Could Cognitive Behavioural Therapy be the secret to helping insomniacs get to sleep faster & stay snoozing for longer?
Most of us know what it’s like to have difficulty sleeping, but one in three of us – including myself – have insomnia.*
The NHS defines insomnia as regular sleeping problems, including finding it hard to go to sleep, waking throughout the night or waking up too early. According to mental health charity Mind, insomnia can also be linked to depression and difficulties in coping with daily life.
A few years ago, I suddenly started waking during the night for up to three hours at a time. I tried ear plugs, eye masks, milky drinks, playing wave sounds, brandy and lavender pillows to no avail. My periods of bad sleep came in waves of a few weeks, improving for a while but always coming back.
During an acute phase I could be snappy and bad-tempered with loved ones – it was an emotional rollercoaster. So I was intrigued when I heard that a new study from Canada’s Queen’s University has found cognitive behavioural therapy (CBT) can help insomniacs get to sleep faster and stay snoozing for longer.
The majority of participants fell asleep between nine to 30 minutes more quickly after having between four to six sessions of CBT with a therapist, compared to up to four minutes for those who didn’t have it. CBT works on the premise that the way we think about situations can affect the way we feel and behave.
CBT for insomnia is readily available from private therapists, but provision on the NHS is patchy. And although sleeping pills can sometimes provide a temporary fix, they aren’t a long-term option because of side effects (such as daytime grogginess) and the fact your body builds up a resistance to the drug.
Ideally, we’d all do CBT with a trained therapist – some forms of it, for example for people with OCD, aren’t suitable to try on your own. But for a specific issue like insomnia, many people access CBT through groups, books and apps.
I decide to give automated CBT a go using Sleepio. It been rigorously tested in clinical trials and evaluated by the National Institute for Clinical Excellence (NICE).
It’s currently only available to NHS patients in some areas of the South East, with the intention of rolling it out across the country soon. So could 20-minute online sessions once a week for six weeks really nip my insomnia in the bud?
Week 1
In the first session, I learn that CBT can help overcome the negative emotions that accompany insomnia. Worrying about not getting to sleep can make us feel anxious, which creates a cycle.
The Prof – a Scottish cartoon character who narrates the Sleepio sessions – explains the aim is to improve sleep efficiency, which is the amount of time spent asleep divided by the amount of time spent in bed.
Mine was 72% as I spent eight hours in bed but slept for under six.I judge my “sleep quality” two out of 10. The program asks you to fill in a daily sleep diary, alongside a sleep quality box in which you grade your sleep, to establish a weekly score.
I learn how to check my bedroom has adequate air and the most comfortable mattress and pillows for me.
Your room must be used only for sleep, so reading, listening to music or talking on the phone can’t happen in bed (sex is an exception).
Week 2
My book and phone usually sit on my bedside table, but this week I leave them in the living room.
Coffee or vigorous exercise in the evenings are forbidden, and I’m told to avoid alcohol for at least four hours before going to bed – while it can help you fall asleep, it also tends to wake you up.
I like a brisk walk at 8pm, so I move that to 6pm instead. The Prof also recommends tensing and relaxing different muscle groups and taking deep, slow breaths in bed.
I’m urged to ditch my ear plugs to acclimatise to noise rather than blocking it out, but I find night road traffic too disturbing, so I keep the ear plugs in. Eye masks are OK for those troubled by light.
Week 3
I now judge my sleep quality to be three, while sleep efficiency is 77%. I’m waking up less and dropping back off quicker. I’m taught that if I wake for more than 15 minutes, I have to get up.
The Prof encourages users to have a “wake-up plan” for this, so I leave a soft lamp, a blanket and a book in the living room.
This helps to build the relationship between bed and sleep, and to break the connection between bed and tossing and turning.
The course also introduces “sleep restriction” – narrowing the window in which we attempt to sleep. If you tend to get around 6.5 hours, stay awake until midnight and rise at 6.30am.
Week 4
Following the 15-minute rule, I get up twice in the night this week. I’m tired, but it feels good to stop trying to sleep and read instead.
When I feel ready to go back to bed, dropping off is easier and I feel under less pressure. I also practise sleep restriction for three nights. My sleep efficiency is now 79%.
The course encourages you to create a vivid mental moving image you can conjure to help you relax in bed – I go for a babbling brook with the wind rustling the trees.
I’m also taught to repeat a meaningless word such as “the” to block unwelcome thoughts by thinking of them like a train that I allow to speed through my mind and come out the other side. Practising these visualisations helps.
Week 5
My sleep efficiency is now 82%. Quality is five out of 10 and I’m feeling more alert, energetic and focused during the day.
The Prof teaches me to “de-catastrophise” my fears around not sleeping.
When I start to panic because I can’t nod off, my mind races with thoughts such as: “I’ll be rubbish at work tomorrow if I don’t sleep now”.
I think about the last time I had a bad night’s sleep and how well I actually coped the next day.
Week 6
My sleep efficiency is 85%, just 5% away from the “healthy” goal of 90%. I feel so different. My mood is better, I feel mentally lighter and more equipped to tackle difficulties.
The benefits are making a big difference to my life – and my partner’s when he stays over. I may even be able to ditch the ear plugs and sleep through his snoring one day.
MOST READ IN FABULOUS
The Sleepio course was great for me because my insomnia isn’t rooted in emotional issues.
However, if yours is, it may not be appropriate for you and you should seek a face-to-face appointment with a therapist if needed.
Now, when I wake in the night, I don’t feel pressure to get back to sleep, which means I’m more likely to drop off. I just wish I’d done it sooner.
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