How To Treat insomnia with Cognitive Behavioral Therapy (CBT)?

Treating insomnia with Cognitive Behavioral Therapy

One in five people suffer from insomnia. If taking sleeping pills remains the main remedy for many insomniacs, behavioral and cognitive therapy is a little-known ally to regain sleep. Explanations from Michel Billiard, neurologist and specialist in sleep disorders.

How Does Cognitive Behavioral Therapy Treat Insomnia?

Behavioral treatment consists of two points: time restriction in bed and stimulus control therapy. Restricting time in bed aims to reduce not the time you sleep, but the time you spend in bed. Indeed to compensate for his lack of sleep, an insomniac will tend to go to bed early and get up late. In the company of the therapist, the patient will keep a sleep log and agree on a wake-up time in the morning which will remain the same, while the bedtime will have to vary. The sleep log will allow, after one or two weeks, to see if the duration of sleep increases or remains low and to estimate an average of "sleep experienced". At the same time, stimulus control therapy is applied, which involves only going to bed when you really want to sleep. For example, if after 15-20 minutes in bed you are not sleeping, you have to get up to practice a calm activity such as reading. Likewise, if you wake up in the night at 4 a.m. and can't get back to sleep, you have to get up. It is not easy, of course, but it is making sure you better regulate your sleep.

The second part of the therapy, the cognitive angle, focuses on the harmful beliefs of chronic insomniacs: it takes a minimum of 8 hours of sleep to function well during the day, if I have a bad night it will be worse the next night ... all these ideas are wrong. Indeed, it is only after several bad nights that the lack of sleep will be felt. Using a questionnaire, the therapist will give the insomniac a real definition of what sleep is and how it works. Relaxation comes in addition to various techniques such as autogenic training, mental imagery, in order not to directly improve sleep, but to reduce the anxiety of the insomniac induced by his daily fear of not sleeping.

Can it completely replace taking sleeping pills?

Studies are lacking in this regard, to know whether insomniacs having followed a TBI have completely stopped the sleeping pills or not, in particular in the long term. What is certain, however, is that you should never stop taking sleeping pills suddenly. The reason is simple: abrupt withdrawal, especially in a long-time user, is harmful both psychologically and biologically, with real heart risks. If you start a TBI, it is only when the first appear that you can, under medical supervision, reduce the sleeping pills. The underlying question is whether to ban sleeping pills altogether. Even in cases where the therapy works well, this does not prevent sometimes having a small glitch in sleep: a snorer nearby, work downstairs ... In these cases, we can very well take a sleeping pill. punctual way.

Is behavioral and cognitive therapy accessible to everyone?

Potentially yes, there is no real contraindication. However, you must be aware that to engage in a CBT is to follow a long-term treatment with its obligations and rules to follow. This is obviously less easy than taking a sleeping pill in the evening before going to bed, as it takes at least 15 days of follow-up to feel the benefits of the therapy. But for those who care, CBT is a very effective remedy for insomnia. Unfortunately, very few of all insomniacs are aware of this and are treated in this way. There is also a lack of specialists trained in sleep TBIs. Indeed, general practitioners cannot take charge of this treatment because the consultations are too long, while too few psychologists choose such a specialization. In this context, platforms that offer to follow a CBT online are useful in supporting people with sleep problems in following their therapy. In addition, they allow more insomniacs the chance to try something other than systematic use of sleeping pills.

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