Cognitive Behavioral Therapy for Insomnia (CBTi) is the most effective treatment for chronic insomnia and chronic insomnia is a major risk factor for developing chronic depression.
A colleague of ours, who is an expert in sleep, suggested, only somewhat in jest, that mood disorders should be considered a type of sleep disorder. Part of what he was talking about is new evidence that what drives mood instability for many people is disrupted sleep (and wakefulness) rhythms.
Cognitive Behavioral Therapy for Insomnia (CBTi) is a structured, evidence-based treatment approach aimed at addressing insomnia by targeting the underlying thoughts and behaviors that perpetuate sleep difficulties. It combines cognitive therapy, which focuses on changing unhelpful thoughts and beliefs about sleep, with behavioral techniques that promote healthy sleep habits and patterns.
CBTi typically involves several key components:
Sleep education: Clients learn about the principles of sleep, including the importance of a consistent sleep schedule, the role of sleep drive, and the impact of lifestyle factors on sleep quality.
Cognitive therapy: Clients identify and challenge negative thoughts and beliefs about sleep, such as catastrophizing about the consequences of poor sleep or having unrealistic expectations about how much sleep they need.
Sleep restriction: This involves temporarily limiting the time spent in bed to match the individual’s actual sleep duration, helping to consolidate sleep and strengthen the association between bed and sleep.
Stimulus control: Clients learn techniques to associate the bed and bedroom environment with sleep rather than wakefulness, such as only using the bed for sleep and sex, and avoiding stimulating activities in the bedroom.
Relaxation training: Techniques such as progressive muscle relaxation, deep breathing, or guided imagery are taught to help reduce physiological arousal and promote relaxation before bedtime.
Sleep hygiene: Clients are educated about lifestyle factors that can influence sleep, such as caffeine consumption, screen time, and exercise, and are encouraged to adopt habits that promote better sleep hygiene.
CBTi is typically delivered over a series of sessions with a trained therapist, although self-help materials and digital programs are also available. Research has consistently demonstrated the effectiveness of CBTi in improving sleep quality and duration, with benefits that are often maintained over the long term. It is considered a first-line treatment for chronic insomnia and can be used alone or in conjunction with other interventions, such as medication, depending on the individual’s needs and preferences.
Resources at Gateway
Naomi Muzac is the therapist in our clinic who has received the most training in CBTi. She has successfully completed and received certification in Cognitive Behavioral Therapy for Insomnia (CBT-I) training from PESI, Inc. She has undergone several courses related to insomnia interventions, including the Essential Acceptance & Commitment Therapy Online Course, the 3-Day Intensive Training on CBT-I, and the Quiet Your Mind and Get to Sleep program.
Other Resources for Insomnia
- In person or virtual sessions with local experts
- Britney Blair – this talented clinician and educator from Stanford’s sleep center offers individual and group at The Clinic, her group psychiatry practice. Ty Canning is a clinician with the group that most of my colleague’s clients actually work with – video or in-person, 6 sessions for most individuals – they accept insurance.
- Monique Thompson in Rockridge.
- Katherine Taylor works at the NCPTSD, and was a primary provider on the CBT-I Coach app. She has worked at Stanford with Rachel Manber on the CBT-I studies there, at the Veterans Administration CBT-I roll-out. She has a special interest in perinatal health, but will see all clients.
- Virtual solutions
- The Sleep Reset– designed with experts like Rachel Manber at Stanford, this solution pairs you with a sleep coach who has years of experience in sleep.
- Lullaby also pairs you with an expert-level coach for individualized CBTi treatment
- Crescent Health– an online solution for CBTi coaching and more. Want coaching on delayed sleep phase and circadian rhythm entrainment? Jet lag preparation? They will do it.
- Dreem Health also does virtual care for sleep difficulties. They can order a sleep study (but the person reading the study will not be a well-known specialist like Dr/’s Claman and Lu, who I refer to) and they can deliver CBTi over a virtual platform.
- Sleepspace– work with a coach to assess and adjust your own specific sleep challenges for the better, in an average of 6 sessions.
- CBT-i Coach is an app developed by the Veteran’s Affairs administration. It can be your companion through the process, it is not meant to be a stand-alone CBTi solution
- Insomnia Coach, developed for veterans, is helpful also –
- There is Sleepio, another CBTi app; this one is prescribed and is covered by insurance. It has a “virtual coach”, but you are ultimately left to do CBTi on your own with its lessons, which can be challenging.
- UCSF’s Osher Center – Individual intake and wrap-up sessions; 5 group education sessions. Takes insurance, but is less individualized than individual therapy with the therapists above
- You may find other therapists at www.behavioralsleep.org
BOOKS
- Quiet Your Mind and Get to Sleep: Solutions to Insomnia for Those with Depression, Anxiety, or Chronic Pain – by New Harbinger Press
- Say Good Night to Insomnia: The Six-Week, Drug-Free Program Developed at Harvard Medical School By Gregg Jacobs PhD
- End the Insomnia Struggle by Colleen Ehrenstrom PhD
- The Depression and Bipolar Workbook: 30 Ways to Lift Your Mood & Strengthen the Brain by Chris Aiken MD has a full guide to CBT-I – along with 2 dozen other techniques to improve mood and energy.
- Monique Thompson’s book The Insomnia Workbook for Teens
MORE INFORMATION
- https://mysleepwell.ca/ for further CBTi options – lots of recommendations, books…
And this nice PDF file that compares sleeping pills with CBT-i!
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