Last updated: Apr 11, 2008
bed-sheets-insomnia-treatment
Staying out of bed until you're truly sleepy is an important part of CBT.
(UYEN LE/BLUESTOCK- ING/ISTOCKPHOTO)
For insomnia patients who don't want to rely indefinitely on medication, cognitive behavioral therapy (CBT) could be a way to get sleep back on track.


Prescription drugs can be expensive, inconvenient, and cause unpleasant side effects. The strategies you learn though CBT, on the other hand, can be used anytime, anywhere—without a prescription or fear of unwanted repercussions.

A 30-year insomniac
A light sleeper in high school, Charles Learn had trouble getting back to sleep when something as routine as a screeching cat woke him up. Three decades later he was spending so much time awake that he averaged just three to four hours of sleep a night.

Learn, 52, a fiber optics inspector from Redlands, Calif., constantly worried about being tired at work. By midnight each night the floodgates had opened and other anxious thoughts poured in—things that needed doing around the house, family problems that needed solving.

He finally visited a cognitive behavioral therapist at age 51, after medication no longer aided his sleep.

Step 1: Understanding why you're awake
In six weekly sessions, Learn examined his sleep and anxiety issues. "My therapist wanted to get to the root of why I was not sleeping, what thoughts were going through my head and keeping me awake," he says. "I had to look at what was going on in my life and put it into proper perspective."

This, of course, was easier said than done: Learn was in the process of building a second house on his property for his aging in-laws. He was also planning one daughter's wedding, while his other daughter—and her children—moved into his home after her marriage broke up.

More about behavioral therapy
But Learn's therapist helped him realize that no matter how busy his days were, he didn't have to suffer at night. The first step, Learn says, was debunking his longtime beliefs about sleep and health.

"I had it in my mind that I needed eight hours of sleep whether I was tired or not," Learn says. "Then I'd lay there in bed, thinking. 'I'm still not sleeping, I'm still not sleeping.'"

Now he knows that some nights six hours is plenty for him. "Realizing and finally accepting that has helped me wipe my mind clean," he says.

Step 2: Controlling nighttime anxiety
Learn's therapist also came up with a strategy for dealing with stress. "He had me find time during the day to write down every troublesome thought, and think of solutions," Learn says. "Then I would ask myself: 'Is this something I should worry about? Am I able to let go of it?'"

If the issues resurfaced at night, Learn could remind himself that he'd already thought them through and more easily push them aside.

Step 3: Living a sleep-friendly lifestyle
The hours leading up to bedtime also became a big part of Learn's therapy. For the past year, he's tried to live by the following rules.

  • No caffeine, chocolate, or heavy foods a few hours before bedtime.
  • Take a hot, relaxing shower before bed.
  • Most importantly, don't go to bed until you're sleepy.
Learn wasn't crazy about all of his therapist's suggestions, and he's even gone back on a few of the cardinal rules of sleep hygiene. For example, he recently treated himself to a flat-panel television monitor in his bedroom. He lets his wife choose the channel at night, however, so he's not particularly interested in what's playing—and knows to make the TV off-limits if his sleep difficulties resurface.

Still, the changes that Learn has stuck with have allowed him to wean himself off medication. "I think I'm a pretty good convert," he says. "Therapy pointed out a lot of good reasons about why I wasn't sleeping, and helped me focus on what's really important."