Q: At night, my brain won’t shut off and I’m up for hours worrying. How can I fall asleep?
The psychologist says… As a first step to treat insomnia, I would interview you to get a sense of your sleep routines and anything else that might be going on with you. Then I’d ask you to log your sleep for about two weeks, so we can design a treatment plan together based on the objective information you provide. Insomnia isn’t defined by a certain number of hours of sleep; instead, it’s defined by dissatisfaction with sleep quantity or quality that is significantly distressing or impairing daytime function. For a diagnosis of insomnia, this has to happen over a minimum of three nights a week for three months, despite an adequate opportunity for sleep.
However, cognitive behavioural therapy (CBT) can help people who struggle with sleep difficulties that don’t reach the threshold for a diagnosis of insomnia. Sleep problems can become characterized by certain worries about sleep or strategies on how to manage sleep difficulty. CBT is based on the relationship between your thoughts, feelings and behaviours, and it’s what I use to help treat insomnia. These sleep experts reveal the six most common causes of insomnia.
So, after looking at how much sleep you’re getting, we’d start to look at your routines.
Certain behaviours, like waking up at the same time every day, not drinking alcohol before bedtime, reserving your bed for only sleep, and giving yourself a wind-down period at night can all help you get a better sleep. (Could sugar be ruining your sleep?) We’d also talk about things like only going to bed when you’re sleepy and getting out of bed when you can’t nod off in order to condition yourself to associate the bed with sleep, rather than a place to stay up and worry. And we’d look at behaviours you’ve adopted to cope with your sleep loss, like taking naps during the day or cutting back on daytime activities, which could be counterproductive to you sleeping well.
Finally, we’d talk about your thoughts around sleep.
People tend to have anxiety about what will happen if they don’t get enough shut-eye, which can lead to hours of watching the clock or increased difficulty getting shut-eye. And, when we are anxious, we tend to focus on worst-case scenario outcomes that may or may not be likely. You can practice asking yourself, “Are there other ways of looking at that thought? What’s the evidence for that?”
It can take as little as four to six sessions to treat insomnia, and the goal is to help you learn the tools to challenge your thoughts and become your own therapist.
Dr. Leorra Newman is a clinical psychologist at CBT Associates Toronto.