5 May 2022

Science Shows Treating A Sleep Disorder With Therapy Yields Lasting Results

Written by Victoria Wise

If you’re struggling with a sleep disorder, you’re not alone. According to the Institute of Medicine (US) Committee on Sleep Medicine and Research, an estimated 50–70 million adults in the US have a sleep-wake disorder of some kind.¹

Between 33–50% of the population have the most common sleep disorder of all — insomnia.²

Another prevalent sleep disorder is obstructive sleep apnea (OSA) which affects roughly 27% of males and 23% of females.³

An unmanaged sleep disorder can impact many aspects of your health, including mental health, chronic pain, weight management, and more. So, it’s vital to seek qualified help for persistent sleep issues for various reasons. For instance, research on pain-sleep interaction shows growing evidence that even a single night of sleep deprivation is connected with worse pain the following day.⁴

You may have noticed that many products are touted for quickly treating sleeplessness—ranging from melatonin tablets to CBD gummies and even sleep hygiene apps. However, evidence suggests that cognitive-behavioral therapy (CBT) may be the most effective treatment for a sleep disorder.

What is a sleep disorder?

Everyone has the occasional poor night’s sleep, but a clinical sleep disorder affects multiple aspects of your sleep-wake cycle, including:

  • How long you sleep

  • When you sleep

  • Sleep quality (how rested you feel) 

Disordered sleep is also characterized by

  • Daytime sleepiness

  • Emotional distress

  • Impaired function

  • Lasting at least three months and affecting you most days

At least 80 types of recognized sleep disorders exist

There are many medically recognized sleep disorders. Some of the most common major sleep disorders include:

Insomnia - Difficulty falling asleep

Sleep apnea - Abnormal breathing while sleeping

Restless legs syndrome - Characterized by the intense urge to move your legs

Narcolepsy - Falling asleep suddenly and having extreme sleepiness

Nightmare disorder  - Frequent terrifying dreams that cause distress

Note: Insomnia and lack of sleep are two different things. Insomnia means that you can’t sleep, even when you have a chance. Many people are sleep deficient due to noise disturbances, taking care of a newborn, shift work, and other life factors. As frustrating as those reasons for lack of sleep can be, they are separate from insomnia or other clinical sleep-wake disorders.

How much sleep does a person actually need?

Sleep requirements differ with age. The following guidelines via the Centers for Disease Control and Prevention (CDC) suggest the ideal amount of sleep per day, including naps.⁵

Daily Sleep Recommendations

Babies and children need more sleep because their still growing and developing. Getting sufficient sleep is crucial for their focus, learning, and memory.

Risks of untreated sleep deprivation

In one prospective study that interviewed 47,860 individuals over 20 years, researchers found that disturbed sleep is a predictor of accidental death at work.⁶

A 2013 report from the National Center for Health Statistics linked inadequate sleep to seven out of 10 of the leading causes of death in the US.⁷ ⁸ These causes of death include:

  • Accidental injuries (particularly driving and work-related)

  • Cancer

  • Heart disease

  • Diabetes

  • Septicemia (infection)

  • High blood pressure

  • Cerebrovascular disease (conditions that affect blood flow to the brain)

Research also links poor sleep with obesity.⁹ It’s important to understand that sleep isn’t just restorative for energy— it also helps regulate metabolic functions, like hormone production. Hormonal disruptions can impact how much you eat, what you eat, and how satisfied you feel after eating.

Unfortunately, being overweight can put you at a higher risk for obstructive sleep apnea (OSA), which reduces sleep quality and can lead to heart disease and diabetes. Conversely, healthy weight loss can improve sleep apnea symptoms for some individuals.¹⁰

Sleep medication or cognitive-behavioral therapy?

Sleep medication is a vital treatment option for addressing acute situations involving lack of sleep, like extreme stress or grief. However, it’s possible to become dependent on sleeping pills or experience side effects like memory loss, drowsiness during the day, high blood pressure, or depression.¹¹

Consequently, researchers are highly interested in alternatives to using pharmaceuticals to treat sleep disorders. 

Guidelines from the American College of Physicians (ACP) and the American Academy of Sleep Medicine recommend CBTI as the first line of treatment for chronic insomnia. However, if CBTI is unsuccessful, a healthcare provider can have a detailed conversation with you about the suitability of sleep medication and its risks and benefits.¹²

A systematic review and meta-analysis found that CBTI was more effective at treating chronic insomnia than medication.

The group with CBTI (cognitive-behavioral therapy for insomnia) had the most significant changes in the ability to sleep (and stay asleep). A key finding was that the benefits lasted up to a year after treatment had ended.¹³

Similarly, a small, randomized controlled trial with 46 participants found that interventions with CBTI were better for both short and long-term management of chronic insomnia than using the sleeping pill Zopiclone.¹⁴

What will cognitive-behavioral therapy be like?

Cognitive-behavioral therapy for insomnia (CBTI) is a specific style of therapy that targets insomnia. CBTI explores the connections between your thinking (cognition), behavior, and sleep. 

During a typical CBTI treatment, a trained professional will help you pinpoint thoughts, feelings, and behavioral patterns that contribute to insomnia. The therapy will be conducted by someone with specialized CBTI training, usually a psychologist, psychiatrist, or medical doctor.⁷

The therapy session may be one-on-one with a therapist, in a group of people with similar sleep concerns, or even online. 

Therapy usually lasts for 6-8 sessions, but the duration will depend on the severity and exact type of sleep disorder you have.¹⁵ Treatment provided by a primary care doctor may be as short as two sessions. 

Sessions are typically weekly or bi-weekly and last 30–60 minutes. Although CBTI is rarely a quick cure, it can yield improvements within just a couple of sessions. 

CBTI is a multi-component treatment, meaning that it combines several approaches. Your therapy sessions may include educational, cognitive, and behavioral components.

Since the symptoms and causes of sleep disorders greatly vary, your CBTI practitioner will tailor the treatment for your needs.

CBTI techniques

Depending on the severity of your symptoms, your CBTI practitioner may recommend a combination of the techniques below.

Stimulus control therapy

Stimulus control focuses on improving your sleep habits. You may be encouraged to:

  • Set a consistent time to wake up and go to sleep

  • Only use your bed for sleeping or having sex

  • Avoid using your phone in bed

  • Resist daytime naps

  • Leave the bedroom if you can’t fall asleep within 20 minutes 

Sleep restriction

Sleep restriction cuts the time you spend in bed because lying in bed awake can aggravate sleeplessness. Restricting sleep results in mild sleep deprivation, making you more tired the next night. Once your sleep improves, you’ll slowly increase your time in bed. Note: Sleep restriction is not suitable for everyone. Your CBTI therapist must know your full medical history and any other health conditions that might be present before using this tactic.

Staying awake

Staying passively awake, sometimes called “paradoxical intention,” means you’ll actually avoid any effort at sleeping. The name of this tactic alludes to a common paradox that feeling anxious about being unable to sleep may be the contributing factor in keeping you awake. Putting this worry aside and letting go of any effort can make it easier to fall asleep.

Sleep hygiene

Sleep hygiene refers to lifestyle choices that impact your sleeping habits. Generally, healthy sleep habits include: avoiding caffeine later in the day, exercising regularly, abstaining from or limiting alcohol intake, and quitting smoking.

Improving the sleep environment

Assessing your sleep environment and making it more comfortable may include not having a TV or clock visible in the room, putting your phone away, and ensuring that the room is dark, quiet, and cool. 

Relaxation training

Using muscle relaxation, meditation, calming imagery, and similar training methods can help prepare you for a restful sleep.

Biofeedback

Biofeedback involves learning to recognize your biological signs like heart rate and muscle tension, and how to adjust them. Your sleep specialist may suggest a biofeedback device to record your daily patterns. This information can help you identify practices that affect your sleeping habits.

70 to 80% of patients with insomnia improve with CBTI

Multi-component CBTI is effective. A meta-analysis showed that as many as 70-80% of patients see an improvement in their insomnia symptoms.¹⁶ The benefits included more time asleep, less time to fall asleep, and waking up less during sleep. The best part? Participants often maintained these results over time.

CBTI was also effective for groups at particularly high risk of experiencing insomnia, such as pregnant individuals, those experiencing post-traumatic stress disorder (PTSD), or having insomnia after cancer treatment. It’s even more effective than medication in some patients.

Interestingly, a randomized control trial indicated that CBTI can provide benefits for people dealing with short-term insomnia. So, CBTI may relieve insomnia, even if you don’t meet the clinical criteria for chronic insomnia.¹⁷

As with most types of therapy, CBTI doesn’t always start working immediately. Certain techniques you’ll learn will take time to practice and integrate into your routine. Some of the methods may involve a significant change to your habits, so it’s helpful to take things slow. Techniques like sleep restriction and stimulus control are gradual.

You may find it beneficial to track your progress over time with note-keeping or a sleep app to stay motivated by the improvements you might not notice otherwise.

In situations where CBTI doesn’t yield the outcome, you’re hoping for, the American College of Physicians recommends talking with your doctor about the appropriateness of using sleep medications along with CBTI treatment.

Lifestyle changes to complement CBTI

Increasing physical activity

Adding a 30-minute exercise session to your day can cut down on how long it takes you to fall asleep. Exercise can also help you sleep longer. 

Making healthy lifestyle choices

Limit or avoid alcohol and caffeine, and don't use nicotine—they can make it harder to sleep, and the effects can last for several hours.

Reducing stress and anxiety in your life

Stress, anxiety, or depression may cause sleeping problems or make an existing problem worse. Managing stress and maintaining a calm, positive outlook can help you sleep better.

Sticking with therapy

CBTI addresses the underlying cause of your insomnia, unlike sleeping pills which only relieve symptoms. Therefore, it’s important to stay the course with your treatment even if you don’t feel like it’s working right away. 

Speak to your therapist about any concerns, and they’ll help assess and optimize your treatment for maximum effectiveness.

If you’re feeling discouraged, remember that CBTI can take a while to get results, but it is the leading treatment option for long-term insomnia relief.

How to find a CBT-I specialist

Certified Behavioral Sleep Medicine specialists aren’t always widely available. You may have to search for a trained practitioner.

If you are interested in finding a CBTI specialist near you, consider referring to directories provided by professional organizations like the Society of Behavioral Sleep Medicine and the American Board of Sleep Medicine

Your doctor may also be able to refer you to a specialist. Your local hospital or major university may also offer group therapy classes or workshops.

The lowdown

Living with any form of sleep disorder can be incredibly frustrating and isolating. Fortunately, sleep disorders are becoming increasingly treatable. CBTI has the potential to significantly improve your quality of life if you have insomnia, and it may also treat nightmare disorders. If you have a mild case of sleep apnea, weight loss and sleeping on your side can reduce symptoms. More complicated cases may require a CPAP machine. Restless legs syndrome treatment usually involves lifestyle changes like butting out cigarettes, keeping good sleep habits, and not consuming stimulants before bed, like coffee. You may need medication in some cases. Regardless of which sleep disorder you have, there is help available. If traditional treatments don’t work for you, clinical trials are constantly looking at different treatments for sleeping disorders, so don’t despair. Speak to your doctor to get started on the most appropriate treatment for you.

The information provided is designed to support, not replace, the relationship that exists between a patient/site visitor and their existing health care professional(s).

Have feedback? Send an email to content@healthmatch.io.

Sources:
  1. Sleep disorders and sleep deprivation (2006)

  2. Clinical guideline for the evaluation and management of chronic insomnia in adults (2008)

  3. Sex differences in obstructive sleep apnoea (2019)

  4. Insomnia co-occurring with chronic pain: Clinical features, interaction, assessments and possible interventions (2008)

  5. How much sleep do I need? | Centers for Disease Control and Prevention

  6. A prospective study of fatal occupational accidents – relationship to sleeping difficulties and occupational factors (2002)

  7. Mortality in the United States, 2013 (2014)

  8. Mortality in the United States, 2013 | Centers for Disease Control and Prevention

  9. Sleep and obesity (2013)

  10. Interactions between obesity and obstructive sleep apnea (2010)

  11. Sleeping pill symptoms and warning signs | Addiction Center

  12. Management of chronic insomnia disorder in adults: A clinical practice guideline from the American college of physicians (2016)

  13. Cognitive behavioral therapy for chronic insomnia : A systematic review and meta-analysis (2015)

  14. Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults : A randomized controlled trial (2006)

  15. Treatment of adult insomnia with cognitive-behavioral therapy (2010)

  16. Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis (2015 - PubMed)

  17. Is digital cognitive behavioural therapy for insomnia effective in treating sub-threshold insomnia: a pilot RCT (2020)

General sources:

Victoria is a writer from the UK with a keen interest in health and science. She loves writing about mental health, scientific advancements, and dispelling pseudoscience. When she’s not writing sass-laden articles, she walks her rescue dogs, giggles at anxiety memes, eats chocolate, and absorbs useless knowledge for quiz shows.

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