Jeanne Bellezzo by Jeanne Bellezzo
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For some people, the challenge is falling asleep. For others, falling asleep is easy, but staying asleep throughout the night is not. Both are symptoms of insomnia, a commonly reported sleep problem that affects about 30% of adults in America.

Being unable to sleep is not only frustrating, it can have significant health consequences. Poor sleep has been linked to headaches, heart disease, obesity, diabetes, dementia and more. Safety is another issue: Driving while drowsy can be similar to driving under the influence of alcohol and is a leading cause of accidents.

While sleep aids available over the counter or by prescription can help, they often have unwanted side effects including morning grogginess and difficulty concentrating the next day. Even some prescription medications, while intended for short-term use, can become habit-forming. 

Learn to Sleep Better

Cognitive behavioral therapy for insomnia, or CBT-I, can help you teach your body to sleep better without medication. CBT-I involves evaluating how you think about sleep (the cognitive part) and how you act (the behavioral part). Negative thoughts about sleep can make the problem worse; for example, if you lie awake in bed worried that you will never get back to sleep, or you spend the day dreading yet another sleepless night, you’re even less likely to sleep well. The behavioral aspect focuses on changing bad sleep habits and developing positive ones that support healthy sleep. Many CBT-I therapists are psychologists or behavioral health specialists certified in Behavioral Sleep Medicine (BSM), but certification is not required.

Often, the first step in CBT-I is keeping a “sleep diary” that details how well (or poorly) you sleep every day, including what you do before bed, what time you go to bed and wake up, how you feel and other information that may be helpful in identifying detrimental thoughts or behaviors. After a week or two of tracking, your therapist will review your results with you and identify areas that need attention.

Sleep 101

Depending on your specific cognitive and behavioral issues, your CBT-I will recommend at least one of the following techniques; many people combine several techniques for better results.

Relaxation training helps you learn to turn off the “noise” in your head and prepare your mind and body for rest. Popular activities include using a guided relaxation or meditation app, listening to soothing music, taking a bath and deep breathing. The best techniques are the ones that work for you, so experiment until you find your favorites. Also, avoid potentially stressful activities close to bedtime, such as watching the news or checking work emails.

Stimulus control therapy teaches you to take control of factors that serve as positive or negative cues for sleep. One of the most common recommendations is to use your bed only for sleep and sex. Avoid watching television, surfing the Internet or doing other non-sleep activities in bed or even in the bedroom. Establish a “bedtime routine” such as reading a book, meditating or other activity that tells your body to prepare for sleep. Try to go to bed and wake up at about the same times every day. If you’re in bed and can’t sleep, get up and go into another room until you are sleepy again. This helps you avoid associating the bed with being unable to sleep. 

Sleep hygiene therapy concerns your lifestyle habits and how they may affect sleep. For example, drinking caffeine after noon, exercising too close to bedtime, drinking alcohol and working up until bedtime can all interfere with falling or staying asleep. Blue light emitted by devices such as laptops, tablets and phones can suppress melatonin, which is the hormone that helps you fall and stay asleep. Avoid using your devices for an hour or so before bed or use the blue light filter or “night” setting if available.  

Sleep environment improvement involves creating a sleep-friendly setting. Common recommendations include keeping your bedroom cool and dark, blocking out noise (wear earplugs if necessary), charging your phone in another room and placing the clock out of view.

Paradoxical intention for insomnia is trying to stay awake rather than trying to go to sleep. When you stop worrying about being able to sleep, you may actually be able to relax and find sleep comes easier—so try not to stress about it.

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