Cognitive Behavioral Therapy

Cognitive Behavioral Therapy for Insomnia (CBT-I) in Colorado

Cognitive Behavioral Therapy for Insomnia (CBT-I) is an evidence-based approach that addresses underlying thoughts and behaviors contributing to sleep difficulties. Unlike sleep medications, CBT-I focuses on identifying and modifying sleep habits and beliefs that interfere with sleep, leading to long-term improvements in sleep quality.

Cost: $350 per session

What are the key components of CBT-I?

Stimulus Control

This technique aims to associate the bed and bedroom with sleep by encouraging practices such as going to bed only when sleepy, using the bed solely for sleep and sex, and getting out of bed within 20 minutes (perceived time, rather than clock watching) if unable to sleep. Once you get out of bed, you should go to another room if possible and do something stimulating enough that you won’t fall asleep doing it, but boring enough you will not want to stay awake and continue to do it. The patient should then return to bed when feeling sleepy again.

Sleep Restriction

Limiting the amount of time in bed to the actual amount of sleep time achieved helps increase sleep drive, leading to more consolidated and restful sleep over time. It is conducted over multiple visits and includes maintenance of a sleep diary in which the time in and out of bed in addition to perceived sleep time are used to calculate sleep efficiency. If the sleep efficiency is less than 85% then the bed window (time from bedtime to rise time) is set to equal the number of hours of sleep based on the sleep diary. This will not be less than 6 hours and will include a consistent bedtime and rise time each day. The patient will continue to keep a sleep diary and time in bed will be adjusted at each visit based upon sleep efficiency.

Cognitive Restructuring

Identifying and challenging unhelpful beliefs and attitudes about sleep can reduce anxiety and promote a healthier sleep mindset. Thoughts and beliefs about sleep can increase arousal near bedtime and delay or prevent sleep. Thoughts and beliefs can also increase the likelihood of engaging in unhelpful behaviors such as extending time in bed to try to catch up on sleep. Mindfulness approaches can also be used in conjunction with behavioral techniques. Often mindfulness exercises are found relaxing and useful as a part of a pre-sleep routine in the evening.

Sleep Hygiene Education

Implementing healthy sleep habits is paramount in insomnia treatment. These include maintaining a consistent sleep schedule, creating a comfortable sleep environment (cold, dark, and quiet), and avoiding stimulants before bedtime.

Relaxation Techniques

Practices such a progressive muscle relaxation, deep breathing and meditation can help reduce physical and mental tension, facilitating easier sleep onset.

Frequently Asked Questions

How effective is CBT-I?

There is moderate-quality evidence that CBT-I results in clinically significant improvement in chronic insomnia patients. A large meta-analysis performed by the American Academy of Sleep Medicine showed improvements in sleep quality, reduction in time it takes to fall asleep (sleep latency) and decreasing nighttime awakenings. It is considered the first line therapy for chronic insomnia and has benefits surpassing those of sleep medications without the associated side effects.

How long does CBT-I usually take?

CBT-I is typically delivered over six to ten sessions of about an hour each, over a six to 20-week period.

What if I want results faster, is there an alternative to CBT-I?

Yes. Brief Behavioral Treatment for Insomnia (BBT-I) is a psychological treatment modality derived from CBT-I which is delivered over 4 consecutive weeks (total of 4 sessions) and focuses on altering behaviors in order to improve sleep. It uses two principles: Sleep restriction and stimulus control to enable the patient to produce sleep predictably and reliably.