Cognitive Therapy for Insomnia

Cognitive therapy is a psychotherapeutic method designed to change a person's beliefs, expectations, appraisals and attributions. In the context of insomnia, cognitive therapy seeks to change sleep expectations, perceived causes and consequences of insomnia, and beliefs about sleep-promoting practices.

The Role of Dysfunctional Cognitions in Insomnia

Insomnia is often precipitated by stressful events such as a change of employment, a separation, medical illness, or bereavement. Sleep usually normalizes after the stressor has faded away or the person has adapted to its more enduring presence. For some individuals, perhaps those who are more vulnerable to insomnia, sleep disturbances may develop a chronic course.

The individual responses to the initial sleep difficulties — mainly your thoughts and behaviors — determine in large part whether the sleep disturbance will cease or develop a chronic course. Insomnia is more likely to persist over time if a person interprets this situational insomnia as a sign of danger or loss of control and begins to monitor sleep loss and to worry about its consequences.

Types of cognitive responses that may become dysfunctional: worrying, having unrealistic expectations and faulty appraisals. These may converge to feel like you are on a vicious cycle of insomnia, emotional distress and more sleep disturbance.

This chain reaction may produce a state of hyperarousal or physiological and psychological agitation. This is the opposite of how you want to feel in order to sleep.

Underlying beliefs about sleep and insomnia include the following:

• Intrusive thoughts that cause anxiety and are laden with your beliefs and attitudes about sleeplessness. These thoughts may occur during the day and night.
• People with insomnia report more negative thoughts about sleep, as well as health, work and family.
• You might attribute illness and other physical or psychological reactions to your lack of sleep.

Many negative cognitions about sleep can also arise. People with sleep latency preceding sleep onset think more about not being able to sleep which tends to cause worry. In addition, insomniacs tend to engage more frequently than good sleepers in self-monitoring activities (clock watching, hypersensitivity and focus of bodily sensations) and in safety behaviors (calculating time left to sleep). It is unclear whether this cognitive activity causes insomnia but it is clearly linked to feeling more anxious about sleep. Dysfunctional beliefs and attitudes about sleep are instrumental in producing insomnia. These beliefs may include assumptions about how many hours you should be sleeping.

Specifically, poor sleepers held more unrealistic expectations about their sleep requirements, reported stronger beliefs about the consequences of insomnia, and worried more about losing control, as well as the overall unpredictability of sleep. Dysfunctional cognitions about sleep and the consequences of lack of sleep are associated with greater emotional distress which may contribute to more severe insomnia complaints.

Interventions aimed at controlling intrusive thoughts at bedtime include the following:

• Imagery training and visualization
• Thought stopping and worry control
• Systematic stress relaxation
• Rules related to sleep engagement: use your bed only for sleeping or sexual activity
  • If you can't fall asleep, get out of bed and go to another room.
  • Read a book or magazine, do not turn on the television or use your computer, might cause too much stimulation.
  • Do not take naps during the day to make up for sleep loss.
  • Do not change the time you go to bedtime to compensate for fatigue earlier in the evening.
    

Thank you for your interest in topics related to your sleep health. If you would like more information, please feel free to contact me at or call 847.674.3600.

Best regards,

Miranda Altman, PsyD, LCSW, MSW
Psychologist, Cognitive Specialist

If you have questions or would like a consultation, ...

...please give us a call at 847.674.3600 or book your appointment online (click top button).