CBT-I: Retraining Sleep Behaviors to Overcome Insomnia

Key Quotes

"The longer it went on, the more he fixated on the issue. And this is the cycle that ultimately, if it continues, leads into insomnia where it becomes more of a steady, consistent problem."

Steve Orma, a clinical psychologist, explains how fixation on sleeplessness can escalate occasional bad nights into a chronic insomnia problem. Orma's personal experience highlights the psychological component of insomnia, where worry itself becomes a significant driver of the condition. This demonstrates that addressing the mental state is crucial for managing persistent sleep issues.

"But sleep, unfortunately, isn't something you can achieve or can even try to do. It's something that happens to you. That can be hard to swallow in this era of constant self-optimization, but when it comes to sleep, doing less is often doing more."

This quote from the podcast emphasizes a counterintuitive aspect of sleep: it is a passive state, not an active achievement. The experts suggest that in an age focused on self-improvement, the approach to sleep should be one of allowing it to happen rather than forcing it. This highlights a potential conflict between modern productivity culture and the natural requirements of sleep.

"See, Steve says often the go-to advice for sleeplessness is practicing better sleep hygiene. And we are not knocking that. Sleep hygiene is all about establishing healthy routines like not eating large meals too late at night, limiting naps, and creating a conducive environment for good sleep. Make your room dark, make your room quiet, make it cool. And all those things are great until you have insomnia, which is a set pattern. Sleep hygiene doesn't do anything."

The podcast explains that while sleep hygiene practices are beneficial for general sleep health, they are insufficient for individuals experiencing insomnia. Steve Orma points out that insomnia is a "set pattern" that sleep hygiene alone cannot address. This analogy suggests that sleep hygiene is like dental care for healthy teeth, but it cannot fix a cavity, which requires a more targeted intervention.

"In CBT-I speak, this is a stimulus control practice, aka making deliberate choices about when you're getting in and out of bed that can help to address conditioned arousal, which is just the fancy scientific phrase for when someone's relationship with their mattress gets turned upside down from too many nights of sleeplessness."

This quote introduces the concept of "stimulus control" within Cognitive Behavioral Therapy for Insomnia (CBT-I). The explanation clarifies that this practice involves intentionally managing time spent in bed to counteract "conditioned arousal." Conditioned arousal is defined as the brain becoming accustomed to associating the bed with wakefulness rather than sleep, a common issue for those with insomnia.

"So if you must track, he says, do so with purpose and a specific goal in mind. You know, measurement without guidance is is where we run into problems. How are you using that information? Is that information helping you make changes in your behavior or your lifestyle that are helpful or is it stressing you out and making the insomnia worse?"

This quote from the podcast addresses the use of sleep trackers and introduces the concept of "orthosomnia." The expert advises that sleep tracking should be purposeful and goal-oriented, rather than simply collecting data. The core issue highlighted is that without a clear objective, the information from trackers can become a source of stress, exacerbating insomnia rather than helping to resolve it.

"In CBT-I, this is called cognitive restructuring, recognizing and replacing your negative sleep thoughts with more accurate and positive thoughts. For example, instead of fixating on how bad your last night of sleep was, you could look ahead. Your body will take care of you, right? Like it's like, you know, when we deprive people of sleep in the laboratory, and we let them sleep the next night, they immediately drop into deep sleep, right? That restorative sleep."

This quote explains "cognitive restructuring" as a technique within CBT-I, focusing on changing negative thought patterns about sleep. The expert suggests shifting focus from past poor sleep to the body's natural ability to recover. The example of laboratory sleep deprivation studies illustrates the body's inherent compensatory mechanisms for sleep, offering a more positive and accurate perspective on sleep recovery.