Treating Insomnia With CBT


Many Americans struggle with sleep problems. The current clinical mind-set, among sleep specialists, is that about a third of the population has insomnia at any given time, with 10 percent of that being chronic.

It is amazing how many people have issues with sleep. I was excited to work with Tia and Dr. Oz on today’s show to teach everyone what CBT is and how it can be so very helpful. Despite its status as the most common sleep disorder among adults in the U.S., many people who suffer from insomnia aren’t receiving treatment. Treatment for insomnia isn’t always—or even often—made accessible and affordable by insurers and health-care organizations, or addressed actively by physicians.

Many people with symptoms of insomnia—whether they recognize them as such or not—take a go-it-alone approach to managing their sleep problems. They attempt to treat their sleep issues themselves, relying on over-the-counter sleep aids and supplements, or using alcohol—mistakenly—as a sleep aid.

The consequences of insomnia to health, safety, performance, and quality of life are enormous. There is an abundance of research that demonstrates the therapeutic effectiveness of treatments for insomnia in alleviating symptoms, improving health, and boosting quality of life.

Recently the American College of Physicians made the recommendation that the initial treatment for insomnia was to be cognitive behavioral therapy for insomnia (what Tia and I did) and not medication!

Cognitive behavioral therapy has been around as a treatment for anxiety and depression for many years. However, it has recently been adapted for use in this population with remarkable results. In many cases, I have personally seen CBT for insomnia be more effective than medication and certainly longer lasting. The basics are a structured therapy that:

  • Teaches a person how to alter behaviors that worsen insomnia, such as:
    • Learning about what the appropriate bedtime should be.
    • Learning about how outside influences can affect sleep (light, sound, what you eat or drink, family, etc.).
    • Learning how to keep a sleep diary, to collect data on their sleep.
  • Teaches new ways to think about and promote sleep, which includes:
    • Learning what the myths about sleep are.
    • How your thinking influence sleep patterns.
    • How you can replace bad thoughts with more accurate good ones about sleep.

So why aren’t most people going to see a behavioral sleep specialist? There simply are not enough of us to go around. While there is some specialized training involved, there are just not enough people well trained for this type of work. Also, most physicians do not know that there is such a person as a behavioral sleep specialist, and trust me if they did, they would gladly send over the patients. In my experience, most doctors have few resources for insomnia other than a prescription pad, and some simple sleep hygiene recommendations.

To start, here are some of the basic steps I ask my patients to do, before we get to formal CBT, which have been quite helpful. Feel free to try them out. Or learn more about the program I did with Tia.

Step 1: Make lifestyle changes to improve sleep.

  • Try not to worry about sleep when you go to bed. Distract yourself with reading, prayer, meditation etc.
  • Avoid clock-watching. Turn your clock around and use only the alarm. In many cases, moving it across the room can be helpful.
  • Make your bedroom comfortable for sleep. Keep it dark, quiet, and not too cold or warm. Use a sleeping mask to block light or earplugs or a fan to block noise.
  • Relax before bedtime by reading, listening to relaxing music, bathing, or doing another relaxing activity.
  • Don’t eat a heavy meal late in the day; a light snack before bedtime may help with sleep, though.

Step 2: Keep a sleep diary and contact a sleep specialist.

If lifestyle changes are not working and you still have sleep problems, start a sleep diary. I ask clients to write down the following in a journal and we review them looking for patterns:

  • The time you went to bed.
  • The approximate time you fell asleep.
  • The time you woke up.
  • The number of times you woke up during the night.
  • The amount of time you stayed awake during the night.
  • If you used any medication.
  • Any grogginess upon waking in the morning or during the day.
  • Naps and duration.

As you saw on the show, we evaluated several different Internet-based courses for CBTi, as well as the face-to-face work I did with Tia. The Internet-based programs seen on the show include:

SLEEPIO $300.00


SHUTI  $135.00

I hope that by watching the show and learning more about CBTi and the many different approaches, you can identify if you or a loved one might benefit from CBTi and can find the right program for you!