Cognitive Behavioral Therapy for Insomnia (CBTi)
Sleep is essential – its a time for your body to repair itself both physically and psychologically. When factors such as anxiety, depression, or poor sleep habits begin to interfere with sleep the consequences can make a person more vulnerable to all types of psychological and physical issues.
Although medications are often prescribed to help people fall asleep and you can find things over the counter (melatonin), medications were never meant to be a long term solution to sleep problems. Medications often have side effects such as drowsiness, and they can cause a person to become dependent on the medication in order to sleep. When factors such as anxiety (physiological hyper-arousal), depression (emotional distress and worry), or poor sleep habits (scrolling or using your phone before bed) interfere with sleep patterns the natural ability of the body to repair itself becomes disrupted. If disrupted for an extended period of time, needed physiological repair cannot take place, which can lead to increased fatigue and pain.
Sleep Basics:
Sleep can be divided into 5 distinct stages on the basis of brain-wave patterns called EEG (electroencephalography). Each sleep cycle (which last about 100 minutes) is divided up into physically repairing sleep and psychologically repairing sleep. When we first fall asleep, more time is spent in physically repairing sleep, later on during the night more time is spent in psychologically repairing sleep. Age influences the balance between these two types of sleep. Babies spend more time in psychologically repairing sleep (dream state) because their bodies don’t need much physical repair. Older adults spend more time in physically repairing sleep because their bodies are more vulnerable to damage.
The first four stages are called non-REM (rapid eye movement) sleep while the 5th stage is called REM sleep.
- Stage 1 – A transitional stage between waking and sleep where alpha waves disappear slowly, and theta waves move in; body muscles relax, heart beats slower.
- Stage 2 – Theta waves prominent, with intermittent sleep spindles and K-complexes (bursts of faster activity and higher amplitude activity, respectively)
- Stage 3 – Appearance of large slow delta waves, which are dominant in stage 4 (This is deep sleep)
- Stage 4 – Delta waves dominate. The sleeper breathes deeply and has slowed heart rate and lowered blood pressure (This is deep sleep)
- Stage 5 – Characterized by REM (rapid eye movements), absence of muscle tone, mixed frequency EEG. Called paradoxical sleep because EEG activity is typical of an aroused nervous system, while the responsivity of the sleeper to the environment is very low.
The sleep cycle lasts 100 minutes and recurs four to six times per night. Early REM are ten minutes long, but increase through the night. By end of sleep, REM periods last up to 50 minutes. In contrast, delta sleep is longest early in the night and shorter at the end of the night. Dreams occur during non-REM and REM sleep, but you remember the ones in REM more because they are more vivid, bizarre, and emotionally laden and are therefore more likely to be remembered when you wake.
What are some effects of not getting a good nights sleep?
- Increased emotional distress and irritability
- Increased clumsiness and poor coordination
- Decreased work performance and memory lapses
- Increased risk of automobile accidents
- Difficulty concentrating
Here are some basic things that you can do on your own to make sure you are practicing good sleep hygiene. Look over this list and see if there are places where you can make some changes every night to set yourself up for sleep.
Who do we see?
We have experience working with individuals who are experiencing problems with getting to sleep and maintaining sleep. Individuals who are interested in learning more about treatment can contact the Behavioral Medicine Program at CARD at (617)-353-9610. Our front desk staff will connect you with a therapist who will answer all of your questions.
Our Treatment Approach:
Cognitive-Behavioral Therapy for Insomnia (CBT-I) is an evidence-based treatment approach that focuses on teaching techniques to modify disruptive behaviors and cognitions that interfere with normal sleep and contribute to insomnia. Unlike sleep medication which can have side effects and cause sleepiness the following day, CBT-I addresses the underlying cause of insomnia rather than just relieving the symptoms. CBT-I teaches patients to recognize and change thoughts and beliefs that can impact their ability to sleep. CBT-I also helps patients to develop good sleep behaviors and habits that can help promote sleep.