CBT) has emerged as a treatment for insomnia that's an effective alternative to sleeping pills, even for people with severe or chronic sleep problems.
CBT is a relatively simple, short-term treatment that has long been used to treat a range of conditions, including depression, panic attacks, anxiety, eating disorders and substance abuse. Studies have shown that psychological and behavioral factors play an important role in insomnia and that CBT can be effective in treating insomnia. A 2006 review of insomnia treatment studies conducted by the American Academy of Sleep Medicine found that CBT can help improve sleep and that benefits can be sustained over a long period of time.
CBT can benefit nearly everyone, including older adults who have been taking sleep medications for years, people with physical problems such as restless legs syndrome, and those with primary insomnia, a lifelong inability to get enough rest.
What's more, the effects seem to last — a year after CBT, most people still show benefits from the therapy and sleep more soundly than before. And there is no evidence that CBT has adverse effects.
How does cognitive behavioral therapy work?
Cognitive behavioral therapy helps you change the thoughts and actions that interfere with your ability to get restful sleep. The approach is based on the idea that how you think (cognition) and act (behavior) affects the way you feel.
The cognitive portion of CBT teaches you to recognize and change false beliefs that affect your ability to sleep. For example, you may believe that you must get eight hours of sleep every night to function. In fact, seven hours of sleep may be adequate for you. Cognitive therapy also deals with misperceptions about the amount of time you actually spend sleeping. People with insomnia often sleep more than they realize.
The behavioral portion of CBT helps reprogram the part of your brain that governs the sleep-wake cycle. It targets specific behaviors — what sleep experts call "sleep hygiene" — that negatively affect your sleep. Such behaviors include failing to exercise or drinking beverages that contain caffeine just before bedtime.
When used as an insomnia treatment, cognitive behavioral therapy usually requires four to eight 30-minute sessions with a trained sleep therapist. The approach works on multiple levels and contains one or more of the following elements:
Insomnia as a symptom of another disorder
Because insomnia can be associated with many underlying disorders, such as depression, substance abuse or another sleep disorder, a thorough sleep evaluation is key in determining the appropriate treatment. In these cases, the root cause should be addressed simultaneously.
Finding help
The American Academy of Sleep Medicine has developed a standardized process and certification for behavioral sleep therapists, and you can locate a practitioner through its Web site.
However, there is currently a shortage of certified sleep therapists, and you may not live near a practitioner who can help. Further, the type of treatment — such as group versus individual — and frequency of sessions, may vary depending on the provider.
You may have to do some searching to find a trained practitioner and a treatment schedule and type that fits your needs. Start by obtaining a list of sleep centers from the National Sleep Foundation Web site. Many are associated with major hospitals. If you can't find one close to you, try locating a therapist who offers phone consultations. CBT books and CDs may be a good option until you find someone to help.
However, new research and sleep studies show that your attitudes about sleep and certain behaviors are often the root cause of insomnia. Changing those attitudes and behaviors can lead to better sleep.
What's so good about a good night's sleep?
Sleep is essential for good physical and mental well-being. Natural sleep restores your body and mind and provides enough dreaming time (REM sleep) to sustain learning, memory and mood.
If you're sleep deprived, you're more likely to develop infections, and have high blood pressure, cardiovascular disease and diabetes. You may also be more prone to make mistakes on the job, take longer to recover from stress, have problems with learning and memory, and experience depression and irritability.
Problems with sleeping pills
There are times — such as during periods of pain or grief — when sleeping pills may help those who experience sleep deprivation. In addition, several hypnotics are now approved by the Food and Drug Administration for indefinite use.
However, many sleeping pills shouldn't be taken for more than a few days to a few weeks. Because they can be habit-forming, some people take these drugs far longer. Others may increase their dosage as the pills become less effective over time. Sleeping pills can also:
- Mask the real causes of poor sleep, such as depression, heart trouble, asthma and Parkinson's disease, and delay treatment of these disorders
- Interact with other medications or alcohol, often with serious, even deadly, results
- Cause next-day grogginess or rebound insomnia — an inability to sleep that's worse than the original problem
- Lead to high blood pressure, dizziness, weakness, nausea, confusion, short-term amnesia
- Cause bizarre behavior that goes beyond traditional sleepwalking to include "sleep binge eating," "sleep shoplifting" and "sleep driving" — none of which the person remembers
Cognitive behavioral therapy (CBT) has emerged as a treatment for insomnia that's an effective alternative to sleeping pills, even for people with severe or chronic sleep problems.
CBT is a relatively simple, short-term treatment that has long been used to treat a range of conditions, including depression, panic attacks, anxiety, eating disorders and substance abuse. Studies have shown that psychological and behavioral factors play an important role in insomnia and that CBT can be effective in treating insomnia. A 2006 review of insomnia treatment studies conducted by the American Academy of Sleep Medicine found that CBT can help improve sleep and that benefits can be sustained over a long period of time.
CBT can benefit nearly everyone, including older adults who have been taking sleep medications for years, people with physical problems such as restless legs syndrome, and those with primary insomnia, a lifelong inability to get enough rest.
What's more, the effects seem to last — a year after CBT, most people still show benefits from the therapy and sleep more soundly than before. And there is no evidence that CBT has adverse effects.
How does cognitive behavioral therapy work?
Cognitive behavioral therapy helps you change the thoughts and actions that interfere with your ability to get restful sleep. The approach is based on the idea that how you think (cognition) and act (behavior) affects the way you feel.
The cognitive portion of CBT teaches you to recognize and change false beliefs that affect your ability to sleep. For example, you may believe that you must get eight hours of sleep every night to function. In fact, seven hours of sleep may be adequate for you. Cognitive therapy also deals with misperceptions about the amount of time you actually spend sleeping. People with insomnia often sleep more than they realize.
The behavioral portion of CBT helps reprogram the part of your brain that governs the sleep-wake cycle. It targets specific behaviors — what sleep experts call "sleep hygiene" — that negatively affect your sleep. Such behaviors include failing to exercise or drinking beverages that contain caffeine just before bedtime.
When used as an insomnia treatment, cognitive behavioral therapy usually requires four to eight 30-minute sessions with a trained sleep therapist. The approach works on multiple levels and contains one or more of the following elements:
- Cognitive control and psychotherapy. This type of therapy helps you control or eliminate negative thoughts and worries that keep you awake. It may also involve eliminating false or worrisome beliefs about sleep, such as the idea that a single restless night will make you sick.
- Sleep restriction. This approach tries to match the time spent in bed with your actual sleep requirement. Reducing the amount of time you spend in bed without sleeping will actually increase your desire to sleep.
- Remain passively awake. Called paradoxical intention, this involves avoiding any effort to fall asleep, with the goal of eliminating any anxiety you may feel about falling asleep easily.
- Stimulus control. This method helps disassociate any negative cues you attach to the bedroom environment and condition a positive response with getting into bed. For example, you might be coached to use the bed only for sleep and sex.
- Sleep hygiene. This method of therapy involves correcting basic lifestyle habits that influence sleep, such as smoking or drinking too much coffee or alcohol late in the day and failing to exercise regularly. It also includes tips that help you sleep better, such as winding down an hour or two before bedtime with a warm bath.
- Relaxation training. This method helps you relax to reduce or eliminate the arousal that disturbs sleep. Approaches include meditation, hypnosis and muscle relaxation.
- Biofeedback. This method measures certain physiological signs, such as muscle tension and brain wave frequency, with the intent of helping you control them.
Insomnia as a symptom of another disorder
Because insomnia can be associated with many underlying disorders, such as depression, substance abuse or another sleep disorder, a thorough sleep evaluation is key in determining the appropriate treatment. In these cases, the root cause should be addressed simultaneously.
Finding help
The American Academy of Sleep Medicine has developed a standardized process and certification for behavioral sleep therapists, and you can locate a practitioner through its Web site.
However, there is currently a shortage of certified sleep therapists, and you may not live near a practitioner who can help. Further, the type of treatment — such as group versus individual — and frequency of sessions, may vary depending on the provider.
You may have to do some searching to find a trained practitioner and a treatment schedule and type that fits your needs. Start by obtaining a list of sleep centers from the National Sleep Foundation Web site. Many are associated with major hospitals. If you can't find one close to you, try locating a therapist who offers phone consultations. CBT books and CDs may be a good option until you find someone to help.
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