Can’t Sleep? Behavioral Therapy May Ease Insomnia

June 29, 2020 — Sleep expert Rachel Manber, PhD, has seen the pervasive miseries of insomnia. Patients who are frustrated and fatigued tell her they toss in bed all night, seeking that elusive comfortable spot. Others give up evening outings or vacations to avoid messing up their sleep schedules. Still others get anxious at bedtime, pondering whether to take sleep medications or wind down with a nightcap.

But trying so hard to fall asleep works against you, says Manber, a professor of insomnia and behavioral sciences at Stanford University Medical Center and a behavioral sleep medicine specialist.

“When you talk to somebody who sleeps well and you ask them, ‘How do you sleep? How do you do that?’ they will likely look at you with blank eyes. They don’t do anything. Sleep is an automatic process,” she says.

“When you talk to somebody who has trouble sleeping, they will name a long list of things that they’re doing to try to sleep. And that very effort to sleep ends up creating arousal and interfering with sleep.”

Instead of trying to sleep, allow sleep to happen, Manber says.

For more than two decades, she has helped patients undo habits that don’t work, stop their sleep medications, and drift into slumber on their own. Her method: cognitive behavioral therapy for insomnia (CBTI), a nondrug treatment that can improve sleep by helping patients change beliefs and behaviors.

More doctors have become aware of CBTI since the American College of Physicians issued a guideline in 2016 calling it the first-line treatment for chronic insomnia in adults, preferred over sleep medications.

It’s not that sleep drugs don’t work. They often do, but they can have side effects and drug interactions, and they aren’t meant for long-term use. Further, once patients stop taking them, insomnia might return, requiring another course of drugs.

In contrast, CBTI resolves insomnia without drugs and gives patients “skills that nobody can take away from them so they can use them should insomnia come back,” Manber says. “As you know, life happens. And when we become stressed, we tend to lose sleep over it.” By applying CBTI skills, people can prevent new bouts of chronic insomnia or recover from them.

When patients get CBTI with a sleep specialist, the insomnia typically improves with four to six sessions, Manber says. During the COVID-19 pandemic, some sleep specialists have been offering CBTI entirely through telemedicine. But many people can find relief with these at-home measures.

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