Cognitive Behavioural Therapy for Insomnia (CBT-i)

Cognitive Behavioural Therapy for Insomnia

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CBT-I: BETTER THAN SLEEPING PILLS

Are you up at night googling “Cognitive behavioural therapy for insomnia near me”?  You’re not alone.

Sleep-wake disturbances are one of the most prevalent and persistent sequalae of traumatic brain injury (TBI).  After concussion, patients often report excessive daytime sleepiness, increased sleep need (at least 1 hour more than pre-injury), insomnia and sleep fragmentation (e.g., more frequent awakenings).  In mild TBI, about 33% report sleep problems within the first 10 days after injury, up to 50% at 6 weeks and up to 40% at one year.  In comparison, 25% of adults in the general population are dissatisfied with their sleep.  Needless to say, in persistent concussion symptoms, searching for  “Cognitive behavioural therapy for insomnia near me” should be one of your first steps.  This is one of the “big 4” pillars our concussion doctors promote when starting to work with new post-concussion patients.

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WHAT IS INSOMNIA?

Insomnia is the most common persistent sleep disturbance after concussion, affecting up to 65% and 25% of patients at 2 years and 5 years after injury, respectively. Insomnia can make it hard to fall asleep, hard to maintain sleep overnight or fall back asleep, or cause you to wake up too early.  Insomnia often aggravates other concussion symptoms like fatigue, headache, cognition, and mood.  It also predicts a poorer prognosis for recovery including greater disability and mental health issues.

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WHAT IS COGNITIVE BEHAVIOURAL THERAPY FOR INSOMNIA (CBT-I)?

CBT-i is a form Cognitive Behavioural Therapy (CBT) with a focus on addressing and reprogramming common themes that pop up during the treatment of insomnia.  CBT-i provides physiological training designed to good quality sleep back into your nights.  Sleep is a strong and highly regulated physiologic drive that can, however, be easily disrupted by multiple factors.  Managing these factors is at the core of CBT-i training.  CBT-i is a validated form of psychotherapeutic training using behavourial conditioning, cognitive restructuring, and sleep hygiene principles to effectively treat insomnia.  Sleep improves significantly for about 80% of patients: they sleep significantly longer and better after the training.  The success of CBT-i training depends ultimately on the patients’ willingness to comply with treatment recommendations.

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HOW DOES CBT-I WORK?

CBT-i is a multimodal, structured insomnia training program that helps you reflect on the link between what you think, what you do and how you sleep.  Five main pillars of CBT-i are used to tackle insomnia, as listed below.

  1. Sleep consolidation: People struggling with sleep often spend more time in bed trying to sleep which worsens the problem. Sleep consolidation (also known as sleep restriction) is a behavioural approach to limit the time spent in bed to the time spent sleeping.
  2. Stimulus control: Another behavioural approach that works on creating and strengthening a positive association between the bed, the bedroom, nighttime, and sleep.
  3. Relaxation training: Relaxation is used as a tool to set the stage for sleep.  Relaxation slows down brain wave pattern hence preparing the brain for sleep.  Different relaxation techniques can be used in addressing insomnia.
  4. Cognitive therapy: In the past, sleep just happened but after struggling with insomnia for a while, beliefs about sleep change and the mind gets bombarded with sleep-interfering thoughts.  During CBT-i training, automatic thoughts are identified, their impact on sleep is understood and alternative, sleep-promoting thoughts are explored.  This is what people think of typically when they think of Cognitive Behavioural Therapy (CBT).  You can read more about cognitive restructuring in Cognitive Behavioural Therapy (CBT) in our library.
  5. Sleep hygiene: This approach explores health practices and environmental factors that can promote better sleep and check insomnia.
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IS CBT-I EFFECTIVE FOR INSOMNIA AFTER CONCUSSION?

Yes, CBT-i is effective for insomnia after a concussion.  Research has shown that not only are sleep parameters (quality, duration, time to fall asleep, etc.) improved after CBT-i but other post-concussion symptoms are also improved overall.

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ARE SLEEPING PILLS MORE EFFECTIVE?

Sleeping pills are often prescribed in patients complaining of insomnia symptoms.  In some cases (e.g., period of high stress or grief), they can be an effective short-term treatment to provide rapid relief. Most sleeping pills are however not approved for long-term use.  Unlike CBT-i, sleeping pills do not treat the root problem of insomnia. They also come with a myriad of undesirable side effects and drug interactions. The focus of CBT-i is to identify and overcome those modifiable, underlying insomnia causes. Just like prescription sleeping pills, CBT-i is a first line therapy for insomnia; however, research has shown that sleep improvements are sustained over time, a clear advantage compared to sleeping pills. Patients also generally prefer CBT-i over sleeping pills.

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I REGULARLY TAKE A SLEEPING PILL TO FALL ASLEEP. CAN I DO CBT-I AT THE SAME TIME?

Yes! Both treatments can be combined; however, patients should be careful as relying on a sleeping pill can take away the self-efficacy CBT-i helps them develop. Some patients also decide to taper or stop their sleeping pill while undertaking CBT-i as they acquire other tools to find sleep. Stopping a prescription sleeping pill should only be done under medical supervision as your physician may have prescribed that drug for other reasons too.

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WHO IS A GOOD CANDIDATE FOR CBT-I?

All adults with insomnia symptoms post-concussion can benefit from CBT-i.  There is also growing evidence that CBT-i is highly effective in teenagers struggling with insomnia.  People with insomnia symptoms and physical disorders (e.g., chronic pain) or mental health issues (e.g., depression, anxiety, PTSD) also benefit from CBT-i; not only do their sleep will improve for most but also their other medical conditions are likely to improve too (e.g., less pain, better mood, etc.).

Patients that are dealing with bipolar disorder, seizures, parasomnias, or untreated obstructive sleep apnea can also undertake CBT-i; however, their program and progress should be individualized and closely monitored by a trained health care provider.

Before undertaking CBT-i it is necessary to have a thorough sleep assessment in order to identify underlying medical conditions, other sleep disorders and/or drug side effects that could be affecting your sleep.

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CBT-I & TORONTO CONCUSSION CLINIC

Look for Cognitive Behavioural Therapy for Insomnia (CBT-i) near me to get started.  If you are in the Toronto area, you can get assessed by our medical doctors at the Toronto Concussion Clinic.  If post-concussion patients prefer to do insomnia assessments and CBT-i online (virtually) with us entirely, then you can book an appointment directly with the occupational therapist.  Our occupational therapy team is not OHIP-Funded but their services may be covered by your extended health benefits.  For post-concussion patients who sustained their concussions during a car accident, car insurance companies will often approve CBT-i online therapy for post-concussion insomnia; our medical team would just have to draft up a treatment plan for you to sign for submission to them.

Book your sleep consultation with our expert team now to see how CBT-i can help you with your sleep.  With our Cognitive Behavioural Therapy-insomnia post-TBI program you will develop the tools and acquire the skills to break old patterns and habits that interfere with your sleep, and get your sleep back.

Last update: December 2023