Insomnia: A Sleep-Wake Disorder

Insomnia is a psychological disorder that is diagnosed when a person has difficulty falling asleep, staying asleep, and is waking up earlier than they wish to for at least 3 months.  Most people have occasional sleep problems that resolve on their own within a few days; however, people with insomnia chronically worry about their sleeping difficulties.  Typical worries include thoughts of whether they can fall asleep, how much time is left before they need to get up, feeling terrible the next day, will they be able to function, or whether they’ll get ill from their sleep problems.  An individual with insomnia engages in what they think are sleep-promoting behaviours such as taking sleeping pills or melatonin, using the right pillow, noisemaker, meditation app, or going to bed early are behaviours that actually worsen insomnia.  These actions perpetuate insomnia worries and maintain the sleep disturbance for months and even years.

Psychological treatment for insomnia has been successfully employed for over 30 years.  Cognitive-Behavioural Therapy for Insomnia (CBT-i) has been shown by research to improve insomnia by simply changing behaviours that maintain insomnia and thoughts (i.e., cognitions) that maintain sleep anxiety.  A CBT-i therapist assists clients to identify the harmful behaviours that are contributing to insomnia and track individual sleep patterns in order to make suggestions for clients to follow a specific sleep pattern.  Because sleep is a biological as well as a psychological process, the cognitive and behavioural approaches employed in CBT-i addresses both aspects of the sleep-wake system.  CBT-i is surprisingly very simple and effective for treating insomnia with no co-occurring conditions such as depression or anxiety.  Even individuals who have insomnia for many years see improvements in their sleep with this treatment.

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