What is insomnia? It can be defined as sleeping too much or not enough, as well as sleep interruptions throughout the night. How does insomnia therapy work? Our Toronto Psychotherapist Montana who is part of our Greystones Health team will discuss some unique and different techniques that are commonly talked about and is based on what is causing one to have sleep troubles.
CBT which stands for cognitive behavioural therapy looks at how our thoughts are connected to our feelings and then our behaviours. Often with thoughts, they evoke a feeling and we react to it. It is important to educate patients on the type of work you’re going to do which is called psychoeducation, where we look at the model or theory behind it.
“I use the CBT triangle which is looking at how thoughts, behaviours and feelings are all connected. This can be used to look at how 9 times out of 10, when it comes to sleep issues, people have unhelpful or inaccurate expectations of sleep, when they should sleep or how they should sleep. People think a lot at night, so it is beneficial to understand how thoughts, feelings and behaviours are contributing to insomnia.
What are the symptoms that someone is experiencing? How is their sleep hygiene? This is the baseline to see what is going on. After that we start cognitive interventions. We look at the unrealistic expectations of sleep or relaxation or other things in a person’s life. Things that stress you out can make it challenging to sleep. We first need to identify what those unhelpful thoughts are. This is usually done with self monitoring such as a sleep diary.
It’s not just about the bedtime habits, it’s all day!
I then encourage my patients to be more mindful throughout the week, over the day and not just at bedtime. Then bring that to your session and talk about it-are there certain patterns or certain times of the day that are more difficult than others?
Understand what those thoughts are and how they influence feelings. Break the cycle. Understanding unrealistic expectations is important. If the circadian rhythm is out of whack, this may require medication depending on the person.
In being more mindful all day, you challenge thoughts and replace them with more balanced and helpful thoughts. This will help you gain some mental health skills and healthy tools to calm your nervous system. Identify thinking traps, overgeneralization, and catastrophizing thoughts which are common problems people experience. You might do behavioural techniques similarly, but it depends on the individual.
What can patients do behaviorally to help with insomnia?
Behaviorally, it’s important to use a lot of mindfulness, relaxation, and self care. Soothing senses would fall under relaxation training where you are activating the body’s natural relaxation response (melatonin). Hypnosis can also contribute to behaviorally aiding insomnia, depending on the person.
It is beneficial to improve sleep hygiene and sleep habits. Some may use the bedroom for purposes other than sleep (productivity, work).
Sometimes people don’t sleep when they’re tired or they force themselves to sleep. Identify what these sleep habits are such as how long it takes for someone to fall asleep. How do they feel in the morning?
Improving these habits is more conducive with relaxation and sleep, putting the phone away, minimal stimulation, and small lifestyle changes to initiate a natural relaxation response. Be more strategic about naps- for example, plan them at a certain time of day. Be aware of caffeine and sugar intake. Monitor your physical health, exercise is a big stress reliever and can help with sleep after.
It’s up to the individual to put in the work, put the phone away, or not have coffee after 4pm. However keep in mind that these techniques work differently from person to person.”