What does a typical course of treatment look like?
I ask clients to commit to approximately 5 individual sessions. You may need more or less depending on your tolerance for the treatment and your desire for support along the way. I offer a variety of treatment packages, including group therapy, to fit the individual needs of my clients.
Our first session will be an initial assessment. We will discuss your history of sleep problems and also do a brief psychological assessment to rule out any other conditions that may be interfering with your sleep. I may ask you to start filling out a sleep log prior to our first appointment, or this may be presented at your first appointment. The sleep log is a way for you to begin tracking your sleep so that we have an accurate representation of the problems you are experiencing with your sleep and the total amount of sleep you are getting each night. Our second session usually occurs after you have completed 2 weeks of your sleep log. We will review the data and discuss which sleep plan is right for you based on your sleep log and your individual preferences and we will develop an individualized treatment plan. We typically meet weekly for the first few weeks as you begin to implement the treatment plan. Our sessions involve cognitive strategies and ACT (acceptance and commitment therapy) strategies to help you stay the course of treatment. We problem solve any difficulties that you are experiencing along the way. Once you feel comfortable in your treatment plan, we may go a few weeks without meeting. If you find you are running into any problems, we can meet again for a session in person or via video/phone.
For more information on the dates and format of my group sessions, click here.
When will I see improvements in my sleep?
This depends. Significant improvements can be made in as little as 5 weeks, but may take up to 8 to 12 weeks, depending on whether or not you are weaning off of medication and how closely you follow the program. Treatment begins after an initial 2 weeks of sleep monitoring (in which you record your nightly sleep) to determine the best treatment plan for you.
I’ve already tried sleep hygiene (limiting my caffeine, not watching tv before bed, setting a bedtime routine) and it didn’t help. How is this different?
It’s awesome that you have already tried some sleep hygiene techniques, and these will be important strategies for boosting your efforts during treatment. CBTI-I involves either sleep restriction or stimulus control, which are specific behavioral plans related to your sleep (how many hours in bed you spend each night, how long you stay in bed awake before getting out of bed, etc). Additionally, specific cognitive techniques (working on unhelpful thoughts, relieving anxiety) as well as mindfulness and acceptance techniques are employed to provide a comprehensive treatment package to increase your likelihood for success.
I take sleep aids like Ambien/Lunesta, Klonpin, Ativan, marijuana etc. Do I have to stop taking these sleep aids to do CBT-I?
It depends! Many people start treatment for their insomnia while working at cutting down their sleep aids. There is not a one-size-fits all approach to this. Depending on how long you have been taking your medications, the frequency in which you take them, and the dosage you are on, you may choose to slowly wean yourself off your sleep aids while engaging in CBT-I or choose to work toward stopping your use of sleep aids before you begin treatment.
If you have been relying on sleep medication for quite some time, it is likely that you will experience “rebound insomnia” when reducing your dosage. Rebound insomnia is a worsening of your insomnia symptoms, which can sometimes be even worse than before you started your sleep aids. It can make you think you’ll never sleep again or that treatment isn’t working. However, rebound insomnia is not permanent.
Some people choose to wean themselves off of their sleep aids before starting CBTI-I so that they do not run the risk of rebound insomnia during the course of treatment. Additionally, coming off of sleep aids before starting CBT-I means that we will be treating your sleep as it is, rather than as it is with the effects of aid. It will be important that you discuss with your prescribing physician the safest and best way to reduce/stop taking your medication before beginning any sleep program.
Some people choose to begin CBT-I before going off of their sleep aids. This approach works well for people who are coming off of their medication slowly and do not want to wait months to begin treatment. Starting CBT-I while weaning off of medication is also helpful for individuals who want support and tools to use while doing this.
We will discuss in your initial assessment any sleep aids you are using and which plan might be best for you.
I’m struggling with depression, anxiety, or other mood problems. How can just targeting my sleep help?
What we know is that when we improve people’s sleep, often their mood symptoms show improvement as well because sleep and mood are closely related. Although you may need additional treatment for your mood symptoms, first fixing your problems with chronic insomnia may provide significant relief and better outcomes in your treatment for depression/anxiety.
Do I need a sleep study?
Maybe. CBT-I is meant to treat insomnia. Many people believe they have insomnia, but instead they have medical conditions such as sleep apnea, restless legs syndrome (RLS), or periodic limb movement disorder (PLMD) that are causing their sleep problems. These conditions require assessment and treatment by a medical doctor. If you are unsure if you have one of these conditions, glance over the following questions below. If you find yourself answering “yes” to many of the screening questions, I strongly advise you to consult with a doctor who is board certified in sleep medicine. After successful treatment of these conditions, you may find that you still have insomnia. If that’s the case, CBT-I may be a great option with you in conjunction with your medical treatment.