Cognitive behaviour therapy for insomnia (CBT-I) is the most widely used and effective psychological treatment for insomnia.7,13-16 CBT-I is made up of a number of different techniques, which are described below.
Learning that your bed is for sleep
People with sleep difficulties sometimes use their time awake in bed for activities other than sleep, such as reading, watching TV, and using electronic media (e.g. e-readers and smartphones), which can stimulate the brain and make it harder to fall asleep. Using bedtime for these other activities can also reduce the connection the brain makes between bed and sleep.
In ‘stimulus control therapy’ therefore, clients are encouraged to use their bed for sleep only (sex being the exception), rather than for other activities that stimulate the brain and interfere with sleep.
People with sleep difficulties also often lie awake in bed and then sleep in, preventing them from developing a good sleep routine.
In ‘sleep restriction therapy’, a strict bedtime and wake-time routine is set up to minimise the amount of time spent in bed awake. For example, if a person usually spends 8 hours in bed but only sleeps for six of those hours, they would be set a schedule of going to bed for 6 hours only and waking at a set time, even if they wanted to sleep in. Gradually, as sleep improves, the time spent in bed is also increased.
Practicing helpful ways of thinking
Worrying about sleep and fretting about not sleeping, can make getting to sleep even harder. Cognitive therapy helps the person identify these unhelpful thoughts, and to find more helpful ways of understanding sleep and cope with sleep-related stress.21
Learning relaxation skills
Relaxation skills training involves teaching the person a variety of techniques that help calm the mind and body. Techniques such as progressive muscle relaxation, breathing exercises, and guided imagery (focusing the mind on positive, soothing images), are used to reduce mental activity such as worry that interferes with sleep.22
Practicing sleep hygiene
Sleep hygiene refers to a set of behaviours or habits that can increase the length and quality of sleep.23
Good sleep hygiene practices include making changes to your bedroom to make it a more comfortable space to sleep in, decreasing activities before bedtime that can interfere with sleep (such as using electronic devices), and improving a range of lifestyle factors that support sleep (such as making changes to diet and exercise). Details of good sleep hygiene practices are included in the tips below.