How Cognitive Behavioral Therapy (CBT-I) Techniques Helpful For Sleep

In these modern days, more people suffer from “sleep debt”, which is the term for not having enough sleep on a regular basis around the world. This leads to increased use of caffeine and other stimulants to stay awake and then we crash when our bodies can’t handle the debt any longer. The price of this chronic debt includes increased stress, impaired cognitive function leading to loss of productivity, and increased accident rates not only outside the home but inside as well. Think about the “clumsy” thing you did the last time. Was it clumsy or were you not fully awake? The sleep debt will also lead to a loss of vitality and optimism that herald the beginning of anxiety and depressive disorders along with compromised immune systems.

The use of the stimulants we have carries its own side effects that can cause high blood pressure, heart disease, stroke, and cancer. While we may be able to mitigate these side effects by using less to “get by”, real healing will happen when we start respecting the importance of sleep and its role in our health.

CBT, also known as cognitive behavioral therapy, is a common form of therapy used to treat behavioral conditions and addictions. CBT is based on the premise that your feelings, thoughts, actions, and physical sensations are all connected. By facing and replacing these negative thoughts, patients can take a more positive approach to overcome whatever plagues them — in this case, insomnia.

CBT-I is specifically used to treat insomnia symptoms and utilizes various techniques. CBT-I works to identify the connection between the way you think, the things you do, and how these impact your sleep. Thoughts and feelings are examined for accuracy, and behaviors are evaluated to see if they promote or hinder sleep.

The goal of CBT-i is to help you make positive lifestyle changes and to change your mindset about falling asleep. To that end, CBT-i focuses on five main components. Your therapist will walk you through these and help you implement them.

1. Consolidation of Sleep (Sleep Restriction)

2. Stimulus Control

3. Relaxation Techniques

4. Sleep Hygiene

5. Cognitive Therapy

1. Consolidation of Sleep (Sleep Restriction)

During sleep, the brain is at its most conducive to the consolidation processes that integrate newly encoded memory into a long-term store, as opposed to the waking state, when it is suitable to the acute processing of external stimuli, which involves the encoding of new information and memory retrieval.

Due to competition for shared neural resources, encoding, and consolidation may be incompatible cognitive processes. Since sleep is characterized by considerably reduced processing of external information, it provides a window of opportunity conducive to memory consolidation. Numerous studies have shown that interference learning, the injection of norepinephrine and protein synthesis inhibitors, or electroconvulsive shocks may successfully impair or increase memory when provided after encoding.

This finding supports the consolidation concept. It is crucial to note that the effects of these interventions are time-dependent and peak soon after learning. Researchers believe that consolidation may occur in waves, with each wave including a separate set of stabilizing mechanisms that follow their own time courses and are dependent on their own underlying neural plasticity processes.

Before you aim to consolidate your sleep, start by figuring out how much time you’re actually sleeping each night versus how much time you’re lying awake in bed and trying to sleep, so you can understand your current level of sleep efficiency and your total sleep need. You can do this manually by keeping a sleep diary or by wearing a device that tracks your sleep, like an Apple Watch, Amazon Halo, or Oura Ring. Subtracting the average amount of time you tend to be awake in bed from the total time you spend in bed in 15-minute increments, while still leaving yourself with at least seven hours in bed (a good minimum for sleep restriction to ensure you don’t risk deprivation). For example, if you often go to bed around 10 p.m., spend about two hours lying awake in bed, and then wake up at 7 a.m. for a total of nine hours spent in bed, start going to bed 15 minutes later each day until your bedtime is at midnight.

Along that journey, you’ll likely find that you begin to fall asleep more easily after getting into bed. Once you determine (or estimate) that you’re spending about 80 to 90 percent of your time in bed actually sleeping, you’ve effectively matched your sleep timing to your sleep need and no longer need to restrict.

While you’re consolidating, be sure to keep your wake-up time the same (and just alter your bedtime), so that you’re restricting potential sleep time but not interfering with your circadian rhythm. And steer clear of naps and any pre-bedtime sleeping — yes, that includes you, Sleep snackers — so that your drive for sleep is always at its maximum when your new bedtime arrives.

2. Stimulus Control

Stimulus control is a behavioral psychology term that refers to a predictable pattern of behavior in the presence of a certain stimulus, and another pattern in the absence of that stimulus. “Discriminative stimulus” refers to anything that can modify behavior or cause a physical or emotional response.

Stimulus control therapy is part of the cognitive behavioral therapy protocol for sufferers of insomnia lasting three months or longer, at least three days each week.

Other components of the therapy include:

· Sleep restriction therapy. Sleep restriction therapy limits the time in bed to the average number of hours spent sleeping.

· Relaxation training. Relaxation training can help insomnia sufferers reduce anxiety and physical tension, allowing the nervous system to relax and making sleep more likely

· Cognitive behavioral therapy. The therapy component of the protocol addresses negative attitudes and misconceptions about sleep.

To alleviate anxiety and negative conditioning, the following behavioral changes are recommended:

1. Go to bed only when sleepy.

2. Go to sleep and wake up at the same time every day, even on weekends.

3. If unable to sleep after approximately ten-fifteen minutes, get up from bed and wait to feel sleepy in another room.

4. Use the bed for sleep only.

5. No watching the clock.

6. Do not nap

7. Be patient.

3. Relaxation Techniques

We’ve all had nights where we’ve had less than stellar sleep, so we all know how poor sleep can mess with us the next day. Having a sleep deficit can really add up when it comes to how we feel during the day. Consistently poor sleep or a lack of quality sleep contributes to brain fog, sluggishness, and even an increased risk of injury.

6 Great Relaxation Techniques for Amazing Sleep

1. Self-Hypnosis

“You are getting very sleepy…”

If you’re only familiar with hypnosis in popular media or comedy routines, then you’re really missing out on how it can be used to aid relaxation and encourage sleep. Hypnosis is a state of consciousness where someone is intensely focused on an idea or outcome, which can make their brain more receptive to new thoughts or ideas.

Hypnosis or hypnotherapy can be used to treat a number of health problems including anxiety, chronic pain, and sleep disturbances. Rather than being hypnotized by a hypnotherapist, with self-hypnosis, you learn to hypnotize yourself through videos or even smartphone apps.

2. Breathing Exercises

I think we’ve all felt the catharsis that a deep healing breath can provide when we’re feeling strung out. A productive breathing exercise can help encourage relaxation, reduce muscle tension, and even lower your heart rate and blood pressure.

One of my favorite breathing techniques is the 4–7–8 Technique. Start by making yourself comfortable — it doesn’t matter if you’re sitting, lying down, or even standing. Then, you want to practice breathing according to this pattern:

• Inhale for 4 seconds
• Hold that breath for 7 seconds
• Slowly exhale for 8 seconds

Repeat this as many times as you need. By practicing deep, diaphragmatic breathing you’re increasing your body’s oxygen levels as well as imitating your breathing patterns as you fall asleep.

3. Yoga Nidra

To practice Yoga Nidra, all you need is a comfortable spot to lie down, and a guided meditation activity, which can be found online or in dedicated apps. Begin by lying face-up in your place of choice — this is known as Corpse Pose — and set an intention for that session, such as stress relief, relaxation, etc. Consider your body and notice any tension or sensations you feel. Follow the instruction of the guided meditation, and allow yourself to transition between states of brain wave activity.

4. The Power Down Hour

This is one of my favorites. The Power Down Hour allows you to finish your daily to-do’s and help you get ready for sleep an hour before bedtime. This exercise is done in three 20-minute sessions.

• In the first 20 minutes, take care of any simple unfinished tasks. This can include light housework and pet care.
• In the second 20 minutes, do something relaxing like talking with family members, doing an additional relaxation technique, or journaling. Avoid scrolling on your phone — the blue light on your screen can inhibit your natural melatonin production and make it harder for you to fall asleep.
• In the last 20 minutes, take care of your personal hygiene. Take a warm bath or shower, brush your teeth, et cetera.

5. Guided Imagery

Guided imagery uses your imagination to engage your senses, reduce stress, and promote good sleep. This simple exercise can be done on your own, or with the help of a therapist or a guided imagery practitioner. Using the link provided earlier in this paragraph will take you to a free, downloadable, guided visualization and progressive muscle relaxation that I created for sleep.

6. Progressive Relaxation

Also known as progressive muscle relaxation, this technique allows you to become more familiar with your body and any of the places you0 may be holding onto stress or tension.

Progressive relaxation involves working with your body in different areas and each muscle group, first by tensing the muscles and then relaxing them. Most people start with their feet and work their way up to the top of the head.

What this does is promote an awareness of how these parts of your body feel when they are tense, as well as when they’re relaxed. With this awareness, you’re much better prepared to address that tension or stress and release it. So not only is this an effective exercise for physical stress, but it’s great for the emotional stress that can keep us awake also.

4. Sleep Hygiene

Sleep hygiene is a catchall term for habits and behaviors that influence sleep. Practicing healthy sleep hygiene can help people fall asleep more quickly, remain asleep throughout the night, and feel refreshed in the morning.

• Follow a consistent sleep-wake schedule: Going to bed and waking up at the same time each day can help you establish a healthy routine and sleep better each night. In order for this system to be effective, you should follow the same schedule on the weekends and during vacation periods. Keep in mind that adults should sleep seven to eight hours each night.
• Carefully time your naps: Napping after 3 p.m. can be disruptive to your sleep. Furthermore, nap duration is an important consideration. Napping for more than 30 minutes can lead to deep sleep that creates feelings of confusion and grogginess after waking that may last for hours. Shorter naps, on the other hand, make you feel refreshed without cognitive impairment.
• Exercise daily: Physical activity during the day can help you feel more tired and ready for sleep in the evening. Exercising close to bedtime may cause arousal that makes falling asleep more difficult, so morning to mid-afternoon will probably be the best time.
• Avoid nicotine products: Cigarettes, chewing tobacco, and other tobacco products that contain nicotine can interfere with healthy sleep. Researchers have documented sleep disturbances among active nicotine users, as well as those experiencing withdrawals from tobacco cessation.
• Spend some time in the sunshine: Natural light and darkness guide the circadian rhythms that regulate your sleep cycle. Exposing yourself to sunshine during the day can help keep your circadian cycle properly aligned.

5. Cognitive Therapy

In people with insomnia, inaccurate or dysfunctional thoughts about sleep may lead to behaviors that make sleep more difficult, which then reinforce the dysfunctional thoughts. Trusted SourceTaylor &Francis OnlineView Source.

For example, prior experiences of insomnia may lead to worry about falling asleep. This worry may lead to spending excessive time in bed to try to force sleep. Both worry and excessive time in bed can make falling and staying asleep more challenging. This can become a frustrating, nightly cycle that can be difficult to break.

Cognitive restructuring begins to break this cycle by identifying, challenging, and altering the thoughts and beliefs that contribute to insomnia. Common thoughts and beliefs that may be addressed during treatment include anxiety about past experiences of insomnia, unrealistic expectations of sleep time and quality, and worry about daytime fatigue or other consequences of missed sleep.

Inaccurate thoughts are identified, challenged, and altered with the help of a trained provider who can assist in evaluating them more objectively. Homework is often assigned to allow time to practice these skills between sessions.

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