Cognitive Therapy for Sleep Problems
Works Better than Drugs
May 20, 2008.
We're getting pounded with ads for sleep meds like Ambien and Lunesta,
but before you take a drug that will decrease your time to fall asleep by only
10 or 15 minutes, and that could increase your risk of car accidents or sleep
walking, consider an alternative.
The most effective therapy for the treatment of insomnia has been shown in studies
to be cognitive behavioral therapy. It is much better than medication to treat sleeplessness,
and results in a significant improvement in sleep duration and quality without side effects.
To truly benefit from cognitive therapy, it is preferable if you can have a few sessions
with a therapist trained in it. The first step it to replace negative thoughts ("I can't
sleep without medications") with more positive ones ("If I take the time to relax, I can
get to sleep without help from pills."). The underlying theory is that you "retrain" your
brain to learn to sleep peacefully and deeply again.
Changing sleep habits is the second piece of cognitive therapy. For example, using the bed
and bedroom only for sleep (no working or TV-watching in bed), setting and maintaining a
regular sleep schedule, eliminating daytime naps, and minimizing or avoiding all together
caffeine, alcohol, stimulants, and heavy or extremely spicy meals four to six hours before
going to bed. Relaxation techniques such as progressive muscle relaxation often help. It
involves alternately contracting individual muscles and relaxing with exhalation; the individual
goes progressively through the body one-muscle group at a time.
Behavioral changes are highly effective and persist for a longer period of time than drug
therapy. About 80% of patients will show improvement. Time to fall asleep is reduced from
65 minutes to 35 minutes, an increase in sleep time of 30 minutes, and improved subjective
ratings of sleep quality.
In a well conducted study 46 patients with insomnia were randomized to receive CBT,
zopiclone, or placebo medication each night for six weeks.208 Sleep was assessed using
sleep diaries and polysomnography. CBT included sleep hygiene, sleep restriction,
stimulus control, cognitive therapy and relaxation. CBT was better than zopiclone for
sleep efficiency, with an increase from 81% to 90% compared to zopiclone which stayed
at 82% before and after treatment. CBT resulted in an increase in slow wave sleep and
decrease in time spent awake at night. Six months after the end of treatment CBT resulted
in better sleep efficiency using polysomnography than placebo or zopiclone. Since long
term use of sleeping pills is not recommended, what this study shows is that people with
chronic insomnia really need to make the effort to get sleep behavioral therapy treatment,
or at a minimum educate themselves through reading or online about the principles that
are promoted in the types of CBT programs utilized in this study.
Meditation and gentle yoga can also help some people fall asleep more easily as part of
a cognitive therapy program or on their own. Insomniacs often spend too much time in
bed trying to sleep, and the best thing to do is to get out of bed and read for a while
or listen to soft music.
So before you go for a prescription sleeper, try some of these 'side effect free' alternatives instead!
Cognitive Therapy for Insomnia
Sleep hygiene: minimizing or avoiding all together caffeine, alcohol, stimulants,
and heavy or extremely spicy meals 4-6 hours before going to bed; exercise Sleep restriction: maintaining a regular sleep schedule, eliminating daytime naps,
use the bedroom only for sleep Stimulus control: Don’t work in bed Cognitive therapy: Replace negative thoughts (“I can’t sleep without medications”)
with more positive ones (“If I take the time to relax, I can get to sleep without help from pills.”). Progressive relaxation: progressive muscle relaxation often help (alternately
contracting individual muscles and relaxing with exhalation; the individual goes
progressively through the body one-muscle group at a time)
You can find cognitive therapists in your area that specialize in this.
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