There are few things more frustrating than lying in bed wide-awake at night while mundane thoughts (like what you should have for lunch tomorrow), mingled with stress over exams, play on an endless loop in your head. As the minutes before your alarm goes off slowly tick by, you try even harder to fall asleep, growing more anxious—and more awake—by the minute.
If this sounds familiar, you’re likely well acquainted with insomnia—the maddening experience of taking a half-hour or longer to fall asleep, difficulty staying asleep, or unrefreshing sleep that occurs three or more times a week for at least one month. It’s not just an annoyance: Sleep deprivation comes with a whole host of negative consequences, like fatigue, mood swings, increased appetite, diminished functioning, memory impairment, and lower grades.
Joel, a student in Wisconsin, was struggling with insomnia. “I saw a psychiatrist who said, ‘I think you would best benefit from changing your thought processes surrounding sleep, so I’m going to give you some exercises. It’ll take a few months, but it will make things easier for you.’ And it really has.”
Joel was prescribed cognitive behavioral therapy (CBT), a type of short-term counseling that challenges your existing behaviors, in a format that specifically addresses insomnia (called CBT-I). “CBT is a pattern of approaches that can be modified to address various issues. At first, it was really uncomfortable because it was hard to get my mind to bend—the initial task was breaking down that barrier,” Joel says. “I had to train myself to be OK with uncertainty. But CBT ultimately gave me the space to breathe. It was almost like a shaft-of-light-descending-from-heaven moment when I finally got over this [insomnia] that had defined my life.”
Experiences like Joel’s are common. “The data is exceptional in that 75–80 percent of insomnia patients improve with this treatment,” says Dr. Kelly Glazer Baron, a clinical psychologist and associate professor at the University of Utah. Students who received CBT-I showed improved sleep quality and reduced fatigue compared to those who didn’t, according to a small study in Behavior Therapy (2014). “This is a simple approach that works,” says Dr. Gregg Jacobs, an insomnia specialist and one of the principal developers of CBT-I. “People say they’ve slept the best they ever have in their life.”
CBT is a therapeutic approach that can help people with a variety of emotional and behavioral issues, including symptoms of post-traumatic stress disorder, depression, and anxiety. It involves a set number of sessions aimed at addressing an identified issue.
To treat insomnia, you need a special form of CBT called CBT-I. Your CBT-I provider or program will help you identify unhelpful thought patterns and behaviors that are messing with your sleep. They will help you reframe those thoughts and substitute more effective behaviors. “[CBT-I] changes the way you think about your sleep,” says Dr. Glazer Baron. (For example, “I always have trouble falling asleep” can be reframed as “I’m going to relax and let myself drift into sleep, and be refreshed tomorrow.”)
During CBT-I, you might keep a diary of your sleep patterns. This can help reveal habits or thoughts that could be contributing to your insomnia. Your clinicians can then offer customized “assignments” intended to reshape your daily approach to nighttime activities. These may include limiting activities in your bed to sleep (no more working or texting in bed), getting up and leaving your bedroom when you can’t sleep, and cutting out naps.
“Ironically, sleep is one of those things where the more you think about trying to sleep, the worse [your ability to sleep] becomes. You can’t ‘try’ to sleep. So there are people who lie in bed for hours trying to sleep, and it’s a self-fulfilling prophecy,” says Dr. Glazer Baron.
CBT-I is available in traditional counseling settings and online.
Online CBT-I programs range in accessibility and cost. Talk to your parents about which option might work best for you—some CBT-I programs are paid for by insurance or only offer clinical trials, so you’ll likely need parental consent. Here are some options:
CBTforInsomnia is a five-week, five-session program developed by Dr. Gregg Jacobs at UMass Memorial Medical Center. Therapy formats include PDF, MP3, and email Q&A.
Somryst™ is an online app that’s used like a prescription from a health care provider (currently being reviewed by the FDA). It’s designed to treat adults with insomnia and depression, so you may need to be 18 or older to use it.
Cost: For information on clinical trial options, check out shuti.me.
Sleepio provides a year of support from sleep scientists who communicate online, offering advice and answering questions.
Cost: Check to see if Sleepio is offered by your health insurance or if you can participate in one of its research studies.
Kelly Glazer Baron, PhD, MPH, clinical psychologist, associate professor, University of Utah.
Gregg Jacobs, PhD, founder of cbtforinsomnia.com.
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