Most adults need 7-8 hours of sleep per night. Fewer than 1% of people have a genetic mutation that enables them to be fully rested with 20-25% less sleep. Yet more than one third of all Americans have insomnia which prevents them from getting the sleep they need and 15% of adults suffer from chronic insomnia.
Chronic insomnia can be the result of factors such as: medical conditions (diabetes, neurological disorders); substance use (caffeine, alcohol, prescription medications or tobacco); mental health issues (anxiety, depression); stress; aging; or poor sleep habits.
Consequences of long-term chronic insomnia can include: increased risk of on-the-job injury or auto injuries; high blood pressure; depression; heart failure; obesity; and a diminished level of cognitive functioning.
Treatments for insomnia can include behavioral therapy or medications. Medications work faster than behavioral interventions, but they do have side effects. Also, though they may increase sleep time, the drugs used to counteract insomnia usually have a negative impact on the quality of the sleep. Finally, sleep medications can lose effectiveness over time and can be addictive.
The Cognitive Behavioral Therapy (CBT) for insomnia usually takes five to ten weeks. CBT focuses on the behaviors and beliefs that are interfering with sleep. A study by Dr. Ryan Wetzler at Sleep Medicine Specialists in Kentucky found that two to ten sessions of CBT resulted in remission of insomnia in 50-66% of patients. Among those who were using sleep medications three or more days a week, 78% slept better and discontinued using the drugs after just four sessions of CBT.
The Cognitive component of CBT for insomnia involves identifying, challenging and replacing beliefs that create anxiety and beliefs that only perpetuate insomnia. Some unhealthy beliefs about sleep include, “I’m never going to get to sleep” or “I’m going to feel awful tomorrow.”
The Behavioral component of CBT for insomnia is referred to as “sleep hygiene” and is focused on education about optimal sleep conditions and encouraging those struggling with insomnia to incorporate those behaviors into their own sleep regimen. This may involve changing long established patterns – not an easy task.
The sleep hygiene psycho-education about ideal sleep practices includes teaching people to wind-down and practice the same bedtime rituals as a way to signal their body that they are expecting to sleep. It also involves stressing the importance of a regular sleep and wakefulness schedule, and reserving time spent in bed to sleep rather than eating, watching television, worrying or even reading. Sleep hygiene also includes optimizing the bedroom setting by making sure that it is dark, cool and quiet and that the clock is out of view.
Success with a course of CBT for insomnia requires both motivation and commitment. There is “homework” that usually includes keeping a sleep log and expectations about practicing the CBT techniques daily, but the benefits are long-lasting.
For more information, visit the National Sleep Foundation web-site.