Cbt For Psychophysiological Insomnia Treatments
CBT-I focuses on exploring the connection between the way we think, the things we do, and how we sleep. During treatment, a trained CBT-I provider helps to identify thoughts, feelings, and behaviors that are contributing to the symptoms of insomnia.
Cbt For Psychophysiological Insomnia Treatments
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 Source Taylor &Francis Online See Full Reference .
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 through 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.
Many people with insomnia begin to dread their bedroom, associating it with wakefulness and frustration. They may also associate their bedroom with habits that make sleeping more difficult, like eating, watching TV, or using a cell phone or computer. Stimulus control attempts to change these associations Trusted Source Annual Reviews Annual Reviews is a nonprofit publisher dedicated to synthesizing and integrating knowledge for the progress of science and the benefit of society. See Full Reference , reclaiming the bedroom as a place for restful sleep.
The American College of Physicians recommends that all adult patients receive CBT-I as a first-line approach Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. See Full Reference . In some patients, CBT-I is more effective than medications . This treatment has also been shown to be effective in groups that are at particularly high risk of experiencing insomnia, such as pregnant people Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. See Full Reference , people with post-traumatic stress disorder (PTSD) Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. See Full Reference , and people experiencing insomnia after cancer treatment Trusted Source Elsevier Elsevier is a publishing company that aims to help researchers and health care professionals advance science and improve health outcomes for the benefit of society. See Full Reference .
If CBT-I alone is not successful in improving the symptoms of insomnia, the American College of Physicians recommends having a discussion with a doctor about the risks and benefits of using sleep medications alongside CBT-I treatment.
Digital CBT-I is effective for treating insomnia in children, adolescents, and adults Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. See Full Reference . Improvement in insomnia symptoms from dCBT-I appear to be similar to face-to-face approaches, although only a few studies have directly compared these different approaches.
Insomnia is a common sleep disorder that can make it hard to fall asleep, hard to stay asleep, or cause you to wake up too early and not be able to get back to sleep. Cognitive behavioral therapy for insomnia, sometimes called CBT-I, is an effective treatment for chronic sleep problems and is usually recommended as the first line of treatment.
Cognitive behavioral therapy for insomnia is a structured program that helps you identify and replace thoughts and behaviors that cause or worsen sleep problems with habits that promote sound sleep. Unlike sleeping pills, CBT-I helps you overcome the underlying causes of your sleep problems.
Cognitive behavioral therapy for insomnia may be a good treatment choice if you have long-term sleep problems, you're worried about becoming dependent on sleep medications, or if medications aren't effective or cause bothersome side effects.
Insomnia is linked to a number of physical and mental health disorders. Ongoing lack of sleep increases your risk of health conditions such as high blood pressure, heart disease, diabetes and chronic pain. Some medications, including over-the-counter medications, also can contribute to insomnia.
If available in your area, meet with a sleep medicine specialist in person for your sessions. However, phone consultation, CDs, books or websites on CBT techniques and insomnia also may be beneficial.
Cognitive behavioral therapy for insomnia can benefit nearly anyone with sleep problems. CBT-I can help people who have primary insomnia as well as people with physical problems, such as chronic pain, or mental health disorders, such as depression and anxiety. What's more, the effects seem to last. And there is no evidence that CBT-I has negative side effects.
A person that struggles with psychophysiological insomnia will have a tendency to worry about their sleep and how a lack of sleep will affect their day. Over time this becomes a vicious cycle, causing a heightened state of arousal which continues to cause difficulty initiating and maintaining sleep. In other words, worrying about sleep interferes with their sleep. Each sleepless night only makes the situation worse.
Primary insomnia might not be linked to physical disease or medication, but various factors still influence the onset. Many of these factors have a psychophysiological origin and are rooted in anxiety about the consequences of sleeplessness. In other words, fear of not being able to sleep frequently perpetuates primary insomnia.
The first step to overcoming psychophysiological insomnia is to understand it. When people with psychophysiological insomnia go to bed and attempt to sleep, they experience something akin to performance anxiety; the same performance anxiety people get when they walk onto a floodlit stage or have their first job interview. Okay, maybe not that bad, but close.
Because primary insomniacs often spend a great deal of the day worrying about the consequences of not getting sleep, they get stage fright when the time comes. The brain and body assume that bedtime is "showtime," and the pressure to perform activates the arousal system. The brain interprets the bed or bedtime as a threat and puts the body on high alert instead of letting it slip into forgetfulness.
Fortunately, psychophysiological insomnia is curable. Cognitive-behavioral therapy (CBT) is an effective treatment for psychophysiological insomnia. Initially developed to treat depression, CBT has been adapted to help people change habits and thinking patterns related to sleep, which is the driving force of psychophysiological insomnia.
For years, CBT for insomnia (CBT-i) has been the gold standard for treating insomnia and has been proven to work in numerous clinical trials. It empowers people to identify and change unhelpful thinking and habits. It reframes their perception of sleep, reduces the time they spend fretting about sleep, interrupts the iterative sleep obsession sequence, and gradually breaks the insomnia cycle.
There is now an overwhelming preponderance of evidence that cognitive behavioural therapy for insomnia (CBT-I) is effective, as effective as sedative hypnotics during acute treatment (4-8 weeks), and is more effective in long term (following treatment). Although the efficacy of CBT-I in the treatment of chronic insomnia is well known, however there is little objective data on the effects of CBT-I on sleep architecture and sleep EEG power densities. The present study evaluated, first, subjective change in sleep quality and quantity, and secondly the modifications occurring in polysomnography and EEG power densities during sleep after 8 weeks of CBT-I. Nine free drug patients with psychophysiological insomnia, aged 33-62 years (mean age 47 +/- 9.7 years), seven female and two male participated in the study. Self-report questionnaires were administered 1 week before and 1 week after CBT-I, a sleep diary was completed each day 1 week before CBT-I, during CBT-I and 1 week after CBT-I. Subjects underwent two consecutive polysomnographic nights before and after CBT-I. Spectral analysis was performed the second night following 16 h of controlled wakefulness. After CBT-I, only scales assessing insomnia were significantly decreased, stages 2, REM sleep and SWS durations were significantly increased. Slow wave activity (SWA) was increased and the SWA decay shortened, beta and sigma activity were reduced. In conclusion CBT-I improves both subjective and objective sleep quality of sleep. CBT-I may enhance sleep pressure and improve homeostatic sleep regulation.
Psychophysiological insomnia (PI) includes arousal to sleep-related stimuli (SS), which can be treated by cognitive behavioral therapy for insomnia (CBT-I). The present study was an exploratory, prospective intervention study that aimed to explore brain response to visual SS in PI before and after CBT-I. Blood oxygen level dependent (BOLD) signal differences in response to SS and neutral stimuli (NS) were compared between 14 drug-free PI patients and 18 good sleepers (GS) using functional magnetic resonance imaging (fMRI). BOLD changes after CBT-I in patients were also examined. PI patients showed higher BOLD activation to SS in the precentral, prefrontal, fusiform, and posterior cingulate cortices before CBT-I. The increased responses to SS were reduced after CBT-I. The increased response to SS in the precentral cortex was associated with longer wake time after sleep onset (WASO), and its reduction after CBT-I was associated with improvements in WASO. Clinical improvements after CBT-I were correlated with BOLD reduction in the right insula and left paracentral cortex in response to SS. PI showed hyper-responses to SS in the precentral cortex, prefrontal cortex, and default mode network and these brain hyper-responses were normalized after CBT-I. CBT-I may exert its treatment effects on PI by reducing hyper-responses to SS in the precentral cortex and insula.