CBT-I: The Gold Standard Treatment for Insomnia
If you’re dealing with insomnia, Cognitive Behavioral Therapy for Insomnia (CBT-I) is the gold-standard treatment. I explain what CBT-I is and why it’s so effective. If you want to overcome insomnia for good, this is the process you want to follow.
// SLEEP SERVICES //
https://www.drorma.com/insomnia-services
// SUBSCRIBE //
Put Insomnia to Bed channel https://www.youtube.com/c/PutInsomniaToBed
WHAT I DO:
I help people overcome insomnia and get good sleep (without medication, drugs or supplements).
To Your Sleeping Better!
-Steve
00:00 Introduction to Insomnia and CBTI
00:27 What is CBTI?
01:30 The Structure and Process of CBTI
03:07 Key Skills in CBTI
07:27 Personalization and Common Mistakes in CBTI
08:25 Why CBTI is the Gold Standard for Insomnia
09:05 Effectiveness and Benefits of CBTI
10:52 CBTI vs. Sleeping Pills
11:54 Long-term Success with CBTI
13:56 CBTI for Various Demographics and Conditions
15:41 Conclusion and Further Resources
VIDEO TRANSCRIPT
Introduction to Insomnia and CBTI
If you're dealing with insomnia, then you want to pay close attention to this video. What I'm going to talk about today is the gold standard treatment for insomnia, which is called Cognitive Behavioral Therapy for Insomnia, or CBTI.
And this is a series that I'm going to start for this channel, where I go into different aspects of CBTI, answer a lot of different questions people might have, describe in general what the treatment involves and why it's so effective, for insomnia.
What is CBT-I?
So first I'm going to go over what is Cognitive Behavioral Therapy for Insomnia or CBT I. And then I'll talk about why CBT I is the first line treatment for insomnia.
So what is CBT-I? CBT-I is a structured treatment for overcoming insomnia. And for establishing a healthy pattern of sleep and being able to maintain it for life.
Essentially If you have insomnia, if you're having difficulty falling asleep, staying asleep, waking up early in the morning, or even a combination of these things, then this is the gold standard [00:01:00] treatment to help you break that pattern and get back to a normal, healthy pattern of sleep. Or if you've never had that, to be able to establish that and then maintain that for the rest of your life.
So when I say it's a structured treatment, I mean, this is a treatment developed specifically just for insomnia. There's a treatment called CBT, which is the kind of umbrella type of treatment that is used for many different things like anxiety and depression. But CBT I is specifically for insomnia.
The Structure and Process of CBT-I
Now the treatment generally takes between 5 to 8 weeks to learn the core skills. It takes longer than that generally to get completely past insomnia. But to learn kind of the core key skills, it takes about five to eight weeks and it's sequential.
And what you're doing each week is you're learning one or two key skills that you then apply to your sleep at night. And then the next week you learn a couple more skills and you build on what you learned the previous week. So it's a layered treatment [00:02:00] that builds over several weeks.
And the reason we do that is to not overwhelm you or overwhelm your body as you're going making these changes with your sleep.
It's a little gentler of a process, but essentially by the third or the fourth week of the process, you're applying everything and then you're adjusting every week based on certain key things that I'll cover here in a minute. So you're building these skills up over several weeks.
The other thing about CBTI is it's not like regular therapy. It's not like talk therapy where you just go to a therapist and just talk about the problem and tell them all about your sleep and how much you're struggling with it. I mean you probably will do that in a first session or if you're trying to figure out if you have insomnia. But once you do that you really need to start changing your behaviors.
This is mainly a behavioral process. You're changing your actual sleep behaviors around the way you're going about sleeping each night, and it's that that actually fixes the sleep.
So it's really about learning [00:03:00] skills in each session or each week is your learning skills. It's more like a class rather than talk therapy.
4 Key Skills in CBT-I
There are really four key skills to CBT I and these are really the core skills. There's a few other skills and other things that you learn as you go through the process, but these four are really the key things and you really need to be doing all four of these for CBT I to be effective.
Many times CBT I is not done incorrectly, it's implemented correctly, or it's taught incorrectly by therapists because they're not very familiar with the treatment or they're not experienced and they'll just leave things out. They'll just do like one thing or two things. You really need to do all four of these things in a certain sequence for it to be effective.
So the first thing is a sleep log. Now a sleep log is really important because it's how this treatment is personalized to treatment itself is the same core skills and the same process, but how you apply these [00:04:00] four key skills is going to differ depending on your particular pattern of sleep and a lot of other things. Like, are you taking medication? And if so, what dosage and what other things are you doing?
And we want to make sure that we're applying the skills to your sleep pattern so it fits your sleep like a glove.
So the sleep log is to be able to capture certain key numbers that we use to then personalize the skills and it's pretty simple. When you wake up each morning, you open your sleep log and you just spend a few minutes answering a few questions about your sleep and what happened that night. And then you just continue to catalog that as you go through the process.
This also shows you how you're making progress. It shows us where the problems are. So it's really important to have the sleep log.
The second is what's called sleep scheduling. Now this is sometimes called sleep restriction. I don't use the term sleep restriction, I use sleep scheduling. And the reason for that is sleep restriction is a very misleading term. It's kind of a scary thing. I'm going to restrict my [00:05:00] sleep. You actually don't restrict your sleep.
And when they talk about restriction, they mean the amount of time that you give yourself in bed each night for sleep.
Generally, people are spending way too much time in bed awake when they have insomnia versus asleep. And that is one of the main things that causes insomnia because it lowers what's called your sleep efficiency. It weakens your sleep system. So we don't want that. But we don't want to shrink down the time that you're in bed so much that it's like impossible for you to be able to get a decent amount of sleep And we never restrict it lower than the amount you've actually been sleeping in terms of your average. And we even add an extra buffer of time to do that.
So that's why I call this sleep scheduling which is creating a bedtime a wake up time and the amount of time in bed based again on your data or your numbers from the last week that we're tracking with the sleep log. That's a very, very key skill to this process.
The third one is what I call 30 30. But it's, often called Stimulus Control, and I don't like that term, it sounds very [00:06:00] clinical. But all this is, is basically we don't want you, even once you have a structure and a schedule for your sleep, even then you're still going to experience insomnia at the beginning because you have insomnia and it takes a little time to break the pattern.
And when you're having difficulty sleeping, you don't want to just hang out in bed because that feeds the problem. And instead, at a certain point, you're going to get out of the bed. And you're going to do certain things. And this has to be done in a certain way, and with a certain frame of mind. It should actually help you calm down, and it actually is a very powerful skill to break the pattern of insomnia. So that's skill number three.
And the last one is just being able to manage your thoughts and emotions as you're going through this process. There's a lot of anxiety, which is very normal with insomnia. It's called sleep anxiety where you're having what are called negative sleep thoughts or NSTs.
And those are just things like, Oh my God, like what's the matter with me? I can't sleep anymore. I'm never going to get over this. It's going to be another horrible night of sleep. These are all called negative sleep thoughts. And they're a normal part of [00:07:00] having insomnia, but they can be a problem when you're going through this process of getting over insomnia because they could sidetrack you and get you kind of spinning and pulled into your own thoughts.
So it's really important to know how to manage your own thoughts and your own emotions, anxiety or frustration or worry, as you're going through the process, so you can stay on track, and that's really key.
So these are the four key skills that should be involved when you're doing CBTI. If any of these are missing, then you're not really getting the full CBTI.
Personalization and Common Mistakes
And it's generally not going to be as effective or effective at all, because it's a combination of things that address the underlying problem.
And as I said, this should also be personalized. Quite often CBTI is done in a very generic way where you go see a therapist or a provider and they just give you kind of a generic way of going about applying the skills that they use with every client. They do the same thing with every client.
And this just doesn't work because everybody's bodies are a [00:08:00] little different. Their biology is different around sleep. Their pattern of insomnia is very different, like you might have difficulty falling asleep, some people have difficulty staying, some people have both. And what that pattern looks like can vary each night. And so we want the skills to be applied, personalized to you based on that pattern instead of just sort of in a general generic way. That's very key.
Okay, so that's a general overview of CBTI.
Why CBT-I is the Gold Standard
Now, why is CBT I, why is this process the first line treatment for insomnia, the gold standard for insomnia?
First of all, this treatment's been around a long time. It's first developed in the 1970s and it's been developed over all those decades, studied, it's been in many, many studies.
So it was developed at places like Stanford University, Harvard, many other places around the United States. And so it's been improved better and better and better over time. And it has a very high success rate.
And so because of that, we know it's a very effective treatment and because it's been studied on so many different [00:09:00] people, that's how we know that this is the gold standard.
As I said, it's also highly effective. So.
Effectiveness and Success Rates
It's been studied on thousands of people and in those studies it's been shown to improve sleep 75 to 80 percent of people, a really large number of people that are going through CBTI.
And the benefits of it include less time to fall asleep, more time spent to sleep, and waking up during sleep.
Now what I've found in my own program and what I've worked with clients is that the success rate can actually be a hundred percent. What these studies don't include is the person's commitment to the process and really getting expert guidance, but particularly the commitment because this is a behavioral treatment.
It's kind of like, You might go to the best personal trainer in the world and they give you the perfect workout, but if you don't do it and you don't stick with it, you're not going to get the benefit. Or if you are trying to lose weight and you go to a really good dietician or nutritionist and they give you this amazing plan for how to transform your eating and your diet, you [00:10:00] don't follow it or you don't stick with it, it's not going to work over time.
And I think that's what the 20 to 25 percent of people that don't fully get over insomnia with CBTI, it's because of the commitment.
What I've seen in my own program is the people that come in and they're just kind of done with insomnia and they're ready to get over it and they're willing to go through the process and stick with it, with my support and my help, the success rate is nearly a hundred percent. would say it's a hundred percent in terms of they always get improvement and they always make progress on their sleep and they get to a way better place. Or they get completely past the insomnia and establish a healthy pattern of sleep because they're coming in with that commitment.
And because CBT I is just addressing the underlying core issue that's causing the insomnia, it's just undoing the problem. And everybody has the ability to sleep. You don't lose that ability. So we're just reestablishing that through this process.
CBT-I vs. Sleeping Pills
It also works better than sleeping pills. So it's been studied against sleeping pills, things like Ambien, and it's been proven to be more effective than sleeping pills. [00:11:00]
There's no side effects because you're not taking a medication. In fact, in the second week of CBTI, there's an option that if you're taking medication, whether it's over the counter or prescribed or you're doing CBD or THC or anything like that, there's a way to taper off of it safely. You're given a plan to taper off it safely, and you share that plan with your physician and they give their sign off on it. It's a very conservative plan.
And therefore you're coming off medication while you're actually implementing skills and changes to your sleep that will address the core issue that the medication isn't.
Now, you don't have to come off medication. If you don't want to, you can do this treatment and continue taking the medication and come off it later. But you do have that option if that's something that you want to do. But the CBTI treatment alone has no side effects because all you're doing is changing your behaviors around the sleep. So it's perfectly safe. It's perfectly natural.
Long-term Benefits of CBT-I
It also maintains improvements in sleep long term. This is something that medication doesn't do. Medication [00:12:00] generally, if it works at all, it doesn't work for that long. And then you have to change to another medication. You have to increase the dosage. You have to keep kind of being stuck in that cycle. And also medications will interfere with your sleep cycle and the quality of the sleep.
With CBT I, once you get past the insomnia, as long as you continue just practicing the general principles good sleep, you'll maintain it, for indefinitely.
Like I had insomnia 10 years ago, that's how I got into this as a specialty. I used the same exact process to overcome insomnia myself. And because you learn relapse prevention, in other words, you learn how to prevent insomnia from coming back at the very end of the process, then you never go back to insomnia.
So I haven't had a relapse. I haven't had insomnia come back again in 10 years because I know how to respond to the things that could lead to insomnia like stressors or if you're traveling and there's changes in time, things like that, that interfere with sleep, you don't slip back into the pattern.
And this actually has been [00:13:00] studied. CBTI has been studied up to 10 years post treatment and the people that they've studied, we're still able to maintain good quality sleep, have no insomnia because they maintain the basic principles.
And in fact, usually what happens is people's sleep get better and better over time as they continue to apply these skills.
It's also so effective, as I said, because it addresses and reverses the underlying root causes of insomnia. These are poor sleep behaviors, and these are negative sleep thoughts.
These are the things that actually create insomnia and maintain it. What happens is most of the other things that are recommended for insomnia, like medication and sleep hygiene, they do not address the underlying root causes. So they might have some benefit in the short term, but they never actually address the core issue.
And therefore they don't really cure or get rid of the insomnia. They just sort of mask it or they, sedate you if you're taking a medication, but they don't address core issue..
CBT-I for Various Demographics and Conditions
CBTI, as I said, has also been used successfully on [00:14:00] hundreds of thousands of people. And it's been studied on people of all ages, genders, ethnicities, races, education. It doesn't matter. It doesn't discern between any of these things. It doesn't matter what your income is, how successful you are in your life. Even how healthy you are and how in good shape you are. I've seen a lot of people in my program, they're extremely fit. They exercise, they run. They have good diets and they still get insomnia because , one doesn't have anything to do with the other.
So it doesn't really matter from what walk of life you come from. It's effective for just about everybody.
It's also been proven effective if you have co occurring issues. So a lot of times when people have insomnia, they have other issues going on like pain, fibromyalgia. You might be pre menopausal or going through menopause or you're having hormonal changes.
You might be dealing with depression or anxiety or other medical issues.
And CBTI improved those other issues. CBTI doesn't directly address PTSD or depression, but just by getting past [00:15:00] insomnia and restoring healthy sleep improved these other issues because sleep has such an impact on the overall functioning of the body.
And also there was a study with CBTI in over 10, 000 sleep clinic patients at Harvard and the University of Massachusetts Medical Schools. And what this study showed is that 90 percent of the patients who were using CBT I reduced or eliminated sleeping pills with CBT I.
So if you're taking medication and you want to come off it and you want to get unstuck from that cycle, CBT I will help you do that in a safe way and also reestablish a normal healthy pattern of sleep where you don't have to rely on the medication and it's highly successful.
Conclusion and Further Resources
Lastly, all of these organizations recommend CBTI as the first line gold standard treatment for insomnia. So that's American Academy of Sleep Medicine, American College of Physicians, American Psychological Association, National Institutes of Health, New England Journal of Medicine Review, Lancet [00:16:00] Review, Consumer Reports and many other associations recommend this because of all the things that I went over.
So if you are dealing with insomnia, if you're struggling with insomnia and you have tried everything under the sun like sleep hygiene, medication, supplements, herbal remedies, CBD, meditation, acupuncture. I mean these are the things that are commonly recommended for insomnia and you have not tried CBT I, then look into CBTI.
And you can get more information here on my website, it's drorma.com, drorma.Com. I have other resources on there, you can get more information about this.
And I'm going to be doing many other videos in this series on CBTI. I'll start creating a playlist as well where I'll put those where I'll kind of address other aspects of CBTI, what's involved in it. There's a lot of myths and misconceptions.
And if you have any questions about CBTI, then just leave those in the comments section below. If you found this video helpful and informative, then just press the like button to let me know [00:17:00] and let others know so they can hear about this treatment that a lot of people really don't know about.
And then leave any comments and ask questions about CBTI and then I can include those in other videos or make a whole video just on your question if I think it's really a common question.
And I'll see you next time.