CBT
Tuesday, March 4th, 2008
The idea behind behavioral modification is that insomnia has been precipitated by a stressful event or events, and has then settled in, like a had habit. Like Pavlov’s dogs, conditioned to salivate at the sound of a bell they’ve learned to associate with food, insomniacs have developed wake-up associations with sleep and bed. “When the stressors fade away,” writes Charles Morin, leading proponent of behavioral modification and the author of Relief from Insomnia, some people “may have developed negative reactions to stimuli normally conducive to sleep (e.g., bed, bedtime, bedroom). What used to be a place and time for relaxation and sleep is now associated with frustration, anxiety, and sleeplessness… Over time, a conditioning process leads to a vicious cycle of insomnia.”
Behavioral modification is a group of therapies aimed at reconditioning us. Stimulus control therapy aims at getting the insomniac to associate the bed with sleep. Go to bed only when sleepy, use the bed only for sleep and sex, avoid naps and so-called sleep-incompatible behaviors, such as reading, watching TV, eating, talking, in the bedroom. Sleep restriction therapy requires that you restrict time in bed to the time you spend asleep. If you think that you get five hours sleep, you should go to bed at your usual time and set the alarm for five hours later. When you wake up before the alarm, make yourself get out of bed –some say after 10 minutes, some say 20, some give a “quarter of an hour rule.” Then go to another room and watch TV or read. When you begin to feel sleepy, go back to bed but if you don’t fall asleep in 10-20 minutes, repeat the process, getting out of bed and going to another room again. However little sleep you’ve had, get up to that alarm without fail, seven days a week. The idea is that by restricting time in bed to the time you actually sleep, you create what Morin calls “mild sleep deprivation, which results in more consolidated and more efficient sleep.” When you find yourself sleeping 90% of the time you spend in bed (i.e., attain 90% sleep efficiency) and sustain this for five consecutive days, you may extend your time in bed by 15 minutes. But if your sleep efficiency drops below 85%, reduce your time in bed to match your average sleep length for the past five days, but do not reduce it to less than five hours….
Taken together, cognitive restructuring, stimulus control, and sleep restriction are called cognitive behavioral therapy (CBT). Sleep hygiene is also important: sleep in a dark, quiet place, cut out caffeine, alcohol, big meals or stimulating activity late in the day, don’t exercise too close to bedtime.
Sleepnet.com tells stories of people who’ve used these methods to teach themselves to sleep again: it’s given me my life back. People who post here recommend readings that have helped them: Gregg Jacob’s Say Goodnight to Insomnia, Peter Hauri’s No More Sleepless Nights, Charles Morin’s Relief from Insomnia, and primarily John Wiedman’s Desperately Seeking Snoozin, which many insomniacs find inspirational because it’s written by someone they identify with, a “recovering” insomniac, as he calls himself, a man who has reformed his sleep by rigorously, religiously, adhering to what he and others call “the program.”
And yet, as Charles Morin acknowledges, “not many people are using CBT, it looks like.”
Sleep restriction is a crucial part of re-conditioning our sleep. Some people find this very effective, as a way of teaching themselves to sleep again. But some do not.
Your experiences with these methods?
“When you can’t sleep, get out of bed and do something else.” This also is crucial to behavioral modification. Does it work for you? Do you ever find that staying in bed is restorative?
**Some say that CBT hasn’t caught on because people don’t know about it and because the pharmaceutical industry is too powerful.
“It is in many people’s interest for us not to know about CBT as a treatment for insomnia. Because upon our anxieties, our insecurities and our feelings of inadequacy, a multi-billion-pound [dollar] industry is built.”
Laura Barton and Charlie Brooker, “Pillows, Pills, and Potions, Guardian Unlimited, UK, Guardian.Co, Feb. 5, 2008
http://www.guardian.co.uk/society/2008/feb/05/health1