Cognitive Behavioral Therapy for Insomnia
before. After keeping a sleep diary , Dr. Posner explained that Christine needed to stop taking naps and going to bed so early. This is called Sleep Restriction Therapy , and it is one of the primary components of CBT-I. Christine was used to going to bed early but Dr. Posner told her not to go to sleep until midnight. Without the mid-day naps and early bedtimes, she had a hard time staying up so late. She explained, "It was the hardest six weeks of my life." Dr. Michael Perlis, Associate Professor of Psychiatry and Psychology at the University of Rochester agreed, "It is true that during this phase of therapy you may feel worse than usual during the day. After a few days of being very sleepy at bedtime, you should find it easy to fall asleep, and that is our goal."
Over time, if Christine reported a good week of sleep in her diary, Dr. Posner would slowly allow her to go to bed earlier and earlier. Christine explained, "I could have lied to him about my sleep improvements if I wanted – but I knew it wouldn't make me better."
Another aspect of CBT-I is called Stimulus Control Instructions . Stimulus Control Instructions are created by looking at the patient’s sleep habits and pinpointing different actions that may be prohibiting sleep. Dr. Posner instructed Christine not to spend time in her bedroom when she wasn't sleeping, leave the bedroom when she wasn't able to sleep and not to return until she was ready to sleep.
CBT-I includes Sleep Hygiene Education , a customized list of things you should and should not do, in order to sleep. It often includes sleeping in a cool, dark room and avoiding caffeine, alcohol and tobacco before bedtime. Dr. Perlis explained, "Sleep hygiene education is most helpful when tailored to an analysis of the patient's sleep/wake behaviors. The tailoring process allows the clinician to:
1. Demonstrate the extent to which they comprehend the patient's individual circumstances (by knowing which items do and do not apply)
2. Critically review the rules,