10% of Canadians have clinical insomnia requiring treatment. The definition of chronic insomnia is:
- Can’t fall asleep and/or can’t stay asleep despite adequate opportunity for sleep.
- Associated distress or daytime functioning impairment.
- Lasts three plus months for at least three nights a week.
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Cognitive Behavioral Therapy for Insomnia (CBT-I)
CBT-I (Cognitive Behavioral Therapy for Insomnia) is the most effective first-line treatment for chronic insomnia. It is also an excellent alternative for patients who wish to treat their trouble sleeping at night without the use of sleep medication, and for those who wish to taper off or reduce their sleep medication. Most patients respond to treatment in 2-6 sessions. Both group and individual treatments are effective.
- Helps you recognize and change beliefs, and to control worries that contribute to poor sleep.
- Helps you develop healthy sleep habits and avoid behaviors that cause sleep deprivation.
CBT-I addresses three factors that contribute to chronic insomnia
- Conditioned arousal
- Maladaptive habits that were aimed to improve insomnia but have become ineffective.
- Worrying about sleep and other causes of increased arousal.
CBT-I VERSUS SLEEPING PILL
Sleep medications can be an effective short-term treatment and provide immediate symptom relief during a period of sleep deprivation due to high stress or grief. Medication for sleep can be beneficial when prescribed and monitored carefully by a sleep physician. However, long term use of sedatives can have adverse effects and that is why CBT-I is important for the long-term management of insomnia.
CBT-I is effective for insomnia long term. It also reduces depression, anxiety chronic pain, fibromyalgia, substance abuse, and PTSD in insomnia patients with these co-morbid health problems. Unlike pills, CBT-I addresses the underlying causes ofinsomnia. This process requires commitment, self-responsibility and a willingness to change on the part of the patient. In some cases, a combination of sleep medication and CBT-I may be the best approach.
CBT-I consists of several components. The most effective treatment approach may combine several of these methods:
- Stimulus control therapy
Remove factors that condition your mind to resist sleep i.e. regular bedtime/ wake time, naps, bed for sleep and intimacy.
- Sleep restriction
Reduces time in bed, causing partial sleep deprivation; makes you more tired the next night.
- Sleep hygiene
Habits that influence insomnia i.e. smoking/ caffeine, alcohol, sedentary life. Tips to improve insomnia i.e. pre-sleep routine.
- Sleep environment
Quiet, dark, cool, no TV in the bedroom, hide clock from view.
- Relaxation training
Calms mind and body i.e. deep breathing, meditation, imagery, muscle relaxation.
- Paradoxical intention
Remaining passively awake. Letting go of worrying about sleep can help you relax and make it easier to fall asleep.
Observe patterns/biological signs via a device i.e. heart rate, muscle tension and adjust them.
- Cognitive distortions, dysfunctional beliefs and myths about sleep
Catostrophic thinking, over generalization.
At the Centre for Sleep and Human Performance our clinical sleep educator (CSE) works collaboratively with the Medical Director and Centre physicians to support an interdisciplinary approach to the diagnosis, management and treatment of insomnia.
Our CBT-I program is highly individualized and patient centred. It guides patients to identify and replace thoughts and behaviors that contribute to sleep deprivation with effective strategies that optimize sleep, help re-gain confidence in sleeping, and to re-frame trouble sleeping in a constructive manner. The most relevant causes of insomnia are identified so patients can focus on changes that will most likely help their sleep problems. Our program consists of 2 to 6, 30-60 minute sessions with the CSE over 8-12 weeks and is covered through Alberta Health and Wellness, at no cost to the patient. The timing of your appointments is adjusted based on your progress and the program is extended if necessary to ensure you attain the benefit, success and confidence you need in managing your sleep, so you can focus on living a full life and enjoy restful sleep.