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Psychotherapy Including Cognitive Behavioral Therapy (CBT)

Insomnia is a classic symptom of depression and stress-related psychological illness. Cognitive behavioral therapy (CBT) is one type of psychotherapy. It involves meeting with a licensed professional on a regular basis in an individual or group setting. CBT works to identify and resolve the psychological factors that contribute to the depression or another psychological illness causing the insomnia. Medication for the underlying problem may be prescribed in conjunction with CBT.

For some, CBT may be as, or more effective, than medication in short- and long-term management of insomnia . CBT may have more lasting treatment effects than medication. CBT is usually given over six weeks, with maintenance therapy given as needed.

Relaxation Therapy

There are specific and effective techniques that may help to reduce or eliminate anxiety and body tension. These can include meditation , visualization, and deep breathing. These techniques can help your mind to stop racing, allow your muscles to relax, and allow restful sleep. It takes some practice to learn these techniques and achieve effective relaxation.

Sleep Restriction

Some people suffering from insomnia spend too much time in bed unsuccessfully trying to sleep. They may benefit from a sleep restriction program that at first allows them only to stay in bed for the number of hours the person actually sleeps, as opposed to the number of hours the person spends in bed tossing and turning. The minimum number of hours for sleep is usually about 5 hours. A person would gradually add more time to their starting amount until a more normal night's sleep is achieved.

Reconditioning

Another treatment that may help some people with insomnia is to recondition them to associate the bed and bedtime with sleep. For most people, this means not using their beds for any activities other than sleep and sex. As part of the reconditioning process, you are usually advised to go to bed only when sleepy. If unable to fall asleep, get up, stay up until sleepy, and then return to bed. Throughout this process, you should avoid naps, and wake up and go to bed at the same time each day. Eventually your body will be conditioned to associate the bed and bedtime with sleep.

When to Contact Your Doctor

Transient and intermittent insomnia often occur in response to a short-term event and will usually resolve in a few days. If you have sleeplessness that continues for more than a week, contact your doctor for an evaluation and consultation about your treatment options.

References:

Borge S, Omvik S, Pallesen S. Cognitive Behavioral Therapy vs Zopiclone for Treatment of Chronic Primary Insomnia in Older Adults: A Randomized Controlled Trial. JAMA . 2006;295(24):2851-2858.

Can't Sleep? What to know about insomnia. National Sleep Foundation website. Available at: http://www.sleepfoundation.org/article/sleep-related-problems/insomnia-and-sleep . Accessed May 15, 2013.

Insomnia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated April 11, 2013. Accessed May 15, 2013.

Insomnia. Quick Answers to Medical Diagnosis and Therapy. Access Medicine website. Available at: http://accessmedicine.com/content.aspx?aid=3267380 . Accessed May 15, 2013

Jacobs GD, Pace-Schott EF, Stickgold R, et al. Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized, controlled trial and direct comparison. Arch Intern Med . 2004 Sep 27;164(17):1888-96.

Morin C, Vallieres A, Bernard G, et al. Cognitive behavioral therapy, singly and combined with medication for persistent insomnia: a randomized controlled trial. JAMA . 2009;301(19):2005-2015.

What is insomnia? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/inso/ . Updated December 13, 2011. Accessed May 15, 2013.



Last reviewed May 2014 by Marcin Chwistek, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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