A very effective treatment for Insomnia: Cognitive Behavioural Therapy for Insomnia-CBTi

“Sleep is like a dove which has landed near one’s hand and stays there as long as one does not pay any attention to it; if one attempts to grab it, it quickly flies away”

 Victor E. Frankl

 We all need oxygen when we are out of breath, water when we are thirsty, food when we are hungry, and sleep when we are sleepy tired. Sleep has many functions; it helps with the removal of toxins, cell regeneration, emotional regulation, and with learning and memory consolidation. Insomnia carries risks, such as a twofold risk of developing depression.

Insomnia disorder (for the diagnostic criteria see DSM-5 307.42) affects 10-12% of the population on a chronic basis. In the UK alone 14 million sleeping pills are prescribed annually, but medication is not the most effective treatment for insomnia. The most effective treatment and the first line recommended treatment in most countries, is Cognitive Behavioural Therapy for insomnia (CBTi). 

CBTi is an empirically based psychological treatment for insomnia with a high-quality research data supporting long term effectiveness.

 Ideally, pharmacological interventions should only be offered if CBT is not effective or not available. CBTi isn’t routinely offered in many places because of the scare resource of practitioners able to effectively deliver this intervention. 

 So, what is CBTi? Firstly, a word about what it isn’t. CBT is not sleep hygiene, in fact sleep hygiene is a check list of lifestyle and bedroom factors which can be routinely addressed, like having a comfy bed and advice from the ministry of no fun about late nights and alcohol consumption. It is only a part of an effective intervention for insomnia. In fact an over emphasis on sleep hygiene can be counterproductive. CBT for Insomnia is a combination of at least one effective behavioural intervention (for instance creating an association between bed and sleep), at least one effective cognitive intervention (for example, unhelpful beliefs around sleep), sometimes one or more relaxation therapeutics (such as progressive muscle relaxation, visualisation, breathing exercises, or attention refocusing training), and some sleep education (about how sleep works). 

Good sleepers don’t go round high fiving each other, in fact good sleepers aren’t good at sleeping and they usually have no idea how they do it. Annoyingly, they just do it automatically. This is the aim of CBT for Insomnia, to regain this automaticity in sleep the same way as most of us walk, eat, and breathe.

 If you have a problem with sleep that might include insomnia, ask how much effort you are putting into sleep. How much do you agree with the following questions?

 Very much, To some extent, or not at all:

I put too much effort into sleeping when it should come naturally 

I feel I should be able to control my sleep 

I put off going to bed at night for fear of not being able to sleep 

I worry about not sleeping if I cannot sleep 

I am no good at sleeping 

I get anxious about sleeping before I go to bed 

I worry about the consequences of not sleeping 

Now ask: ‘How would a good sleeper answer these questions?’ 

There is no perfect answer to insomnia, but there is an effective alternative answer in CBTi. Nearly 70% of people who undertake CBT for insomnia experience remission of chronic insomnia and significant improvement in quality of life, and for most of the remaining 30% there is meaningful improvement.

 High quality CBT for Insomnia (CBTi) is now available face to face or online at CBT.Tokyo. 

The average length of treatment is 6-8 sessions.