CBTi: Sleep therapy for insomnia

Sleep is an essential part of our biological functioning, but chronic sleep disturbances can have adverse effects on our overall health. Our cognitive behavioural therapy for insomnia (CBTi) programme can improve  sleep disturbances within 8 weeks, working to address sleep-related anxiety, address behavioural sleep issues and aid relaxation for improved sleep quality.

What is insomnia?

Insomnia is a sleep condition which affects a person’s ability to fall asleep or stay asleep.

Disturbed sleep is common, with around one third of adults having difficulty sleeping. However, only 6% of the population has been diagnosed with insomnia, with chronic insomnia being diagnosed when the sleep disturbances occur more than three times a week, and last for more than three months.

Despite being associated with night-time, insomnia can widely affect aspects of the waking day. Aside from fatigue and daytime sleepiness, chronically disturbed sleep can cause irritability, impaired concentration and reduced motivation.

As a result, insomnia can affect work performance and even relationships, as many people avoid socialising as they’re worried it may affect their evening routine and they won’t get any sleep.

Dr Allie Hare, consultant physician in respiratory and sleep medicine at Royal Brompton Hospital, explains: “Insomnia is a 24-hour condition. If people aren’t sleeping, they may be worrying about whether they’ll sleep that night. There’s a lot of anxiety around sleep – or the lack of it”.

Consequentially, insomnia can perpetuate or worsen mental health conditions, such as depression or anxiety. In fact, up to 36% of people living with insomnia also have anxiety disorder.

Our cognitive behavioural therapy for insomnia programme aims to reduce this sleep-related anxiety and aid relaxation for better quality sleep.

What causes insomnia?

There are many factors which can cause insomnia. We often receive referrals for patients who are experiencing bereavement, work stress or who frequently travel across time zones – which can upset sleep routine.

The pandemic has also had an adverse effect on sleep patterns due to a loss of routine and the workspace invading the home – and particularly, the bedroom.

Shift work, pain conditions, alcohol, caffeine and recreational drugs can also perpetuate poor sleep quality.

Insomnia is also a common symptom of perimenopause and menopause, with up to 40% of women of menopausal age experiencing sleep disturbances. “As we age, our sleep changes, but insomnia in later life doesn’t have to be accepted. We can treat it in the same way as it’s treated in other life stages”, clarifies Dr Hare.

Coexisting conditions

Insomnia can often overlap with other conditions, such as sleep apnoea or restless leg syndrome. When we come to diagnose and treat insomnia, it’s important for us to identify overlapping conditions which may perpetuate sleep disturbances.

39% of people with insomnia also have obstructive sleep apnoea, a condition which causes the breathing to stop and start during sleep. We have access to a full respiratory polygraphy test to diagnose sleep apnoea so its symptoms can be managed alongside the insomnia treatment.

Another common co-existing condition is restless leg syndrome, which causes discomfort in the legs and an intense urge to move the legs, usually when lying down. For other parasomnias (unusual sleep behaviours) such as night terrors and sleep walking, we have access to full video polysomnography to diagnose and manage the conditions before addressing the insomnia.

Insomnia diagnosis

Once we have ruled out co-existing conditions, an insomnia diagnosis relies heavily on a patient’s clinical history. We will look at the impact of the sleep disturbances, mental and physical health, alcohol, caffeine and drug use – whether illicit or prescribed.

Patients will be asked to complete a sleep diary, which is the cornerstone of diagnosis and treatment. Collateral history from a bed partner is often useful, as they may witness snoring and nocturnal movements, which the patient themselves is not always aware of.

CBTi as a treatment for insomnia

Recommended by The National Institute for Health and Care Excellence (NICE), CBTi is the “gold standard treatment for insomnia”, as Dr Hare, the lead for our service, explains.

A standard course of CBTi consists of six to eight weekly sessions, with each session lasting between 20 and 40 minutes. We offer video and in-person sessions, depending on our patient’s preference.

There are two approaches to our treatment: cognitive and behavioural. The cognitive aspect involves strategies to reduce sleep-related anxiety and aid relaxation. These strategies include cognitive distraction (focusing thoughts on one thing) and progressive muscle relaxation to aid mindfulness.

The behavioural strategies rely on sleep restriction (reducing the time spent in bed) and stimulus control therapy to help create a positive association with bedtime.

If you have been experiencing sleep disturbances which have been affecting your daily life, our experts at our specialist sleep centre can help. Please get in touch with our customer services team to book an appointment.