By Tom McDonagh, Psy.D.
CA License #: PSY25741
WA License #: PY61408367
One of the great treatments for sleep disorders is cognitive behavioral therapy. And really, it helps people with a prescribed plan for what to do.
One of the issues with sleep disorders is that we feel like the thing we’ve been doing consistently doesn’t seem to work anymore. And we’re at a loss for what to do. So CBT kind of has that nice structured plan for people to follow. It tends to be or leans more towards the behavioral side as opposed to the cognitive side.
There are some cognitive techniques, but there’s a lot of behaviors you want to focus on.
I’m sure people are mostly familiar with some of the behaviors, which include good sleep hygiene, or these are essentially positive, useful, good night routines. So you want to try to have the same night routine consistently.
And then other positive or useful sleep hygiene tricks include just making sure you’re not working out too late in the evening because our body temperature influences sleep. We want to make sure that the room is cool. It doesn’t have to be freezing, but a little bit cooler at night. Try to do some wind down activities before you go to bed.
Don’t play video games or watch a horror movie right before you go to bed. Those kind of get in the way. So those are what we mean when we say good sleep hygiene. So that’s necessary, but not the entire picture. The other part of it has to do with the way in which we set our sleep schedule.
So often if people just have mild to moderate sleep problems, I’ll just emphasize, try to make sure you wake up at the exact same time every single day. The reason is again, our bodies run on these circadian rhythms, these very dedicated routines. And if you wake up at the same time every day, it really helps to set that sleep cycle that we’re looking for.
In more extreme or more difficult cases, we can try something that’s called compressed sleep. And this is where you’d really wouldn’t want to work with a professional one on one, but essentially you appreciate the fact that our bodies have a desire to sleep. So after working with a professional, you determine a certain window of time where you reduce the amount of time you allow yourself to be in bed.
Then over a period of time, you gradually increase the time you allow yourself to be in bed. And the idea there is that the drive or the desire to sleep helps push through those pockets throughout the night when we have difficulty sleeping. So that’s more the behavioral side of things.
The cognitive side of things, commonly what I’ll see are people have some sort of irrational thoughts about sleep, such as they feel like they have to stay in bed for longer than is needed, often because they feel like when sleep comes, they have to be ready for it.
That’s not actually what we’re looking for. That actually encourages your body and your mind to be awake in bed more often. So we actually want to prevent that. So there are some cognitive behavioral techniques we have around those types of unhelpful thoughts. Also, people tend to have worry thoughts.
Either as they’re going to bed or when they wake up at two o’clock in the morning, these kind of worry thoughts come up. Other cognitive behavioral techniques that can help with those types of worry thoughts include types of journaling, mindfulness, or even thought records. Which are all things you can work with an individual therapist for more directly to help with those types of thoughts.
So one case study or an example, I’ve actually worked with a client with Cognitive Behavioral Therapy for Insomnia, or CBTI, was someone who had a lot of worry thoughts when they were waking up at two o’clock or three o’clock in the morning. They didn’t have a lot of difficulty falling asleep. But it was staying asleep that tend to be the problem for this individual. And with that individual, one of the biggest hurdles we ran into was how they approached sleep and then also how they approached catching up on their sleep.
So we really emphasize making sure that they woke up at the same time every single day, including the weekends. In this case, seven o’clock was the time that we landed on. And before going to sleep, we really emphasize a lot of good sleep habits. This individual tended to watch a lot of movies or be on their computer until they felt tired.
And we were realizing that some of the things they were watching or engaging with were pretty activating. So that was a big part of it. So we worked on types of activities that are more relaxing, such as reading. Or in this individual’s case, too, they worked with a lot of the worry thoughts, writing them out in complete sentences, not challenging them at all, just simply writing out what their worry thoughts were in a complete sentence about an hour before they went to bed.
Until they felt a nice sense of like satisfaction or completion, and then they continue with the rest of their night routine. And those two changes, the changing in the way which they approached sleep and then making sure that they woke up at the same time every day, they didn’t sleep in on the weekends, really seemed to make the change for them at about a two to three week period.
That’s the cognitive behavioral therapy approach to sleep disorders and if you think you’re experiencing some of those, please feel free to reach out to us at Good Therapy SF. Thank you.
