Getting a Good Night's Sleep With the Help of Psychology

Cognitive behavioral therapy is becoming the "treatment of choice" for many people with insomnia.

Findings

More sleep would make most people happier, healthier and safer. But for people with sleep disorders, trying to get more sleep can be a nightmarish experience. Surveys conducted by the National Sleep Foundation reveal that at least 40 million Americans suffer from over 70 different sleep disorders and 60 percent of adults report having sleep problems a few nights a week or more. Sleep disorders and sleep disturbances comprise a broad range of problems, including sleep apnea, narcolepsy, insomnia, jet-lag syndrome, and disturbed biological and circadian rhythms.

For the estimated one in 10 people who suffer from chronic insomnia, psychologists are helping them get a good night's sleep through the benefits of cognitive behavioral therapy (CBT). In a 2001 study published in the Journal of the American Medical Association (JAMA), psychologist Jack Edinger, PhD and colleagues found the CBT worked better than either progressive muscle relaxation or a placebo treatment for people with insomnia. Another JAMA study two years earlier by psychologist Charles Morin, PhD, found that behavioral and pharmacological therapies, alone or in combination, are effective in the short-term management of late life insomnia. But those who received CBT had the best long-term results and the participants rated the behavioral therapy as more effective and satisfying. A 2001 German study by Jutta Backhaus and colleagues found that the benefits of short-term CBT had long-term effects. After therapy the participants improved their total sleep time and sleep efficiency and reduced their sleep latency and negative sleep-related cognitions, and those improvements were sustained during the three-year follow-up period.

How does cognitive behavioral therapy help people sleep better? Research shows that CBT reduces false beliefs about sleep (the cognitive part) and also addresses the behavioral aspect, such as what to do when you are lying in bed and can't fall asleep. A 2002 study by Dr. Morin highlighting people's misconceptions about sleep found those that who received CBT reduced their false beliefs, which resulted in increases in the amount of time they spend in bed actually sleeping. Misconceptions regarding sleep can involve unrealistic expectations about sleep ("I must get 8 hours of sleep every night"), exaggeration of the consequences of not getting enough sleep ("If I don't get a full 8 hours of sleep tonight a catastrophe will happen"), faulty thinking about the cause of your insomnia ("My insomnia is completely caused by a biochemical imbalance"), and misconceptions about health sleep practices.

A 2004 study by psychologist Célyne Bastien, PhD, and colleagues found that group therapy and telephone consultations using cognitive-behavioral therapy was a cost-effective alternative to individual therapy for the management of insomnia. All three CBT treatment methods produced improvements in sleep that were maintained for six months after the treatment period ended.

Significance

Up to 40 percent of adults report at least occasional difficulty sleeping, and the National Institutues of Health reports that chronic and severe forms of insomnia affects between 10 to 15 percents of adults. Even small disruptions in sleep can wreak havoc on human safety and performance. Estimates by the National Highway Traffic Safety Administration indicate that drowsy or fatigued driving leads to more than 100,000 motor vehicle crashes per year.

Practical Application

Findings from controlled clinical trials indicate that 70 to 80 percent of insomnia patients benefit from cognitive-behavioral interventions. Although CBT is now considered the treatment of choice for chronic insomnia, no single treatment method is effective for all insomnia patients, so behavioral and pharmacological approaches sometimes need to be integrated.

More and more sleep disorder clinics are popping up across the country - there are now more than 300, with most hospitals offering sleep clinics. Look for those that offer more than just pharmacological treatment options.

Here are some tips for anyone, including those without serious sleep problems, that is looking for ways to get a good night's sleep:

  • Restrict the amount of time spent in bed as close as possible to the actual sleep time                                                                                                                                              

  • Go to bed only when sleepy, not just fatigue but sleepy

  • If unable to sleep (e.g., within 20 min), get out of bed and go to another room and return to bed only when sleep is imminent

  • Use the bed and bedroom for sleep (and sex) only; no eating, TV watching, radio listening, planning or problem solving in bed

  • Maintain a regular sleep schedule, particularly a strict arising time every morning regardless of the amount of sleep the night before

  • Avoid daytime napping

Cited Research

Backhaus, J., Hohagen, F., Voderholzer, U., Riemann, D. (2001). Long-term effectiveness of a short-term cognitive-behavioral group treatment for primary insomnia. European Archives of Psychiatry & Clinical Neuroscience, Vol. 251, No. 1, pp. 35-41.

Bastien, C.H., Morin, C.M., Ouellet, M., Blais, F.C., Bouchard, S. (2004). Cognitive-behavioral therapy for insomnia: Comparison of individual therapy, group therapy, and telephone consultations. Journal of Consulting and Clinical Psychology, Vol. 72, No. 4, pp. 63-659.

Edinger, J.D., Wohlgemuth, W.K., Radtke, R.A., Marsh, G.R., Quillian, R.E. (2001). Cognitive behavioral therapy for treatment of chronic primary insomnia: A randomized controlled trial. Journal of the American Medical Association, Vol. 285, No. 14, pp. 1856-1864.

Morin, C.M. (2002). Contributions of cognitive-behavioral approaches to the clinical management of insomnia. Primary Care Companion, Journal of Clinical Psychiatry (suppl 1), pp. 21-26.

Morin, C.M., Blais, F., Savard, J. (2002). Are changes in beliefs and attitudes about sleep related to sleep improvements in the treatment of insomnia? Behaviour Research & Therapy, Vol. 40, No. 7, pp. 741-752.

Morin, C.M., Colecchi, C., Stone, J., Sood, R., Brink, D. (1999). Behavioral and pharmacological therapies for late-life insomnia: A randomized controlled trial. Journal of the American Medical Association, Vol. 281, No. 11, pp. 991-999.


American Psychological Association, September 15, 2004

Additional Sources