In essence, insomnia refers to the inability to get enough quality sleep effectively. We can compare insomnia to fever, a common disease in our daily lives, and we may get cold for many reasons. Insomnia is also a symptom caused by many factors. When we go to the hospital with a fever, the doctor will not just prescribe an aspirin prescription; in the same way, insomnia cannot only be treated with sleeping pills.
For the treatment of insomnia, in addition to drug treatment, the most effective and long-term method is to change the behavior and cognition that cause insomnia. This method is called cognitive-behavioral therapy (CBT). The purpose of CBT treatment is to help the insomniac get adequate sleep by changing the bad habits of the insomniac that affect sleep.
Cognitive behavior therapy to treat insomnia includes the following methods.
Stimulus control
simulation control is used to help patients with psychophysiological insomnia.
These patients will find that when they feel sleepy near the time of sleep, once they enter the sleep environment, they immediately become awake and cannot fall asleep. This reflective connection between the inability to fall asleep and the sleeping environment may need to be interrupted by instructing patients to avoid “struggling to fall asleep.”
The following process can be repeated as many times as necessary until the conditioned reflex disappears when entering the bedroom.
- Only go to bed when you feel sleepy and intend to sleep.
- If you find that you still can’t fall asleep 10 to 20 minutes after you stay in bed, you should get up and leave the bedroom and then return to bed when you are drowsy.
- The bed is only used for sleeping and sex. Don’t watch TV, read, work, talk on the phone, or perform other activities unrelated to sleep.
- Get up regularly with an alarm clock every morning.
Relaxation training
Relaxation therapy is a kind of skill training that can reduce the degree of awakening during sleep and improve nighttime sleep quality. It is especially helpful for patients with difficulty falling asleep.
- Practice relaxing muscles every day and do relaxation training step by step. The same effect can also be achieved through a biofeedback device.
- Abdominal breathing, breathing with the diaphragm, develops a relatively slow and relaxed breathing frequency and helps to divert attention.
- Under the therapist’s guidance, a symbolic imagination can help divert attention, stop paying attention to the state of being awake, and stop generating negative thoughts such as “I can’t sleep,” thereby reducing the patient’s repetition before bedtime.
Sleep restriction
Sleep restriction is applied to patients with severe persistent insomnia. This is a set of sleep exercises that make people want to go to sleep more quickly, and the purpose is to improve sleep efficiency by limiting the time in bed to the actual sleep time.
Many insomniacs spend more time in bed to get enough sleep. As a result, much of the time spent in bed is awake time, not sleep time. Sleep restriction aims to switch this mode.
- Limit the awakening time in bed, calculate the average number of actual sleep hours per day according to the sleep diary, and use this as a basis to formulate a strict schedule in bed.
- Because the sleep time will decrease when sleepiness strikes, bedtime will be used more for sleeping.
- When sleep efficiency (actual total sleep time/bedtime * 100%) is not less than 85%, you can increase the bedtime by 15 to 30 minutes in advance.
- Each new bedtime must be maintained for at least five days before it can be increased again.
- If sleep efficiency is less than 85% after ten days of treatment, postpone the sleep time by 15 to 30 minutes.
- No matter how long you sleep at night, you need to get up regularly.
Maintain circadian rhythm
Circadian rhythm maintenance is particularly useful in treating patients with chronic insomnia and difficulty falling asleep.
To establish and maintain sufficient sleep, you need to fall asleep simultaneously every day and wake up at the same time. Irregular sleep times will lead to a decline in sleep quality.
- Maintain a regular sleep-wake cycle every day, even on weekends and holidays—sleeping on time is a good habit. Choose a time to ensure 8 hours of sleep per night (increasing or decreasing according to sleep needs).
- Don’t take a nap for too long: a nap at noon (about 20 minutes) can restore your energy. Over this time, you will have trouble sleeping that night.
- If you do exercise, try to end it as much as 4 hours before sleep time.
- Avoid bright lights at night.
- Illuminate with bright light in the early morning.
Reconstruction of positive sleep beliefs
Some unreasonable beliefs about sleep will increase the body’s level of awakening and increase muscle tone, which is not conducive to sleep. By adjusting these irrational beliefs, sleep quality can be improved.
These unreasonable beliefs include:
- Sleep cannot be controlled. If a person loses sleep, he will not be able to fall asleep.
- Overestimate the number of hours required for adequate sleep.
- Fear of getting out of bed, worrying that I won’t fall asleep if I don’t lie in bed now.
Sleep hygiene
The quality of sleep can be improved by restricting the behavior of unfavorable sleep.
- Cultivate a habit of staying calm before going to bed, distinguishing between sleeping and waking activities: the practice of keeping calm before going to bed, such as bathing, brushing teeth, reading, praying, etc.
- Avoid strenuous activities and aerobic exercise before going to bed: performing some regular workouts in the evening may be beneficial to sleep that night.
- Do not consume anything containing caffeine within a few hours before going to bed. If you are particularly sensitive to caffeine, it will take longer. Do not drink alcohol before going to bed, especially do not use alcohol to help sleep; do not smoke a few hours before going to bed.
- Avoid drinking much water at night. Holding back urine will make people sleepless, and it is easy for us to wake up for the toilet.
- If you feel anxious after going to bed, tell yourself to leave the anxiety to tomorrow and later recall or imagine other calm and relaxing things. If you have a concern while sleeping, usually write down your possible problems and write possible solutions earlier in the day.
- Make sure that the body temperature is not too high, and the quilt is not covered too much. The bedroom layout should help sleep. Dark and quiet bedrooms, comfortable beds, and a suitable temperature and humidity can significantly promote sleep.
Many treatment steps seem to be completed by the individual. Whether an individual or a group, guided by a trained professional, the treatment effect will be much better.
Professionals will better formulate treatment plans for them, determine treatment steps, and provide more support and encouragement for patients. Moreover, professionals are also good at finding problems and will make appropriate adjustments. During the treatment process of cognitive-behavioral therapy, the therapist needs to observe and record the patient’s treatment compliance status and progress and make timely adjustments. After the treatment, the patient needs to be guided to maintain the effect and prevent relapse.
As far as short-term efficacy is concerned, cognitive behavioral therapy is as effective as sleeping drugs. However, cognitive-behavioral therapy is better than sleeping pills if it lasts for months or years. It can shorten the time to fall asleep, reduce the wake-up time after the start of sleep, and increase the total sleep time. CBT can work for most patients with insomnia and can also be used as an adjunct to other psychotherapy.