CBTi treatment for insomnia

General health
A woman sits awake while her bed partner sleeps.
Our CBTi treatment for insomnia aims to treat chronic sleep disturbances within 8 weeks.

Most people have had trouble sleeping at some point, but chronic insomnia can have mental and physical affects that far exceed nocturnal matters. Our cognitive behavioural therapy for insomnia (CBTi) aims to treat sleep disturbances within 8 weeks, working to aid relaxation for better quality sleep.

Insomnia is a 24-hour condition

One in three adults has difficulty sleeping. However, only 6% of the population has been diagnosed with insomnia.  

Characterised by struggling to get to sleep, stay asleep or awakening too early, patients will often become distressed as they think about sleep all day and all night. 

Dr Allie Hare, consultant physician in respiratory and sleep medicine at Royal Brompton Hospital, explains, “People will often stop going out and socialising because they’re worried it will affect their evening routine and they won’t get any sleep.” 

Concentration can become poor and work performance may be affected. “Insomnia is not a condition of sleep”, Dr Hare clarifies, “it’s actually a condition of wakefulness.”  

Our CBTi service teaches our patients strategies to overcome the mental and behavioural factors which contribute to their sleep disturbances.  

The repercussions of chronic sleep disturbances

Mental health conditions are often associated with insomnia. People with chronic insomnia can become depressed or anxious, or pre-existing mental health conditions can become worsened by their poor sleep. In fact, anxiety disorder is present in up to 36% of people living with insomnia. 

Insomnia impairs cognitive and physical functioning, and thus people with chronic insomnia can be more prone to accidents, reduced quality of life and have worsened cardiovascular outcomes, such as hypertension and cardiac disease. Cognitive and behavioural affects also include impaired concentration, irritability and reduced motivation.  

“For patients, anxiety around sleep can perpetuate insomnia so we don’t tend to focus on adverse outcomes with them. Part of the CBTi treatment is actually to reduce sleep-related anxiety”, explains Dr Hare. However, when a patient reports that they are struggling with their sleep, referrers should know the associated risks to physical and mental health. 

Insomnia causes: Who does insomnia affect?

Woman sleeping on a plane

There are many factors at interplay when we consider the causes of insomnia, such as bereavement, work stress or frequent travel across time zones. The pandemic has also had an adverse effect on sleep patterns, due to a loss of routine and the workspace invading the home – and especially, the bedroom. 

Insomnia can be precipitated by a period of ill health. For example, we often receive referrals from our oncology partners, as CBTi can be an effective treatment for insomnia related to cancer treatment.  

While sleep becomes more fragmented as we age, insomnia in later life doesn’t have to be accepted. On that note, disturbed sleep is a common symptom of (peri)menopause, with up to 40% of women of menopausal age experiencing sleep complaints. “While CBTi is effective for menopause-related sleep disturbances, I will often work with GPs to provide HRT also”, adds Dr Hare.

Comorbid sleep conditions

Conditions comorbid with insomnia are common, so we will sometimes perform sleep studies if we suspect there may be more than one sleep condition at play, such as sleep apnoea or restless leg syndrome.  

It’s important for us to diagnose and manage sleep conditions comorbid with insomnia, as the symptoms often overlap and perpetuate each other.  

39% of people with insomnia also have obstructive sleep apnoea, a condition which causes the repetitive collapse of the upper airway during sleep. We can perform a full respiratory polygraphy test, which Dr Hare cites as “the gold standard for the diagnosis for sleep apnoea”.  

For other parasomnias, such as night terrors and sleep walking, we have access to full video polysomnography at our sleep centre.  

Diagnosing insomnia

For a chronic insomnia diagnosis, sleep disturbances must occur at least three nights a week, lasting for at least three months.  

We will consider a patient’s clinical history; the impact of the sleep disturbances, mental and physical health, the patient’s typical evening routine, alcohol, caffeine and drug use – whether illicit or prescribed. 

“I always ask my patients to complete a sleep diary; they are the cornerstone of diagnosis and treatment”, explains Dr Hare.   

Collateral history from a bed partner is also useful, as they may witness snoring, nocturnal movements and daytime sleepiness, which the patient themselves is not always aware of.  

CBTi as a treatment for insomnia

CBTi is the recommended treatment for insomnia, as recognised by NICE.

A classic course of CBTi consists of six to eight weekly sessions, which tends to be convenient for most patients. Each session lasts between 20 and 40 minutes and can be delivered in person or via a video meeting.  

The cognitive aspect of our treatment involves strategies to reduce sleep-related anxiety and aid relaxation, such as cognitive distraction and progressive muscle relaxation. 

The behavioural work comprises of two main strategies: sleep restriction and stimulus control therapy. 

Sleep restriction therapy aims to improve sleep efficiency by reducing the time spent in bed, slowly increasing that time over the course of treatment. 

Stimulus control therapy seeks to reinforce a positive association with bedtime, so that the bed becomes a restful place, rather than an anxiety inducing place. 

When to refer to us

CBTi should be the first option of treatment for insomnia; it is considered to be more effective than medication in managing chronic sleep disturbances. 

Referral to our specialist sleep clinic is recommended when insomnia has not responded to management in primary care, and/or when an individual has symptoms of another sleep disorder. 

Get in touch

To find out more about our specialist sleep clinic and CBTi treatment, please contact our customer services team.