What is CBTi?
The primary psychological treatment for sleep is evidence-based CBTi, cognitive behavioural therapy for insomnia. Recognised by the National Institute of Clinical Excellence (NICE) for many people, CBTi is equally or more effective than many sleep medications.
There are different ways to access CBTi, books, online apps or in-person therapy. However, many people benefit from working face to face. As psychotherapist, I also help my clients to unpick some of the other factors that might have triggered their sleep issues alongside a program of CBTi.
There are five aspects of CBTI, each undertaken simultaneously.
Clinically the definition of sleep hygiene is that it is a set of general recommendations about lifestyle stress reduction – diet – exercise, caffeine / alcohol use and environmental factors – light – noise or temperature that may promote or interfere with sleep. Sleep hygiene includes education about what constitutes "normal" sleep and changes in sleep patterns with ageing.
This helps you identify any negative thoughts about sleep that may be keeping you awake. By finding more positive and helpful ways to regard sleep, you can change your approach to bedtime.
This approach has proved highly effective in moving patients from a position of frustratedly trying to force themselves to sleep, to calmly allowing sleep to happen. Once a sleep problem is overcome, if it starts to become an issue again, patients know what to do to prevent the problem from escalating.
It may seem strange but spending too much time in bed can actually cause you to have difficulties sleeping. By cutting time in bed, you retrain the body to know what time is available for sleep. Sleep restriction is a highly effective method to improve sleep and has been shown to be as clinically effective as some sleep medications.
Sleep restriction increases your ability to sleep by increasing sleep pressure by limiting the amount of time you allow yourself to sleep in bed. This consolidates sleep into one place – leading to less 3-4 am waking, and improved sleep efficiency. Research has shown that sleep restriction therapy is the most effective sleep hygiene technique available. It works as well as medication with a longer-lasting effect.
However, it takes several weeks of diligent dedication to altering your sleep schedule in order to see results. You may feel sleepier and experience more disrupted sleep initially. Because of this, ideally, you should seek advice before attempting a sleep restriction programme. It is not suitable for those who have to drive or operate machinery for a living.
The irony about improving sleep is how hard we work at it. If we can let go of that and turn our attention to prioritising relaxation, many of our issues with sleep would fade away. Together we explore a variety of techniques to use throughout the day and at bedtime, you can encourage your mind and body to relax and better prepare for sleep.
This tackles the problem of lying in bed expecting not to sleep. After 15-20 minutes, if you are struggling, I recommend you get out of bed. Part of our work together specifically addresses the steps you will take when you cannot sleep.
Prior to our first session, I will ask you to fill out a health questionnaire. The importance of this is to assess whether there is a clinical sleep issue that may require medical support. There are many reasons for why someone may have issues with sleep and it is important that we check this and in that session discuss and plan for next steps.