Cognitive Behaviour Therapy for Insomnia: Interestingly in the Sleep Conference the Neurologist were recommending only CBT as long term management for Insomnia. Well shared my work experiences on CBT-I with the Neurologists.

1. Psychological Therapy for
Insomnia: Cognitive Behaviour
Therapy
Ravi Samuel MA, MPhil, PGCARM(Lond)
Psychotherapist
Chennai

2. Presenting complaint Insomnia





Anxiety
Depression
PTSD
Burn out IT/BPO
Grief Reaction
Neurologist
Psychiatrist
General Practioner
Psychotherapist
Detailed Evaluation is very essential to
diagnose the primary cause of insomnia!
Primary or secondary to a more
established physical or psychiatric
condition.

3. Dynamics of person with
insomnia
Irritability / Distress
 Desperation to sleep
 Anxiety
 Fail to acknowledge the little
 Negative statements and
interpretations
 Higher level of distress
 Affects the day time functioning
significantly


4. Difference in obj. and sub.

Subjective and Objective Element
Sleep disturbance can cause extreme
distress
Can adversely affect the day time
functioning
Can adversely affect the person’s mood
The reaction to Insomnia can further affect
the sleep disorder.

5. Cognitive Behaviour Therapy

Anxiety / Depression

Stress (will vary with person)

Unrealistic Expectations

Cognitive Errors

Coping with life events, change, loss,
exams etc.

6. Cognitive Behaviour Therapy
Thoughts:
 Emotions: interpretations and
reasoning
 Behaviour:
 Beliefs:
 Thought processes (whatever the
situation is there mind will come with a
negative outcome)
 Attitudes: Superiority over others /
Inferiority over others etc.


7. Efficacy



Nile Wagley et al. (2013) Effectiveness of
CBT-I in Psychiatric Outpatients. Journal
of Clinical Psychology. Vol 69(10) 10431055.
Okajima et al (2010) A meta-analysis on
the treatment effectiveness of CBT for
primary insomnia. Sleep and Biological
Rhythms. 9. 24-34.
Mathew et al (2012) Comparative
effectiveness of CBT for Insomnia: a
systematic review. Bio Medical Central
13

8. CBT

Looks very simple and common sense
oriented but…

Process

Emotionally sensitive

Individualized to suit patient’s
intelligence, cognition and emotional
state.

9. Insomnia

Stress

Life Events

Life Style

Psychological Problems

Psychiatric Problems

10. Sleep Hygiene – common sense
advice
Each person has a time and way of
sleeping!
9 – 4am!!
 Sleep wake time
 What and not to drink
 Avoiding Caffeine
 Avoiding Clock – as it increases the
anxiety levels
 Avoiding Alcohol
Known to be effective with other forms of
therapy not independently to restore sleep!


11. Stimulus Control
Mathew et al (2012) Cog and Beh. Treatment options
for Insomnia. Mount Sinai Journal of Medicine 79: 512
 Go to bed only while feeling sleepy

Bedroom is for sleep and sex

If not getting sleep for 10 minutes go to
another room

Get up the same time

No naps during the day

12. Sleep Restriction Therapy

Depending on the sleep log of the
patient a sleeping time is allotted so
also wake up time.
Sleep Efficiency is calculated: Time
slept/time in bed X100.
 85 % Sleep Efficiency is expected.
Accordingly the time in bed is reduced
or increased.


13. Paradoxical Intention

The mind does exactly the opposite of
what we want to do!

This works for patients who are
desperate to sleep. (Clinical judgment
has to be used as to how the patient’s
mind works)

It will be a good idea not to tell the
patient that it is to make him sleep we
are asking him to be awake.

14. Jacobson’s Progressive Muscle
Relaxation Therapy

Reduces the anxiety

Increases physical exertion

Induces sleep due to the lengthy procedure
which occupies their mind.

Helps them to take their mind off from their
real life concerns and sleep issues.

60 per cent of the people respond very
positively at this stage of the treatment itself!

15. Case I

55 year old man with insomnia for
three months.

Change of technology has took him
out of business
“How will I spend my retired life”
Difficulty in coping with change

16. Case II


23 year old Lady after her PG got insomnia.
Week of sleeplessness drove her to marijuana
and alcohol.
Psychological Evaluation: Depression
Difficulty in accepting the fact that she is not
being accepted by a boy for marriage
 Uncertainty about her studies and career
 Changing her unrealistic goals of going to USA



Not interpreting the rejection as personal
rejection – but to see the other possible
explanations and reasons.

17. Case III

28 year man having sleepless nights:
His wife was expecting. Extreme
tension in the night about his career,
future of the family
Jacobson’s Relaxation Exercise
 CBT towards faulty beliefs and life
style.


Restored normal and refreshing sleep.

18. Conclusion
CBT is an effective therapeutic approach
to address cognitive, behavioural and
life style issues to promote sleep.

19. Thank You
Ladies and Gentlemen