Tips from CBT-I to Improve Your Sleep

You wake up, roll over and check your phone: 2:13 a.m. Sighing heavily, you realize you only dozed off for a few minutes. It’s been almost two hours of endless tossing and turning. No matter what you try — scrolling through social media, sorting through your emails, counting imaginary sheep, turning the light on and reading the book on your end table — sleep is nowhere to be found. The longer you are awake the more annoyed you get: “Why? WHY can’t I just fall asleep already?!?” Eventually, you fall into a light sleep and wake up feeling fatigued and irritable. Sound familiar? 

You are not alone. Prior to the pandemic, 30% of the population reported sleep disturbances and numerous studies have shown an increase in reported rates of sleep disturbances since the pandemic began. For example, the Journal of Clinical Sleep Medicine conducted a study where they analyzed the Google trends for insomnia and found a 58% increase in internet searches for “insomnia” during the first 5 months of 2020, compared to the same 5 months of the previous three years. The American Academy of Sleep Medicine and the Sleep Research Society recommend that adults receive at least 7 hours of sleep each night to maintain physical and mental health. Unfortunately, that number is far from realistic for the many Americans currently struggling with sleep. Prolonged periods of disturbed sleep have been associated with poor health outcomes such as depression, anxiety, weight gain, and hypertension — all of which can negatively impact your relationships, work performance, and overall quality of life. 

One of the criteria for insomnia is experiencing sleep disturbances at least 3 nights per week for at least 3 months. The National Institute of Health recommends a treatment called Cognitive Behavioral Therapy for Insomnia (CBT-I) as the first-line treatment for insomnia. CBT-I is an evidence-based therapy that has been heavily researched and is shown to be more effective than medications prescribed for sleep. The overall goal of CBT-I is to identify biological, psychological and environmental factors that are contributing to insomnia, explore ways to increase control over these contributing factors, and learn helpful skills to improve overall quality of sleep. 

When utilizing CBT-I with my clients, I find it helpful to start by focusing on the three factors that impact sleep: if you sleep, how well you sleep and when you sleep. Sleep drive is a term used to refer to how much your body/brain needs sleep. When your sleep drive is low, you will be less likely to be able to fall asleep and vice versa. Typically, our need for sleep increases as the day progresses. However, there are several things that can lower your sleep drive, such as certain medications, caffeine intake and taking naps.

Tip #1: If you’re tempted to drink caffeine in the afternoon or take a nap, get up and engage in a physical activity such as aerobic exercise, dancing or yoga. These activities can make you feel re-energized in the moment by releasing endorphins and more importantly, will increase your sleep drive later, making it easier to fall asleep.

Then there are the factors that impact how well we sleep. The brain’s main job is to protect us from harm’s way so it is constantly working to predict when we might need to jump-start our nervous system into “fight, flight or freeze” mode. An important fact to consider is that our brain doesn’t know the difference between perceived threat and actual threat. The way our brain reacts to high levels of stress is to kick on our nervous system to be ready to react to whatever threats we are anticipating, regardless of whether it is real or imagined. When this happens, chemicals in our brains that help with sleep, such as melatonin, are prohibited from being released. This prevents us from feeling sleepy which in turn makes it difficult to fall asleep. It is therefore important to take time to relax your nervous system prior to bed, especially following an emotionally stressful day.

Tip #2: Writing down your thoughts before bedtime can be a helpful way to get them out of your head and let go of the emotions associated with these thoughts. You might also try a calming meditation app like Calm or Headspace to quiet your mind before sleep.

Last but not least, when you sleep refers to your circadian rhythm. Our brain is impacted not only by our state of mind and nervous system but also by many things in the environment. For example, you may have heard the term “blue light” which refers to the type of light emitted from electronics such as smartphones and computers. What many people don’t know is that any type of light can disrupt our circadian rhythm since our brains are hardwired to go to sleep when it is dark outside. Although there are features to minimize blue light, it is more helpful to completely avoid screen time at least 30 minutes before bed. This can be a hard habit to break, especially for those of us that are working from home.

Tip #3: Make it a rule to only use electronics outside of your bed. Try charging them in a space that requires you to physically get out of bed to reach them.

These tips can help improve the quality and quantity of sleep. However, when working to change your behavior, it can be extremely helpful to have a trained professional on your team to support you through the process and hold you accountable. If you continue to have difficulty sleeping and believe you may have insomnia, or you have been struggling to find mental health support for other difficulties, I recommend seeking out a CBT-I practitioner that can tailor a plan to your specific needs. Sleep is essential for physical health, memory function, emotional regulation, stress management, and more. Don’t let another week of poor sleep go by without making a plan of action to improve it!

Katie Strickland, PsyD, is a psychologist at PRESENCE, an integrative wellness center helping you to optimize your mental, physical and relationship health so you can heal, grow, and thrive in life through science-based psychotherapy and medicine.