Episode 44

CBT-I, Part 2

What is CBT-I?

In this episode, I break down the individual components of cognitive behavioral therapy for insomnia, or CBT-I. 

CBT-I is the most effective treatment for this condition. CBT, as we saw in Episode 42, is the gold standard intervention that involves addressing our thoughts, emotions, and behaviors.

As demonstrated in Episode 43 last week, it is highly effective for insomnia, improving the time to fall asleep (known as sleep onset latency), reducing time spent awake across the night (known as wake after sleep onset or WASO), increasing the total amount of sleep, increasing sleep efficiency (sleep time divided by time in bed), and importantly, improving daytime function.

It holds true that CBTI is effective whether old or young, pregnant or menopausal, arthritic or depressed or asthmatic or dealing with sleep apnea; it holds true whether delivered individually or in a group, in person or via telecommunication, handled solo with an app, with a book, or guided by a board-certified provider.

CBT-I involves reinforcing the necessary (but not sufficient) components of sleep hygiene, including issues of timing, activity, and substances. It involves behavioral adjustments - primarily relating to when and how long you are physically in the bed. It involves strategies to improve relaxation toward the end of the day, and challenging unskillful and dysfunctional beliefs about sleep, but relating to them in a way that doesn’t breed shame or guilt or embarrassment. And CBTI does this all without harmful drugs or expensive devices, and with no snake oil tinctures, supplements, or scams.