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Insomnia Treatment Option: Cognitive Therapy

Addressing Anxious Thinking May Improve Your Rest

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Updated February 10, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Prolonged insomnia may seem likely to unravel your very sanity, but when should you actually seek therapy as a treatment option? How can the anxiety associated with insomnia become self-destructive? Are there other behavioral changes that can improve your insomnia? What is the difference between cognitive therapy and cognitive behavioral therapy?

To answer these questions, let’s review an excerpt from UpToDate - a trusted electronic medical reference used by healthcare providers and patients alike. Then, read on for additional information about what all of this means for you.

"People who are awake at night commonly become concerned that they will perform poorly the next day if they do not sleep enough. Such thoughts can initiate a cycle where staying awake at night increases your anxiety, which then makes it more difficult to sleep. You may begin to blame all negative events in your life on poor sleep.

"During cognitive therapy, you work with a therapist to deal with your anxiety and negative thinking. The therapist will help you to accept that poor sleep alone cannot be the cause of all of your problems.

"Cognitive behavioral therapy is a training course that combines several of the previously described approaches over an 8 to 10 week period.

"A sample 8-session program may include an introductory education session, followed by two sessions that focus on stimulus control and sleep restriction. These may be followed by two sessions that focus on cognitive therapy and then a session on sleep hygiene. Finally, there may be a session that reviews and integrates the previous session and a session that addresses future problems, such as stress and relapse."

Sleep can suffer greatly when negative emotions begin to undermine it. A psychological storm of stress, anxiety and negativism may quickly decimate any chance of a restful slumber. For those who suffer from an inability to fall or stay asleep, hallmarks of insomnia, a negative reaction to this state may add fuel to the fire, leading to fits of restlessness and additional distress.

Often insomnia can spiral out of control in this setting. Sleep cannot be compelled. By dwelling on an inability to sleep - trying to mentally force ourselves to fall asleep - we accomplish the opposite. The associated anxiety alerts our minds, and an associated burst of a stress hormone called cortisol awakens our bodies. As part of this, many people will begin to "catastrophize." In other words, the outcome of a poor night’s sleep goes to the absolute extreme catastrophe that could occur, even if this is unreasonable.

Let’s take an example. You have trouble falling asleep. As you lie there, watching the minutes tick by on the clock, you begin to worry. "I can’t get to sleep," you think to yourself. "I need to sleep or I won’t be able to get up for work tomorrow." This initially may seem rational. But, as the minutes become hours, your anxiety builds. "I can’t sleep. I’ll oversleep in the morning. If I am late, I could be fired. I won’t be able to concentrate and my work will suffer. If I’m fired, I’ll lose my house. I’ll be homeless." Suddenly difficulty sleeping - by itself common and relatively unimportant - has spiraled to fear of losing your job and homelessness. These would be devastating consequences, but are they reasonable ones?

Cognitive therapy attempts to correct your patterns of thinking, to carry your anxious thoughts to their conclusions and, once there, to have you honestly reflect on whether they are reasonable. In the above example, a therapist may prod, "Yes, but have you ever slept in and missed work?" The answer is likely no. Once pulled apart, the worried thinking can be defused. As part of this, you will also address what you may inappropriately blame on poor sleep.

Some people benefit from a structured program of cognitive behavioral therapy. This formal training builds on the techniques introduced in basic cognitive therapy. It typically takes place over several months. As part of this, two behavioral interventions that can be effective in treating insomnia may be employed: stimulus control and sleep restriction. Each limits the amount of time that you spend awake in bed, so that it does not become a place of rumination.

These changes in thinking are sometimes difficult to implement, and thus these therapies are best undertaken with the assistance of a therapist trained in the techniques. You may wish to seek the counsel of a specially trained psychologist, psychiatrist or sleep specialist. By addressing the important interplay between emotions and sleep, you hopefully will be able to lay your fears to rest and finally get the sleep that you need.

Want to learn more? See UpToDate's topic, "Insomnia treatments," for additional in-depth medical information.

Source:

Bonnet, Michael et al. "Insomnia treatments." UpToDate. Accessed: November 2011.

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