November wellbeing session: CBT for sleep

In today’s session, we learned how to use cognitive behavioural therapy (CBT) to help overcome sleep problems, also known as CBTi (CBT for insomnia). This isn’t a definitive guide, just my personal experience of how it helped me go from 2-3 hours a night to 7-8 hours in just 5 months, which I shared with people in the session.

I’ve never had a sleep problem in my life and then in June this year one smacked me in the face full pelt! It started off as a physical reason but once that was solved I was left with a huge psychological problem that I just couldn’t shift. In July and August I was often getting just 2-3 hours a night and it started to have a huge impact on every part of my life.

After trying every possible solution I could think off (apps, books, podcasts herbal medication, relaxation techniques…. you name it, I tried it!) I finally came across CBT. I taught myself to begin with (there are loads of videos on YouTube) and then I decided to see a professional CBT counsellor to make sure I was doing it right and get any extra support I needed.

First CBT session with professional

In the first session, we spent a lot of time talking about my life, health and sleep hygiene to identify if there were any underlying issues. There weren’t. She confirmed my condition as ‘sleep anxiety’ which in my case was preventing me from falling asleep.

Next we made sure that I had all the basics covered – I was able to tick off every single one of these:

• Spend time outside every day
• Don’t use your phone / ipad an hour before bed
• Limited caffeine during the day (2-3 cups) – or change to caffeine free
• No naps
• Dinner at least 2 hours before bed
• Healthy eating through the day
• Wake and sleep at consistent times (even at the weekends)
• Limited or preferably no alcohol in the week
• No TV in the bedroom
• Dark room
• Quiet room
• Room temperature not too hot or too cold
• No working late
• Comfortable mattress (when did you last change it?)
• Correct pillow height (add a layer of memory foam if it needs bulking up a little)
• Exercise in the day (at least 30 mins)
• Relaxation / yoga
• Mindfulness
• Deep breathing

The basic principles of CBTi

The underlying principles of CBTi are quite simple – don’t go to bed until you’re tired and if you don’t fall asleep within 15 minutes then go back downstairs and do something boring!

You’re not allowed to do anything in the bedroom apart from sleep, or be in the 15 minute ‘falling asleep’ zone.

If you don’t fall asleep within 15 minutes, go downstairs and do something that will keep your mind occupied just a little bit but that doesn’t interest you.

Then when you’re feeling tired, try going back to bed again. Personally, I tend to wait until my eyes keep closing and that’s my sign to try again.

When you’re back in bed, if you don’t fall asleep within 15 mins, go back downstairs and do it all again.

Over time your brain will start to understand that BED = SLEEP. This can take a bit of time though as you are effectively forming a new habit. At first I was going downstairs 6/7 times a night which was really hard – I almost gave up a couple of times as I just felt that it wasn’t working.

But soon the number of times I was going downstairs started to reduce and also the amount of time I was downstairs each time started to reduce.

Other things to incorporate

The counsellor also gave me lots of really useful tips to run alongside the CBT, including:

• Keep a sleep diary
• Get up at the same time every day (yes even at the weekend!)
• Absolutely no naps in the day!
• Stop watching TV / gaming / working / screens 1 hour before bed
• Establish a 1-hour bedtime routine (bath, read, calm app, relaxation, candles, music)
• No caffeine
• Don’t look at the clock (can create anxiety)
• Wear a sleep tracker (for sleep diary)
• Dim screens after 7pm (inc Kindle)
• Prepare lounge for the night ahead (cushions, blanket, water, book, leave small lamp on etc)

Be patient

My one piece of advice would be to persevere – I’m so glad I didn’t give up! You have to keep reminding yourself that you’re trying to form a new habit and, for many people, undo years of bad sleep habits. It took me about 5 months to get to a consistent level of good sleep.

I’m now getting 7-8 hours a night which is fantastic but it’s still early days so I will definitely be continuing with everything I’ve learned so far. And if insomnia rears its ugly head again in the future, I now have a tried and tested toolkit to kick it into touch.

Awesome resources

This video on YouTube offers a really good and clear overview of CBTi, including the sleep deprivation stage.

Sleepio is a fantastic online CBT programme that I can highly recommend. Following a questionnaire, you enter your sleep data every morning and it takes you through a 6/7 week programme with personalised sleeping plans and reviews. It’s brilliant!