WHAT IS IT?
Cognitive behavioral therapy for insomnia (CBTI) is a type of therapy for sleep problems.
CBTI can help you identify thoughts and behaviors that are causing sleep problems and replace them with better habits. CBTI helps you figure out if your sleep environment is good. It covers strategies for stress reduction and relaxation. Your therapist will have you keep a sleep diary, to check your habits and schedule. CBTI also involves a stretch of nights with less sleep, to reset your body’s rhythms.
It is offered in group or individual sessions, on the phone, online, and through paid apps. The number of sessions varies.
Working with a therapist will likely be more successful than using a CBTI app. People are more likely to follow the whole program if they have to report to a therapist. The sleep deprivation portion of the therapy is very important and can be hard to stick to without a therapist.
OUR BOTTOM LINE: DOES IT HELP?
YES. There is strong evidence that cognitive behavioral therapy for insomnia works for sleep problem. And, unlike sleep medications, it has no risks. It is as effective or even more effective that sleep medicines in the short term, and works better in the long term. The effect of sleep medicines goes away when they are stopped. While CBTI continues to work because it addresses the underlying causes of sleep problems. The effect lasts for at least a year after therapy.
SLEEP PROBLEMS & INSOMNIA
CBTI decreases overall sleep problems in women with menopause symptoms – and it keeps on working after the therapy is done. In one study of a telephone-based program, 70% of women had no clinically significant insomnia at the end of the study compared to only 24% of women in the control group.
MOOD, ANXIETY & DEPRESSION
While not studied specifically in menopausal women, CBTI does improve anxiety and depression in those with sleep problems.
HOT FLASHES AND NIGHT SWEATS
CBTI does not decrease the number or severity of hot flashes or night sweats. However, CBTI does decrease how much hot flashes interfere with women’s’ daily lives.
POTENTIAL RISKS & SIDE EFFECTS
There are no risks with CBTI.
QUALITY OF LIFE EXPECTATIONS
In addition to helping with sleep, CBTI improves overall menopause related quality of life, including areas of vasomotor symptoms, sexual functions, and psychosocial symptoms.
IF I WANT TO TRY THIS TREATMENT WHAT ARE MY NEXT STEPS?
Look online for CBTI therapists in your area. Some geographic areas or insurance providers publish a directory of providers. You can look for a certified sleep center on the American Academy of Sleep Medicine website. Check to see what is covered by your insurance.
As a first step, you can make sure that your “sleep hygiene” (sleep environment) is good. Here are suggestions from the American Association of Sleep Medicine:
- Keep a regular sleep schedule. Get up at the same time every day, even on weekends or during vacations.
- Set a bedtime that is early enough for you to get at least 7 hours of sleep.
- Don’t go to bed unless you are sleepy.
- If you don’t fall asleep after 20 minutes, get out of bed.
- Establish a relaxing bedtime routine.
- Use your bed only for sleep and sex.
- Make your bedroom quiet and relaxing. Keep the room at a comfortable, cool temperature.
- Limit exposure to bright light in the evenings.
- Turn off electronic devices at least 30 minutes before bedtime.
- Don’t eat a large meal before bedtime. If you are hungry at night, eat a light, healthy snack.
- Exercise regularly and maintain a healthy diet.
- Avoid consuming caffeine in the late afternoon or evening.
- Avoid consuming alcohol before bedtime.
- Reduce your fluid intake before bedtime.
- You may want to use this insomnia screening tool to help you decide if you need to talk with a doctor or therapist about sleep problems.
- You can use this National Sleep Foundation Sleep Diary to track your sleep and see what helps you sleep and what can be improved
Insomnia is a major public health problem. It is highly prevalent and can have a profound impact on daily life. Cognitive behavioral treatment for insomnia (CBTI) is the preferred treatment. A recent meta-analysis found that CBTI had significant effects on: insomnia severity index, sleep efficiency, Pittsburgh sleep quality index, wake after sleep onset and sleep onset latency, number of awakenings, and sleep quality. Face-to-face treatments of at least four sessions seem to be more effective than self-help interventions or face-to-face interventions with fewer sessions. Results are the same for patients with or without comorbid disease, younger or older patients, and those using or not using sleep medication.
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Last reviewed July, 2021