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Tired? Can’t fall asleep at night? If you have insomnia, you may take a half-hour or longer to fall asleep and frequently get less than six hours, according to the Mayo Clinic. And you know how badly that messes with your life. Sleep deprivation leads to fatigue, mood swings, increased appetite, diminished functioning, memory impairment and lower grades, and contributes to physical and emotional health problems, research shows.

Even if you’re familiar with insomnia, you may not know its first-line treatment: cognitive behavioural therapy (CBT), a type of short-term counselling, in a format that specifically addresses insomnia (CBT-I). “Our research shows that CBT-I is an effective treatment for insomnia—95% of patients have improved their sleep after a six-week program and are confident that they can maintain it,” says Adrijana Krsmanovic, a PhD student at Queen’s University, Ontario, who evaluates CBT-I programs with the Kingston Family Health Team and Dr. Judith Davidson, Psychologist and Sleep Researcher.

Students who received CBT-I showed improved sleep quality and reduced fatigue compared to those who didn’t, according to a small study in Behavior Therapy (2014). “The majority of patients no longer experience clinically significant insomnia after treatment,” says Krsmanovic.

Student’s story

“I finally got over this thing that had defined my life”

Joel C., a fourth-year undergraduate, has used CBT to help him with insomnia, depression, anxiety, and addictive tendencies.

“Medication wasn’t working for me. I saw a psychiatrist who said, ‘I think you would best benefit from changing your thought processes surrounding sleep, so I’m going to give you some exercises. It’ll take a few months, but it will make things easier for you.’ And it really has.

“CBT is a pattern of approaches that can be modified to address various issues. At first it was really uncomfortable, because it was hard to get my mind to bend. The initial task was breaking down that barrier. I had to train myself to be OK with uncertainty. But CBT ultimately gave me the space to breathe. It was almost like a shaft-of-light-descending-from-heaven moment when I finally got over this [insomnia] that had defined my life.”

For methods, see Short-term therapy: How CBT-I works

 

No pills: Why CBT-I is the first-line insomnia treatment

  • CBT-I is so effective that it’s the first-line treatment for adults with chronic insomnia. That’s the recommendation of the American College of Physicians (ACP), following more than a decade of research.
  • What’s the problem with sleeping pills? Sleeping medications can be useful for some people in some situations, but they don’t provide a long-term fix, and they come with side effects and risk, including dependency and addiction.
  • In studies, medications such as Ambien and Restoril appear to double the users’ risk of car accidents (American Journal of Public Health, 2015). In a 2012 study, the use of prescription sleep medication was associated with markedly earlier death, according to BMJ Open (this does not mean the medications actually caused those deaths). In addition, sleeping pills don’t extend our sleep nearly as long as we might think—most add only a few minutes a night, according to a 2007 analysis in the Journal of General Internal Medicine.

“CBT-I is an excellent treatment option for college students because it is safe (i.e., doesn’t involve medication), it works fairly quickly (people see improvements within 2–3 weeks), and it can be maintained long-term, as opposed to being a quick fix that loses effectiveness.”
—Adrijana Krsmanovic, PhD student in Clinical Psychology and CBT-I researcher at Queen’s University, Ontario

 

How to get online sleep therapy

Online CBT-I programs range in accessibility and cost*. Although there is no current online service available uniquely for Canadians, there are many international options available. Your options include:

CBTforInsomnia 5-week, 5-session program was developed by Dr. Gregg Jacobs at UMass Memorial Medical Center. Therapy formats include PDF, MP3, and email Q&A.
Cost $30-$50

SHUTi 6-week, 6-session program, with access to online materials for 16 weeks.

SleepTutor 8-week program with weekly progress reports and therapist feedback.
Cost $149.

Sleepio A year of support from sleep scientists who communicate online, offering advice and answering questions.
Cost $300

*Prices in US dollars.

Short-term therapy: How CBT-I works

  • CBT is a short-term therapeutic approach that can help people with a variety of emotional and behavioural issues, including symptoms of post-traumatic stress disorder, depression, and anxiety.
  • CBT involves a set number of sessions aimed at addressing an identified issue. To treat insomnia, you need CBT-I specifically.
  • CBT-I is available in traditional counselling settings and online.
  • Your CBT-I provider or program will help you identify the unhelpful thought patterns and behaviours that are messing with your sleep. They will help you reframe those thoughts and substitute more effective behaviours.

“Many people who suffer from insomnia have learned to associate their bed with wakefulness, rather than sleep. One technique used in CBT-I is to leave the bed if you can’t fall asleep or go back to sleep within 10–15 minutes, in order to help your mind break the connection between lying in bed and being awake,” says Adrijana Krsmanovic, PhD student in Clinical Psychology who researches the effectiveness of CBT-I programs at Queen’s University, Ontario.

  • During CBT-I, you might keep a diary of your sleep patterns. This can help reveal habits or thoughts that could be contributing to your insomnia. Your clinicians can then offer customized “assignments” intended to reshape your daily approach to nocturnal activities.

“Sleep is elusive—the more we search for it, the more it escapes us! People will often have unhelpful beliefs like, ‘No matter what I do, I can’t sleep well,’ which then creates stress and prevents the body from relaxing enough to fall asleep. It’s a vicious cycle. CBT-I is especially helpful because it targets both the behavioural and cognitive components of insomnia and includes elements of relaxation.”
—Adrijana Krsmanovic, PhD student in Clinical Psychology and CBT-I researcher at Queen’s University, Ontario

How to get in-person CBT-I

 

Insomnia symptoms: Mayo Clinic

 

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Article sources

Kelly Glazer Baron, PhD, MPH, clinical psychologist, founder of the Behavioral Sleep Medicine training program, Northwestern University Feinberg School of Medicine, Illinois.

Gregg Jacobs, PhD, assistant professor, behavioral and cognitive psychology, health psychology, UMass Memorial Medical Center, Massachusetts.

Asano, K., Ishimura, I., Abe, H., Nakazato, M., et al. (2015). Cognitive behavioral therapy as the basis for preventive intervention in a sleep health program: A quasi-experimental study of e-mail newsletters to college students. Open Journal of Medical Psychology, 4, 9–16.

Buscemi, N., Vandermeer, B., Friesen, C., Bialy, L., et al. (2007). The efficacy and safety of drug treatments for chronic insomnia in adults: A meta-analysis of RCTs. Journal of General Internal Medicine, 22(9), 1335–1350.

Hansen, R., Boudreau, D. M., Ebel, B. E., Grossman, D. C., et al. (2015). Sedative hypnotic medication use and the risk of motor vehicle crash. American Journal of Public Health, 105(8), e64­—e69.

Hershner, S. D., & Chervin, R. D. (2014). Causes and consequences of sleepiness among college students. Nature and Science of Sleep, 6, 73–84. http://doi.org/10.2147/NSS.S62907

Kripke, D. F., Langer, R. D., & Kline, L. E. (2012). Hypnotics’ association with mortality or cancer: A matched cohort study. BMJ Open, 2(1), e000850. doi:10.1136/bmjopen-2012-000850

Martin, B. (2013). In-depth: Cognitive behavioral therapy. Psych Central. Retrieved from http://psychcentral.com/lib/in-depth-cognitive-behavioral-therapy

Park, A. (2012, February 28). Study: Sleeping pills linked with early death. Time. Retrieved from http://healthland.time.com/2012/02/28/study-sleeping-pills-linked-with-early-death/

Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., et al. (2016). Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. [Epub ahead of print 3 May 2016.] doi:10.7326/M15-2175

Taylor, D. J., Zimmerman, M. R., Gardner, C. E., Williams, J. M., et al. (2014). A pilot randomized controlled trial of the effects of cognitive-behavioral therapy for insomnia on sleep and daytime functioning in college students. Behavior Therapy, 45(3), 376–389.

Roth, T. (2007). Insomnia: Definition, prevalence, etiology, and consequences. Journal of Clinical Sleep Medicine, 3(5), S7–S10.

Wilt, T. J., MacDonald, R., Brasure, M., Olson, C. M. , et al. (2016). Pharmacologic treatment of insomnia disorder: An evidence report for a clinical practice guideline by the American College of Physicians. Annals of Internal Medicine. [Epub ahead of print 3 May 2016.] doi:10.7326/M15-1781

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Isaac Feldberg is a third-year journalism and media and screen studies major at Northeastern University. He works as a living/arts correspondents at the Boston Globe.

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Charlotte Ottaway is a freelance writer and journalist whose work has been published in Canadian Business, Zoomer magazine, The Globe and Mail, and the Huffington Post Canada. She is the founder of Web of Words, where she helps solopreneurs and small business owners create real human connections online through blogging and social media. Find her at charlotteottaway.com and follow her on Twitter @charlottaway.