A Refreshing Approach To Sleep
Some say that the regenerative abilities of sleep are the closest thing to a superpower that humans can aspire to.
When structured correctly, a good night's sleep can help us recover from physical exhaustion, reduce anxiety levels, or even unlock a problem that has been in our minds for several days.
To achieve this desired structure, we must pay attention not only to the period during which we are sleeping but also to what precedes and follows it. Unfortunately, a significant portion of the world's population suffers from chronic disruptions of one or even all of these critical periods, which, in one way or another, promote chronic insomnia and all its deleterious effects.
Due to their significant interference in people's daily lives, these disruptions have led to a high consumption of medications over the last few decades. However, while medication has a place in treating insomnia, it should not be considered a first-line tool and should always be viewed as a complement to a multidimensional approach.
In recent years, and in my view, in a positive way, the topic of sleep hygiene has been in the spotlight, both professionally and non-professionally, serving as a reminder of the importance of sleep in our lives. Despite this importance, this topic can be integrated into a more structured and effective approach to sleep that is only now gaining more attention, called Cognitive Behavioral Therapy for Insomnia (CBT-I).
According to various studies, this approach is as effective as the usual medications used for insomnia in the short term, but more effective in the long term (1). There are also data indicating that about 80% of people who undergo CBT-I experience some improvement in sleep quality in 4 to 8 sessions (2). In these sessions, in addition to addressing the aspects related to sleep hygiene, various anxiety-related aspects of sleep are also explored, and this is where this approach stands out.
The main goals of the training are, therefore, to help identify thoughts, feelings, or behavioral patterns that contribute to insomnia.
In this way, we can enumerate the various areas of intervention of this technique (3):
Cognitive interventions: restructuring negative thoughts about sleep;
Behavioral interventions: satellite practices related to sleep that increase relaxation and, therefore, quality during sleep;
Psychoeducational interventions: establishing connections between thoughts, feelings, behaviors, and sleep itself.
In this sense, some of the most commonly used techniques are listed below:
Cognitive restructuring: reversing negative thoughts about sleep, which in people with chronic insomnia can cause daily anxiety about the upcoming sleep period, anticipating some of the difficulties they think they will have that night and consequently the next day;
Stimulus control: this part is more related to sleep hygiene, especially by avoiding sources of stimulation before sleep, such as electronic devices, alcohol, or work-related discussions. It is also essential to reserve the bed only for sleep and sex, excluding any other sources of stimulation. In fact, one of the most commonly used techniques is to encourage people to leave the bed if they cannot fall asleep in the first 20 to 30 minutes, promoting the practice of some quiet activity under warm lighting that does not involve the use of any electronic devices outside the bedroom;
Compliance with schedules: it is important to establish regular bedtime and wake-up times;
Sleep restriction: several techniques are used to ensure that people targeted for this type of intervention spend as little time as possible in bed without sleeping. For example, if a person has a goal of sleeping 8 hours but can only sleep 5 in the initial phase, the initial sleep length is restricted to 5 hours and 30 minutes (this 30 minutes are reserved for the falling asleep period, which will then gradually increase);
Relaxation: in order to increase sleep efficiency, various relaxation techniques that are also used in other areas of life come in hand, to reduce stress and alertness levels at bedtime, such as meditation.
Thus, CBT-I, despite still being relatively unknown and having a limited number of professionals capable of applying it, turns out to be possibly the most multidimensional approach to insomnia today. Continuing to demonstrate effectiveness compared to other more individualized interventions, it holds great growth potential, and we look forward to new developments in this area.
1 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8808745/
2 - https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2016.6b19
3 - https://www.sleepfoundation.org/insomnia/treatment/cognitive-behavioral-therapy-insomnia
