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Therapy for Sleep Disorders: Beyond Pills & Masks!

Therapy for Sleep Disorders can prove more productive than sleeping pills for numerous sleep issues like insomnia, offering relief without undesirable side effects or potential long-term health risks.

Why therapy for sleep disorders and not medication?

When the desperation for sleep sets in, the temptation to resort to sleeping pills or over-the-counter sleep aids can be strong. However, it’s important to recognize that sleep medication doesn’t address the root cause or underlying symptoms; it may exacerbate sleep problems in the long run. While there may be situations where sleep medication is appropriate, its effectiveness is maximized when used sparingly for short-term needs, such as adjusting to different time zones or recovering from a medical procedure. Even in cases where prescription medication is necessary for a sleep disorder, experts advise combining it with therapy and making positive lifestyle changes.

Cognitive-behavioral therapy (CBT) can enhance sleep by modifying bedtime behavior and addressing thought patterns that hinder falling asleep. It also concentrates on enhancing relaxation skills and altering lifestyle habits affecting sleep. Since sleep disorders can both result from and contribute to emotional health issues like anxiety, stress, and depression, therapy becomes a potent method of treating the underlying problems rather than merely addressing symptoms. A recent Harvard Medical School study revealed that CBT outperformed prescription sleep medication in treating chronic insomnia. Patients undergoing CBT experienced substantial improvements in their ability to initiate and sustain sleep, with these benefits persisting even a year after treatment concluded. For individuals grappling with sleep disorders, therapy offers the potential to calm the mind, shift perspectives, improve daytime habits, and establish enduring healthy sleep patterns.

What defines a sleep disorder?

A sleep disorder is a condition that regularly interferes with your capacity to obtain sufficient, restful sleep, resulting in daytime exhaustion or drowsiness. Common sleep disorders encompass insomnia, sleep apnea, narcolepsy, restless legs syndrome (RLS), and circadian rhythm sleep disorders, which can be provoked by factors such as shift work or jet lag.

Therapy utilizing cognitive-behavioral techniques for insomnia and various sleep disorders.

Cognitive-behavioral therapy is the most commonly employed therapeutic approach for addressing sleep disorders. It can be administered on an individual basis, in group settings with individuals facing similar sleep issues, or even through online platforms. Given the considerable variation in the causes and symptoms of sleep disorders, it is crucial to tailor cognitive-behavioral therapy (CBT) to address the specific challenges you are encountering. An example of this specificity is Cognitive Behavioral Therapy for Insomnia (CBT-I), a specialized form of therapy designed for individuals struggling to attain the necessary amount of sleep to feel rested and refreshed upon waking.

The duration of therapy is contingent on the type and severity of the sleep disorder. While CBT is not typically an immediate or effortless remedy, it is relatively short-term. Many CBT programs targeting insomnia, for instance, have reported notable improvements in sleep patterns after a series of 5 to 8 weekly sessions.

How does CBT work for sleep disorders?

CBT tackles the negative thoughts and behavior patterns that contribute to insomnia and other sleep-related issues. As implied by its name, cognitive-behavioral therapy encompasses two key components:

Cognitive therapy guides you in identifying and altering negative beliefs and thoughts (cognitions) that contribute to your sleep problems.

Behavioral therapy instructs you on avoiding behaviors that hinder your ability to sleep at night and guides you in adopting improved sleep habits in their place.

Using a sleep diary in CBT

To discern patterns in your sleep-related challenges and determine the most suitable treatment strategy, your therapist might initiate the process by requesting you to maintain a sleep diary. The specifics recorded in the diary can be crucial, shedding light on how certain behaviors may be undermining your opportunity for a restful night’s sleep. You can download or print HelpGuide’s sleep diary (PDF) and bring it to your therapist, facilitating the identification of your specific problems.

Therapy for Sleep Disorders: Beyond Pills & Masks!

Thought challenges in CBT

The cognitive facets of CBT encompass thought challenges, also known as cognitive restructuring. This process involves challenging negative thinking patterns that contribute to sleep problems and substituting them with more positive and realistic thoughts. The fundamental concept is that altering the way you think can, in turn, influence how you feel and ultimately impact your sleep.

This process involves three distinct steps:

  1. Identifying negative thoughts: For individuals with sleep disorders like insomnia, the perceived obstacles to a good night’s sleep may seem more significant than they are. An example is continually telling oneself that sleep is only possible with a sleeping pill. The repetition of this belief can lead to increased anxiety when not taking a pill, making it more challenging to fall asleep.
  2. Challenging negative thoughts: In this step, your therapist will guide you in evaluating thoughts that disrupt your sleep. This involves questioning the evidence supporting these thoughts, analyzing unhelpful beliefs, and testing the reality of negative predictions.
  3. Replacing negative thoughts with realistic thoughts: After identifying negative distortions in your thinking, you can substitute them with new, accurate, and positive thoughts. Your therapist may also assist you in formulating realistic and soothing statements to recite as part of your bedtime routine.

Challenging negative thoughts that fuel insomnia and other sleep problems

Unrealistic Expectations

Negative thought: I should be able to sleep well every night like a typical person.

Sleep-promoting response: Many people encounter occasional sleep struggles. With practice, I can improve my sleep.


Negative thought: Every night feels identical, another instance of sleepless distress.

Sleep-promoting response: Each night is unique, and some nights I experience better sleep than others.


Negative thought: If I don’t get some sleep, I’ll tank at work and jeopardize my job.

Sleep-promoting response: Even if I’m tired, I can manage work. I can prioritize rest tonight, even if sleep is challenging.


Negative thought: I won’t be able to achieve restful sleep. It’s out of my control.

Sleep-promoting response: Sleep problems can be addressed. ByI can overcome this challenge by focusing on positive solutions instead of excessive worry, Fortune Telling

Negative thought:  It will likely take me at least an hour to fall asleep tonight. I just know it.

Sleep-promoting response: I cannot predict tonight’s outcome. By implementing the new strategies I’ve learned, I might find it easier to fall asleep.

Since negative thoughts often form part of a longstanding thinking pattern, replacing them with more realistic ones may not be immediate. Nevertheless, with consistent practice, breaking this habit is achievable. This underscores the importance of applying the techniques learned in therapy independently at home.

Techniques focusing on behavior in Cognitive-Behavioral Therapy for sleep disorders.

In addition to altering your thought patterns about sleep, Cognitive-Behavioral Therapy (CBT) is effective in modifying habits and behaviors that hinder restful sleep. Depending on your specific symptoms and requirements, your therapist may implement various techniques:

Sleep Restriction Therapy (SRT): SRT diminishes the time spent lying awake in bed by eliminating naps and necessitating staying up beyond your usual bedtime. This method, particularly useful for insomnia, not only induces greater fatigue the following night but also strengthens the association between bed and sleep instead of bed and wakefulness.

Stimulus Control Therapy: This approach identifies and transforms sleep habits that impede restful sleep. It involves training you to use your bedroom exclusively for sleep and intimacy, excluding activities like working or watching TV. Additionally, maintaining consistent sleep-wake times, even on weekends, is emphasized.

Enhancing Sleep Environment and Sleep Hygiene: Your therapist may suggest improvements to your sleep environment, ensuring it is dark, quiet, cool, and comfortable. Recommendations may include blackout shades, earplugs, or a sound machine to mitigate noise disruptions. Sleep hygiene involves refining daytime habits, incorporating regular exercise, avoiding nicotine and caffeine in the evening, and acquiring relaxation skills for nighttime unwinding.

Remaining Passively Awake (Paradoxical Intention): Recognizing that anxiety about not being able to sleep can perpetuate wakefulness, this technique involves relinquishing the worry and refraining from active efforts to sleep. Paradoxically, this approach may facilitate relaxation and encourage better sleep.

Relaxation Training: Consistent practice of relaxation techniques such as mindfulness meditation, progressive muscle relaxation, and breathing exercises can foster nighttime relaxation. These techniques help alleviate tension and anxiety, preparing you for a more tranquil sleep.

Biofeedback employs sensors to measure distinct physiological functions like heart rate, breathing, and muscle tension. The goal of biofeedback is to instruct you in recognizing and managing your body’s anxiety response, which can influence sleep patterns.

In Cognitive-Behavioral Therapy (CBT) for sleep disorders, hypnosis is occasionally integrated. During a state of deep relaxation, a hypnotherapist utilizes various therapeutic techniques to assist you in altering negative thought patterns or unproductive habits, thereby fostering a more restful sleep environment.

Relaxation techniques for insomnia

Abdominal breathing involves taking deep and full breaths, engaging not only the chest but also the belly, lower back, and ribcage, promoting relaxation. To practice, close your eyes and breathe deeply and slowly, progressively increasing the depth of each breath. Breathe in through your nostrils and breathe out through your mouth.

For Progressive Muscle Relaxation, find a comfortable position. Starting with your feet, intentionally tense the muscles as tightly as possible, holding for a count of 10, and then release the tension. Repeat this process for each muscle group in your body, gradually working your way up to the top of your head.

Mindfulness meditation entails sitting quietly and directing your attention to your natural breathing and your present bodily sensations. Allow thoughts and emotions to flow without judgment, consistently returning your focus to your breath and body.

Therapy for Sleep Disorders: Beyond Pills & Masks!

Making therapy work for you

Improving your sleep often requires both time and commitment. It’s crucial to find a therapist who is the right fit for you—a trustworthy and comfortable partner in your recovery. Once you’ve identified the right therapist, adherence to the treatment plan and following their advice is essential. If the pace of recovery feels discouraging, remember that therapy for sleep disorders proves highly effective in the long run. Staying committed to the process will yield significant benefits.

You can further support your therapy by incorporating positive lifestyle choices that enhance your sleep:

Increase Physical Activity: Incorporate regular exercise into your routine, aiming for at least 30 minutes on most days. Nonetheless, refrain from exercising too close to bedtime, as it might disrupt your sleep.

Mindful Eating and Drinking: Be mindful of your diet and timing. Refrain from consuming late meals within two hours of bedtime. Refrain from consuming caffeinated beverages at least eight hours before bedtime. Nicotine, sugary foods, and alcohol, although initially inducing sleepiness, can negatively impact sleep quality and exacerbate sleep disorder symptoms.

Stress Reduction: Manage stress and anxiety effectively. Seek assistance with stress management if work, family, or school-related stressors are affecting your sleep. By addressing stress constructively and maintaining a calm, positive outlook, you can enhance your ability to achieve better sleep at night.

Sleep therapy online or in-person?

Engaging with a therapist online presents a convenient and cost-effective alternative to in-person meetings, proving to be just as efficacious, especially for individuals grappling with sleep issues.

While online therapy may have some drawbacks, such as the absence of face-to-face interaction, the benefits are significant. For those hindered by challenges like taking time off work, commuting to appointments, navigating traffic, waiting in a physical office, or arranging childcare, online therapy emerges as an ideal solution, eliminating these barriers to seeking assistance.

Prashant Prabhat
Prashant Prabhat
I myself, Prashant Kumar Prabhat from New Delhi. Versatile and experienced medical writers and editors specializing in health, health care, education and criminal justice. As a former newspaper reporter, Thrive is under deadline pressure and is drawn to people's stories. Some special about me:- Traced and communicated veteran details and interacted with customers. Necessary research was conducted in a timely and efficient manner, using appropriate resources. With manager's input, scientifically accurate, strategically aligned, grammatically correct and impact content was developed from outline to completion.


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