To eliminate primary insomnia and to make sure that the elimination lasts for long, the arguably best treatment procedure for Insomnia is of course Cognitive Behavioral Therapy or CBT. However, it is a must that the treatment is done properly and also the patient sticks to the program throughout. It is an intensive and time consuming process that is not suitable for every patient suffering from insomnia.

About Insomnia:

It is a disorder in which a person experiences difficulty in falling asleep, stay asleep and also getting adequate sleep, when there is ample scope or opportunity for it. There are two types of insomnia – primary and secondary. The primary insomnia is a disorder in which the insomnia itself is the problem and is not associated as a side effect of any other problem or health condition. Secondary insomnia on the other hand is a disorder that is a result of some other health conditions such as cancer, asthma, arthritis, heartburn, depression and others. The symptoms of insomnia are –

Cognitive Behavioral Therapy for Treating Insomnia

  • Difficulty in falling asleep
  • Waking up late till night
  • Once sleep is disturbed and broken, difficulty in going back to sleep
  • Always feeling tired due to inadequate sleep
  • Waking up early in the morning
  • Irritability, depression or anxiety
  • Headaches
  • Difficulty in concentrating, paying attention and repeatedly making mistakes
  • Difficulty in remembering.

If insomnia persists, it can lead to severe health deterioration as sleep is needed for the body and mind to stay healthy and fit. Hence, treatments are must.

Traditional Treatment Modes for Insomnia:

The doctor at first recommends a few general sleep improvement habits. These habits are improved depending on the cause of insomnia such as stress or work load, anxiety and depression. Changing these conditions and by providing a healthy sleeping atmosphere, insomnia can be got ridden of significantly. However, if none of these work, a few medicines and drugs are recommended by the doctor such as ramelteon (Rozerem), zaleplon (Sonata), eszopiclone (Lunesta) or zolpidem (Ambien). But, these cannot be prolonged for more than a week as they have serious side effects on the health of the insomniac person.

Therapeutic Treatment vs. Sleeping Pills for Insomnia:

When these procedures do not work, over-the-counter and non-prescription procedures and therapies are used and recommended by the doctor to treat Insomnia. These are very helpful and effective as they impart no harm to the person or do not deteriorate the health condition under any circumstances. The sleeping pills or prescribed medicines on the other hand leave long lasting side effects. Although they can seem very effective for the time period in which you stay dependent on the pills, but as you stop taking them, the insomnia will recur. Moreover, there will be a constant feeling of drowsiness and a sense of being 'hung over' will persist especially in the morning. Sleep walking or somnambulism and sleep driving are serious and severe side effects of these pills.

Cognitive Behavioral Therapy for Treating Insomnia:

In cognitive behavioral therapy, a person's behaviour is addressed by establishing better sleep habits and by providing proper education regarding sleep. It is a time consuming therapy that engages the patients with insomnia into 4 to 12 long sessions of 30 minutes each. During each session, a psychologist with a special interest in insomnia and other medical practitioners like psychiatrists, nurse, physician and others are present to give the patient a proper training. The goal of the cognitive behavioral therapy is to eliminate misconceptions regarding sleep in general and better sleeping hygiene habits are developed.

The most useful aspect of cognitive behavioral therapy or CBT is that rather than treating the symptoms of the disorder, treats the cause of it. Hence, with proper following of the therapy, insomnia will disappear forever and would not recur. Those, who are suffering from severe insomnia, can also be benefited with cognitive behavioral therapy as it can be continued along with traditional medical treatment procedure, without interrupting either procedure of treatment. The three main objectives or focuses of cognitive behavioral therapy in treating Insomnia are:

  • Conditional arousal
  • Identifying the habits that were developed to improve sleep, but are ineffective and eliminate them
  • Reducing worry, tension and anxiety that lack of sleep might develop.

Some of the techniques that need to be followed in Cognitive Behavioral Therapy for Treating Insomnia are as follows:

Relaxation Training for Sleep Disorders: An Effective Cognitive Behavior Technique to Treat Insomnia:

In this treatment procedure, the patient is given a progressive muscle relaxation or PMR, meditation, imagery and also assisted with self-hypnosis techniques and deep breathing techniques to help him overcome the sleep disorder. The target of this technique is to reduce or eliminate tensions as well as the intrusive thoughts that are causing hindrance or are interfering in falling asleep. The progressive muscle relaxation or PMR technique is exceptionally useful as it sequentially relaxes as well as tenses the major muscle groups of the body in order to make them feel wearied and contributing in falling asleep. The technique concentrates on sending contrasting sensations of tension and relaxation.

In the relaxation technique, biofeedback is a very important part of the treatment therapy. A sensor connected to a machine is attached to the body to measure its responses like heart rate, muscle tension etc. The sensor machine produces sounds and images that assist you to control how your body responds to breathing.

Stimulus Control Therapy: Cognitive Behavior Technique to Help Get Rid of Insomnia

In this therapy, the conditions and factors in the mind that are resisting the person from falling asleep are addressed and removed. To address conditioned arousal, Richard Bootzin developed and designed this therapy technique in which the bed is used as a stimulus or a cue for sleep and eliminates and weakens the idea that the bed is a cue of wakefulness. The patient is assisted to build a habit to eliminate the habit of doing any other work but sleep and sex, on the bed. From eliminating the habit of taking a small nap, to watching TV, playing video games and be busy with the smart phone on the bed, all habits are gradually removed to make the bed a stimulus to understand that as you enter the bedroom and get to the bed, you fall asleep. The therapist will assist the patient to condition the patient in a way that he enters the bedroom and gets to the bed only when he is sleepy and not earlier. This will gradually make sure that the patient, along with feeling tired, is not 'weary' or not sleepy, but is conditioned to fall asleep as he sees the bed.

Sleep Restriction: An Effective Cognitive Therapy For Insomnia

Sleep restriction therapy or SRT is a useful therapeutic technique in which the amount of time the patient spends in bed is reduced. This helps the person not to stay awake, despite lying on bed. The impact is that the following night, the patient is more tired and gradually falls asleep a bit earlier. As the habit of staying awake lying on bed changes, the time the patient spends on bed is gradually increased.

Sleep Hygiene—To Promote Better Sleeping

Environmental factors, habits and practices play a very important role in getting sound sleep. In the Cognitive Behavioral Therapy or CBT treatment procedure, these are addressed and good deal of lifestyle changes are introduced to help the patient get rid of insomnia.

  • As cardiac rhythm is a factor that is closely associated with and influences sleep, it is bettered and made proper by exercise, exposure to light, proper nap times, and bedtime.
  • Regular exercise regimes are suggested to properly train the muscles to become weary during bedtime, so that the patient easily falls asleep.
  • Assistance and techniques are suggested to help the patient stay away from drinking, smoking and caffeine consumption, as they can significantly contribute in insomnia.
  • Additional support is provided to make sure that the bedroom atmosphere and environment is calm, quiet, dark and soundless. In this step, the clocks are hid and the TV is shifted to another room.
  • Relaxing activities such as writing, reading, taking a bath and listening to calm music are good habits that are encouraged in this process.
  • Stimulating activities on the other hand, such as watching television, being under bright lights and using a computer are eliminated from the daily regime, before going to sleep.

Paradoxical Intention to Treat Insomnia

In this Cognitive Behavioral Therapy or CBT technique, the patient undergoes reverse psychology. The person although learning sleeping techniques and trying to eliminate insomnia, tries to stay awake. The logic behind this technique is that as most people fail to fall asleep out of the fear and worry that they are not falling asleep, they actually overcome the fear in this pattern. As the psychology helps them to believe that they are voluntarily staying awake, the fear disappears that they are not being able to sleep.

CBT or cognitive behavioural therapy is a very effective process if properly done. Although it takes time, it comes without the side effects of sleeping pills. Moreover, if you are suffering from prolonged insomnia and want to avoid the side effects of sleeping pills; this is the only and the best alternative to cure the condition without any side effect. You only have to follow the instructions of your therapist and continue the therapy till the end, to get complete results.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: July 11, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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