Whenever most people have serious trouble sleeping, they automatically reach for a sleeping aid, whether that’s a prescription or over-the-counter medication or a natural remedy.
But these solutions, as psychologist and sleep specialist Stephanie Silberman, Ph.D, explained, are anything but.
In fact, the preferred solution — the one that research also supports — is a treatment that many people, even medical professionals, are unaware of.
Research has shown that cognitive-behavioral therapy (CBT) is highly effective for insomnia. (Effective results have been shown in a recent meta-analysis and article review.)
Below, Dr. Silberman, author of The Insomnia Workbook: A Comprehensive Guide to Getting the Sleep You Need, offers insight into insomnia and its treatment and shares several strategies readers can try at home.
What is Normal Sleep?
Before thinking about disturbed sleep, it’s important to understand what normal sleep really is. Normal slumber involves falling asleep relatively easily once you’re in bed, Silberman said. “People have a range of how quickly they go to sleep,” she said, but typically they can drift off to sleep anywhere from a few minutes to 15 minutes.
Normal sleepers will also go through four stages of sleep several times a night, she said. According to The Insomnia Workbook, the stages are:
- Stage N1: the lightest stage, which usually makes up 10 percent of your total sleep time.
- Stage N2: unlike stage N1, you lose awareness of external stimuli, and people spend most of their sleep time in this stage.
- Stage N3: known as slow-wave sleep, and believed to be the most restorative.
- Stage R: known as REM sleep, or rapid eye movement. It’s the most active of the stages for your brain and body functions, such as breathing and heart rate. Your muscles relax, however, so you don’t act out your dreams.It’s also normal for it to take about 20 to 30 minutes to feel truly awake in the morning.
What Is Insomnia?
“Most people with insomnia have difficulty either falling asleep, known as sleep onset insomnia, or staying asleep, known as sleep maintenance insomnia,” Silberman writes in her book, which provides readers with information on insomnia and strategies to treat it and sleep better.
People with insomnia also might feel moody or fatigued during the day. (Here’s more on insomnia.) The most common type of insomnia is conditioned or learned insomnia. Initially, a person starts sleeping poorly because of a stressor, Silberman writes. Then the insufficient sleep almost becomes routine because you continue to ruminate about your sleeping problems, leading to increased arousal before bed. This then becomes “a conditioned physiological response that contributes to difficulties falling asleep.”
There also are many myths that can undermine your sleep and insomnia treatment. One of the biggest, Silberman reiterated, is the idea that sleeping pills are an effective remedy that improves your sleep. In fact, research has found that CBT is more effective than pharmacological interventions.
Specifically, sleeping pills actually make you feel groggy and sleepy during the day, they cause dependency and disrupt and change sleep architecture. (Sleep architecture refers to the structure of your sleep and the “cycling in and out of the different stages of sleep during the night,” Silberman writes in her book.)
For instance, benzodiazepines are commonly prescribed for sleep but they actually “suppress the slow-wave sleep,” she said. The problem? Recall that slow-wave sleep is essential to a good, restorative sleep. Plus, as she noted, we don’t know the long-term consequences of disrupted slow-wave sleep.
Nonbenzodiazepines, a class of sedative-hypnotic drugs, such as Lunesta and Ambien, “affect other areas of sleep,” such as respiration, Silberman said. They have potentially serious side effects and also can lead to psychological and physiological dependence.
Some sedative hypnotics can cause rebound insomnia after they’re discontinued. Naturally, many people get discouraged, thinking they can’t sleep without the sleeping aid. But, as Silberman said, “this is par for the course,” because you’re taking away a medication that caused changes to your body.
Herbal and “natural” remedies, such as melatonin, valerian root and kava, are not any better. In fact, they aren’t regulated by the Food and Drug Administration, so they’re not tested for effectiveness or safety. In her book, Silberman discusses the disturbing results of one consumer agency study that tested valerian products. It found that some products didn’t contain measurable amounts of the ingredient, others contained half of the amount stated on the bottle and one bottle even contained a poisonous metal!
Also, people erroneously believe that “there is no rhyme or reason to their sleep,” Silberman said. Similar to that, they believe they have little control over their sleep. (This might be another reason why people turn to sleeping pills.) But in reality, there are targeted and well-tested techniques you can do to have a good night’s sleep. Also, once you observe your sleeping, you’ll be able to pick up on patterns that affect your sleep, so it’s not so random after all.
Another misconception is that spending more time in bed will increase your chances of sleeping longer. To the contrary, this can actually sabotage your sleep and create a negative association with your bed. As Silberman said, “the more time a person spends in bed, the more they reinforce the idea that the bed is not a sleep-promoting place.”
How CBT for Insomnia Works
What does CBT for insomnia look like? When a client first sees Silberman, they work on uncovering the client’s current sleep pattern and the factors that are negatively affecting their sleep. They accomplish this by completing sleep logs, for instance.
They talk about a variety of potential issues, such as: “What’s causing them to have these problems at night? Are they tossing and turning because they can’t turn off their brain at night or is it some kind of pain or an environmental stimulus, such as a baby waking you up?” Is smoking one of the culprits? (Smoking is a stimulant, so smoking right before bed can make it tougher to fall asleep.) They ponder whether physiological factors are to blame. For instance, a medication you’re taking might be causing poor sleep.
When treating insomnia, in addition to sleep logs, other techniques include sleep restriction (described later) and reducing any anxious or worrisome thoughts the person may be having around sleep or their life in general.
Sleeping Strategies To Try
Silberman shared the following strategies you can try on your own to improve your sleep.
1. Observe your sleep.
Gathering data is key when trying to treat insomnia or any kind of sleep trouble, Silberman said. In her book, she provides readers with several worksheets to log in your sleep. This is essential because it helps you figure out what habits are hindering your sleep (such as a stressful event, caffeine intake, daytime napping or TV watching) and how long you’re actually sleeping.
In fact, Silberman said that many different things can affect your sleep. At first, sleep or lack thereof seems random. But once you commit your habits to paper, you might notice that the three glasses of wine or two cups of coffee you had led to your sleeping poorly. Maybe another day, you ate a super-spicy meal for dinner, leading to heartburn and little sleep.
When observing your sleep, it’s helpful to consider: what time you went to bed, how long it took you to fall asleep, how often you woke up during the night, what time you finally got up and how many hours you slept. Recording this information each morning for a week helps you spot patterns.
2. Restrict your time in bed.
Sleep studies have shown that sleep restriction is effective for treating insomnia. This is why collecting your sleep data is so important. It gives you a good idea of how long you’re actually sleeping, because you want to be in bed for that number of hours. Lying awake in bed only “increases frustration, anxiety and annoyance with the process,” Silberman said.
“By restricting the amount of time to bed,” she said, you “will start getting more solid sleep.” How do you calculate the time you spend in bed? Just add up the time you’ve actually spent sleeping each night for a week; and divide by seven to get an average time.
Then about 30 minutes to an hour before bedtime, establish a routine that primes your body for relaxation. For instance, you might listen to soothing music, take a warm bath or read a book.
3. Practice good sleep hygiene and habits.
While good sleep hygiene won’t dramatically change your insomnia, it does help you optimize your sleep, Silberman said. Some examples are limiting caffeine and alcohol intake, making your room cool and dark and exercising four or five hours before bedtime.
Other helpful habits include engaging in relaxation techniques and working through any worry thoughts. “In particular it’s important to practice [relaxation techniques] when you’re not anxious or stressed out, so they work better when you need them.”
One way to reduce anxious thoughts is by asking yourself “what’s the evidence for and against these thoughts I’m having,” Silberman said. Not surprisingly, there’s usually “very little evidence for the irrational thought.” Then, you “can come up with an alternative thought or new explanation.”
Again, remember that you do have control over your sleep. Studies have repeatedly shown that CBT is a highly effective treatment for insomnia.
Source: PsychCentral. The First Line Treatment for Insomnia That'll Surprise You. http://www.cnn.com/2015/04/01/business/sleep-and-leadership/index.html