Cognitive Behavioral Therapy for Insomnia

 

What is It and How Does It Work?

 

What Is CBT-I
(Cognitive Behavioral Therapy for Insomnia)

 

CBT-I (Cognitive Behavioral Therapy for Insomnia) is based on CBT (Cognitive Behavioral Therapy). So what is CBT? 

The "C" in CBT

The “C” in CBT refers to cognition - that is, the often distorted, dysfunctional thoughts and beliefs that affect every area of our lives - physical and psychological - which we're usually partially or totally unaware of.

If you're not very familiar with mind-body medicine, you might believe that whatever your physical problems are, they have nothing to do with what you think. But research shows that examining the deeply hidden beliefs and assumptions underlying our stories about what's happening in our lives, can have powerful effects, including: 

  • Reducing or eliminating symptoms of asthma, migraines and other forms of pain

  • Altering physiological hunger signals, making healthy eating much easier

  • Reducing symptoms of Parkinson's Disease

  • Reducing symptoms of depression and trauma

  • Changing the neural pathways associated with autism ADHD, and OCD

and so much more.

The “B” in CBT-I

The "B" in CBT refers to behavior. CBT uses various kinds of behavioral techniques that can radically help people with severe depression, trauma, OCD, physical pain of all kinds, and of course, insomnia. 

Cognitive Behavior Therapy for Insomnia, CBT-I, reduces, or at its best, totally cures insomnia through a combination of both cognitive and behavioral methods that calm the mind and substantially change the physiology underlying our sleep-wake cycle such that it becomes easy to fall asleep and get back to sleep.

 
 

The History and Science Behind CBT-I

 

I was certified in CBT-I through a program created by Dr. Gregg Jacobs. Dr. Jacobs developed the Behavioral Medicine Insomnia Program at Harvard Medical School’s Deaconess Hospital in Boston, in 1991. It was the first comprehensive program for insomnia that did not use drugs. Over the past 30 years, it has been taught to thousands of patients and healthcare practitioners. It was considered successful enough that he was awarded a four-year grant by the National Institutes of Health to study the effectiveness of his Insomnia Program compared to medications prescribed for sleep. (Spoiler alert: it was more successful).

CBT-I, as developed by Dr. Jacobs and others, is based on a simple principle: rather than making an effort to sleep, we can learn how our brain and body function naturally to help us sleep, and then learn how to cooperate with that natural functioning. When we're in harmony with our natural functioning, sleep happens effortlessly. 

Not only human, but all mammals and reptiles have natural sleep-wake cycles along with a number of other natural cycles. But we tend to live our lives with so little awareness of these cycles that it may be hard to believe that our bodies could actually be ready and eager to sleep or eat all on their own.

We can learn to tune into these circadian cycles (cycles that occur within a 24-hour period), not only to get high quality, restorative sleep with relatively little effort, but to more easily develop healthy work, eating, exercise and recreational habits as well.

In addition to our sleep-wake cycle, circadian rhythms regulate our digestion, immune, and other systems of the body. They affect our metabolism and weight through regulating blood sugar and cholesterol levels, and can even affect our mental-emotional state, particularly our levels of happiness and sadness (SAD, or “seasonal affective disorder,” is an example of this). There are also cycles of greater and lesser susceptibility to illness, and even times throughout the day that are more favorable for analytic or creative thinking!

Some of our body's natural rhythms are independent of the environment, but for the most part, sleeping and waking are affected by sunlight. Light stimulates our hypothalamus (the “master clock” in our brain) to produce hormones such as cortisol and acetylcholine that increase alertness, and darkness stimulates it to produce melatonin, adenosine and other “sleep” hormones. These circadian rhythms harmonize our sleep-wake drive with the sun so that we generally stay alert throughout the day (except for a dip in energy which often occurs in mid-to-late afternoon) until the sun goes down when our sleep drive takes over.

In 1987, psychiatrist and sleep specialist Arthur Spielman developed a protocol to help people find a sleep schedule that would best align them with their natural sleep-wake cycles. (Dr. Spielman referred to this process as “sleep restriction,” the term which is commonly used in CBT-I. Since that term tends to evoke an uncomfortable feeling of control, the opposite of what we’re aiming for, I’ve chosen to refer to it as “sleep scheduling” instead.) Sleep researchers around the world have come to agree that if you could choose just one thing to do to improve your sleep, it would be to go through the steps of the process for determining your ideal sleep schedule.

In our sleep course, in addition to CBT-I, you'll learn Effortless Mindfulness And Yoga Nidra (otherwise known as Non-Sleep Deep Rest) practices which research shows can significantly increase the success of CBT-I. And, you'll have music specially composed for sleep.