Cognitive behavioural therapy for insomnia (CBTi)

Sleep is an essential part of our biological functioning, but chronic sleep disturbances can have adverse effects on our overall health. Our cognitive behavioural therapy for insomnia (CBTi) programme can improve sleep disturbances within 8 weeks, working to address sleep-related anxiety, address behavioural sleep issues and aid relaxation for improved sleep quality. 

What is insomnia?

Insomnia is a sleep condition which affects a person’s ability to fall asleep or stay asleep. Disturbed sleep is common, with around a third of adults having difficulty sleeping. 

However, only 6% of the population has been diagnosed with insomnia, with chronic insomnia being diagnosed when the sleep disturbances occur more than 3 times a week, and last for more than 3 months.

What are the symptoms of insomnia?

Despite being associated with night time, insomnia can widely affect aspects of the waking day. Aside from fatigue and daytime sleepiness, chronically disturbed sleep can cause irritability, impaired concentration, memory problems and reduced motivation. 

As a result, insomnia can affect work performance and even relationships, as many people avoid socialising as they’re worried it may affect their evening routine and prevent good sleep. 

Consequentially, insomnia can perpetuate or worsen mental health conditions, such as depression or anxiety. Up to 36% of people living with insomnia also have anxiety disorder. 

Our CBTi programme aims to reduce sleep-related anxiety and aid relaxation for better quality sleep. 

Cognitive behavioural therapy (CBTi) for insomnia

Recommended by The National Institute for Health and Care Excellence (NICE),Cognitive Behavioral Therapy for Insomnia (CBTi) is the gold standard treatment for insomnia.  

CBTi encourages you to explore and confront your thoughts, feelings and actions that could be negatively contributing to the symptoms of insomnia. You will also learn relaxation techniques and methods to aid a more restful night’s sleep.  

A standard course of CBTi consists of 6 to 8 weekly sessions, with each session lasting between 20 and 40 minutes. We offer video and in-person sessions so you can work towards your goals from the comfort of your home, at a time that suits you. For patients who prefer an in-person approach, we have appointments available at Royal Brompton Hospital 

 There are two approaches to our treatment: cognitive and behavioural. 

Cognitive

The cognitive aspect focuses on strategies to reduce sleep-related anxiety and sleep deprivation by addressing unhelpful or inaccurate thoughts. Your consultant will work with you to break negative cycles by identifying the source of your anxiety, challenging these thoughts, and implementing a strategy to reframe your mindset and emotions towards sleep. These strategies may include cognitive distraction (focusing attention on a single task) and progressive muscle relaxation to encourage mindfulness.

 Behavioural

There are a number of behavioural strategies that can be used to help create a positive association with bedtime, such as sleep rescheduling (reducing the time spent in bed) and stimulus control therapy.

Sleep rescheduling

Insomnia often results in too much time spent lying in bed awake. By limiting the amount of time you spend in bed, you can increase the drive to sleep. You will be asked to keep a sleep diary so you can accurately assess how much sleep you’re getting on a typical night. You will be encouraged to reduce the amount of time spent in bed when not sleeping. Initially, you may experience some daytime fatigue. After you begin to spend more of your time in bed asleep, your overall time in bed can be increased.

Stimulus control therapy

Insomnia can be debilitating. Some people with insomnia can have negative associations with the bedroom due to frustrations surrounding lack of sleep. People can also develop unhelpful habits such as scrolling on your phone, watching TV and snacking, all of which can negatively impact your sleep. 

Stimulus control therapy encourages you to reclaim the bedroom as a place of rest. During treatment, patients must only use the bed for sleep and sex. You will be encouraged to follow a nighttime routine by setting an alarm for the same time every morning. You should avoid daytime nap as this can make you less tired at nighttime. 

Benefits and risks

CBTi is an effective method of treatment for most people with insomnia. It can also help to manage mental health conditions, physical and medical issues, and lifestyle issues that may be affecting sleep. 

CBTi can be an effective, long-term solution for sleep problems compared to sleeping pills, which may offer a short-term treatment but are not the best long-term treatment for most people. 

Challenging your unhelpful thoughts, feelings and behaviour can be uncomfortable, stressful and draining. You may find that some approaches cause you to lose sleep as you reduce the time spent in bed, before your sleep improves. However, it is important to ensure you continue the treatment to see lasting results. Your consultant is there to support you throughout your journey to better health.