Understanding CBT-I: Changing Your Thoughts About Sleep
When you have insomnia, you may have unhelpful thoughts and beliefs about sleep. You may think that you’ll never get a good night’s sleep. You may worry that your sleep will never be “normal.” You may feel like you can’t function well because of the lack of sleep. Thoughts and beliefs like these can cause stress and make it harder to sleep.
Cognitive therapy can help you change these thoughts and beliefs so you can get to sleep. It’s also known as cognitive restructuring. By helping you change unhelpful thoughts and beliefs, cognitive therapy can help you fall asleep, stay asleep, and feel better during the day.
Problem thoughts and beliefs
A person’s mind can sometimes create thoughts and beliefs that lead to negative emotions or unhelpful behaviors. These thoughts and beliefs are mistakes in thinking. Common mistakes in thinking include:
Assuming you know what will happen in the future
Making things bigger than they really are
“All or nothing” black-and-white thinking
Forgetting positive experiences
Imagining the worst-case scenario
Turning feelings into facts
For example, you may have had thoughts and beliefs about your sleep such as:
“If I can’t sleep tonight, tomorrow I’m going to have a miserable day.”
“If I don’t get the right amount of sleep, there will be serious health consequences.”
“Insomnia is caused by a chemical imbalance. There is nothing I can do to help my sleep problems other than medications.”
“I can’t sleep because of pain. I’ll always have pain, so I’ll never sleep well.”
“I’ve tried all these things and they don’t work.”
“I’m too tired to get out of bed at the same time in the morning.”
“I know I should get out of bed when I can’t sleep, but it just wakes me up more.”
These thoughts and beliefs can actually hurt your sleep more by maintaining an unhelpful pattern. Working with a healthcare provider trained in this technique can help you change these thoughts.
How it works
Cognitive therapy is done with a trained healthcare provider. The provider talks with you about your thoughts and beliefs about sleep. You may be asked to do an exercise such as this:
1. Write down a negative thought or belief you have about your sleep. Example: “If I can’t sleep tonight, tomorrow is going to be a miserable day.”
2. How does this thought or belief make you feel? Example: “Panicky and desperate for sleep.”
3. Is this thought helping you change the situation? Or does it keep you stuck in your current pattern? Example: “This thought keeps me stuck. Feeling panicky and desperate for sleep makes me less likely to sleep.”
4. What is an alternative thought or belief about this? Example: “I’ve had many days of disturbed sleep before. Although I am often tired after a night of disrupted sleep, I am usually able to go to work and have an OK day.”
When you have insomnia, it can be hard to change thoughts and beliefs about sleep. But cognitive therapy works for many people. By working with your healthcare provider, you can help retrain your mind and body for sleep.
Working with CBT-I
The tools of CBT-I are often used together. Cognitive therapy is often done along with other CBT-I tools. These can include stimulus control, sleep efficiency training, relaxation, and sleep hygiene. Your healthcare provider can tell you more about these tools and which can work best for you.
For more information
If you are a Veteran and you have insomnia, contact your VA healthcare provider about CBT-I or check out some of the below resources.