Disrupted sleep rhythms may drive mood instability and sleep and insomnia are some of the most frequently cited problems of people seeking help for mood disorders.
Research has shown that most frequently prescribed medications are not very helpful – they may lengthen sleep times by only 15 – 45 minutes per night.
Cognitive Behavioral Therapy for Insomnia
Cognitive Behavior Therapy for insomnia (CBTi) has the strongest evidence for reducing or eliminating insomnia.
We have had a lot of experience both with CBTi delivered in one-on-one sessions as well as delivered as an online therapy. Results have been very good and everyone who completes the therapy reports significant long-term improvements in sleep quality.
Recently, studies have looked at a type of CBTi called “Stimulus Control Therapy” (SCT). This system, developed by the late Dr. Richard Bootzin, longtime faculty member of the University of Arizona, depends on behavioral changes made by the patient.
Stimulus Control Therapy Rules
- Use your bed only for sleeping or sex. Do not lie in bed trying to drop off for more than 20 – 30 minutes. If you don’t fall asleep within 20 minutes of retiring, get up and do something else. Don’t use the bed for reading, watching TV, working on a laptop, etc.
- Get up at the same time each morning. Eventually going to bed at the same time each night is also important, but it is easier to establish a regular wake time first. And since bedtime should depend on feeling sleepy (see below)
- Learn to distinguish between fatigue and sleepiness. Fatigue is feeling tired, even though you may not feel like sleeping. Sleepiness, is a state when you are beginning to drowse and may have trouble keeping your eyes open. In that state, if you go to bed, you will likely fall asleep quickly. However, fatigue, or low mental or physical energy may occur at any time, even if you can’t sleep. If you find that you go to bed when you are feeling fatigued or depleted by a difficult day but not sleepy, you will very likely lie awake unable to sleep.
- Avoid taking too many or long naps during the day. One 15- to 30-minute nap in the mid-afternoon can be refreshing, but napping within a few hours of rising, or a few hours before bedtime, can interrupt your sleep and waking rhythm.
It is easy to summarize the rules but often very difficult to implement them, for that reason stimulus control therapy is much more likely to be effective if provided as part of ongoing therapy or in a standalone online therapy or group therapy program.
For some people it may even be necessary to receive this treatment in a residential program.
Morin, C., Bootzin, R., Buysse, D., Edinger, J., Espie, C., & Lichstein, K. (2006). Psychological and behavioral treatment of insomnia: Update of the recent evidence (1998-2004). Sleep, 29, 1398-1414.
Morin, C.M., Hauri, P.J., Espie, C.A., Spielman, A.J., Buysse, D.J., & Bootzin, R.R. (1999). Nonpharmacologic treatment of chronic insomnia: An American Academy of Sleep Medicine review. Sleep, 22, 1134-1156.