How to Make CBT for Insomnia Even More Effective

by Martin Reed Patient Advocate
*Credit: iStock*

Cognitive behavioral therapy for insomnia (CBTI) is recommended as a first-line treatment for insomnia by professional organizations such as the National Institutes of Health and the British Association for Psychopharmacology. The American Academy of Sleep Medicine recommends CBTI as a generally accepted insomnia treatment strategy with a high level of clinical certainty.

How effective is CBTI?

One study found that between 70 and 80 percent of individuals benefited from cognitive behavioral therapy. However, only 40 percent of individuals achieved clinical remission.

So although CBTI can improve sleep, there is still room for improvement.

A study published in the journal Clinical Psychology and Psychotherapy set out to investigate whether additional sessions of cognitive therapy or mindfulness-based therapy could make CBTI more effective.

Participants in the study were enrolled in four one-hour sessions of CBTI, then randomly allocated to one of two treatments; four additional one-hour sessions of cognitive therapy or four one-hour sessions of mindfulness-based therapy.

CBTI typically involves:

The additional cognitive therapy sessions set out to correct:

  • Worry

  • Unhelpful beliefs about sleep

  • Selective attention and monitoring

  • Misperception of sleep and daytime tiredness

  • Safety behaviors (such as spending too much time in bed)

What is mindfulness therapy?

Mindfulness is the process of concentrating thoughts and awareness on the present, rather than the past or the future. Practicing mindfulness can help you identify negative thoughts and redirect your attention to the present.

Mindfulness is based on meditation and involves focusing attention on aspects such as breathing, awareness of the body, and environmental sounds.

Does mindfulness therapy work?

A review of 22 studies found mindfulness-based therapy beneficial for conditions such as:

How does mindfulness therapy improve sleep?

Mindfulness helps address stress and worry-related arousal that is common in insomnia sufferers. It can also help you accept your current sleep situation and reduce the temptation to try forcing sleep, which can actually make sleep more difficult.

The Clinical Psychology and Psychotherapy study found that after four sessions of CBTI, there were significant improvements in insomnia symptoms, sleep efficiency, and sleep duration.

It also found the additional cognitive therapy sessions and mindfulness-based therapy sessions both further significantly improved insomnia symptoms, total sleep time, wakefulness after sleep onset, and sleep efficiency.

Mindfulness for the digital age

You don't necessarily need to visit a therapist if you want to give mindfulness a try. Digital mindfulness platforms can help you incorporate meditation and mindfulness into your day at a time and place that suits you.

Yunha Kim, the founder and CEO of the personalized meditation app Simple Habit, points out that digital mindfulness platforms are less expensive and require less time out of your day compared to in-person mindfulness therapy.

Mindfulness apps can be accessed whenever you need them; if you are about to enter a stressful meeting you can load up an app and spend five minutes practicing a guided meditation. If you are lying in bed and struggling to fall asleep, you can practice a mindfulness session.

The sleep-based sessions are the most popular meditations at Simple Habit, with Kim pointing out that mindfulness can be particularly effective at relieving stress and anxiety related to challenges such as life changes and career and relationship issues. She recommends setting aside five minutes for meditation every day.

Digital platforms that add new sessions on a regular basis and offer a variety of instructors can also help you remain motivated and prevent boredom.

Kim does say that if you struggle to remain motivated without any social pressure, you may do better with in-person mindfulness training. For example, if having a personal trainer is the only way you are able to commit to regular gym visits, a digital mindfulness app may not be the right choice for you.

How to improve your sleep

CBTI should be high on your list as you investigate the best way to cure your insomnia. Supplementing CBTI with additional cognitive therapy sessions or mindfulness therapy can make CBTI even more effective.

Because cognitive therapy may be harder to find (and more expensive) compared to mindfulness-based therapy, you may want to investigate digital platforms that offer mindfulness meditation — either as a supplement to CBTI or even as an initial treatment option for your insomnia.

Martin is the creator of Insomnia Land’s free sleep training for insomnia. His online course uses CBT techniques to teach participants how to sleep without relying on sleeping pills. More than 5,000 insomniacs have completed his course and 97 percent of graduates say they would recommend it to a friend.

Martin Reed
Meet Our Writer
Martin Reed

Martin is the creator of Insomnia Coach, an eight-week course that combines online sleep education with individual sleep coaching. His course helps clients improve their sleep so they can enjoy a better life with more energy and start each day feeling happy, healthy, rested, and refreshed. Martin also runs a free sleep training course that has helped over 5,000 insomniacs. He holds a master’s degree in health and wellness education and studied clinical sleep health at the University of Delaware.