A comprehensive intake evaluation will be conducted by a physician with expertise in insomnia and psychiatric disorders. You will have an opportunity to complete questionnaires for a systematic evaluation of emotional symptoms, stress, and various factors that will be considered for the recommendation of the appropriate modality of insomnia treatment. Then, a physician will conduct an interview with you. Following this thorough assessment, the evaluating physician will discuss treatment options with you, taking into account various factors including your own preference.
Cognitive Behavioral Therapy for Insomnia (CBT-I)
CBT-I is the first-line treatment for insomnia. The American College of Physicians, the largest medical-specialty organization and second-largest physician group in the United States, recommends all adults to receive CBT-I as the initial treatment for chronic insomnia due to its proven short- and long-term efficacy. While insomnia can be triggered by a variety of factors, changes to a person’s thoughts and behaviors in response to insomnia are what actually cause the insomnia to persist. For this reason, CBT-I helps you identify and change these faulty thoughts and behaviors in order to develop healthier sleep habits and patterns. Unlike sleeping pills, CBT-I helps you overcome the underlying causes of your sleep problems. The UCLA Insomnia Clinic provides a structured CBT-I program composed of 7 to 8 weekly sessions.
To identify how to best treat your insomnia and track your progress, we will ask you to keep a sleep diary for one to two weeks. The cognitive part of CBT-I will teach you how to recognize and change thoughts and beliefs that impact your ability to sleep. You will learn skills that will help you to challenge and change negative thought patterns and worries that may prevent sleep. The behavioral part of CBT-I will help you develop good sleep habits, become aware of behaviors that keep you from sleeping well, and restore your ability to sleep soundly.
Depending on your needs, we will recommend some of the following CBT-I techniques:
- Cognitive restructuring: This technique teaches you how to identify, challenge, and change unhelpful thoughts and beliefs that keep you awake in order to better manage any anxiety you may experience surrounding the impacts of sleep loss.
- Stimulus control: This method helps remove factors that condition your mind and body to resist sleep. For example, too many sleepless nights in bed can cause you to associate your bed with not sleeping. Stimulus control will recondition your brain to associate your bed with quality sleep.
- Time in bed restriction: Lying in bed when you are awake can become a habit that leads to poor sleep as it reduces your sleep drive and strengthens the association between your bed and not sleeping. Your body requires sleep drive in order to sleep soundly throughout the night. Time in bed restriction works by initially reducing the amount of time you spend in bed in order to increase your sleep drive. Once your sleep has improved, your time in bed is gradually increased.
- Sleep hygiene will provide you with information on basic lifestyle habits that influence sleep, such as the impact of caffeine, nicotine, and alcohol consumption on sleep. It also teaches you how to create an optimal wind-down routine and a comfortable sleep environment.
- Relaxation training: Your mind and body need to be calm in order to produce optimal sleep. Relaxation training teaches you methods to soothe your mind and body through various approaches including meditation, imagery, muscle relaxation, and others.
Mindfulness-Based Behavioral Therapy for Insomnia (MBBT-I)
The UCLA Insomnia Clinic offers a program composed of 8 weekly sessions of MBBT-I, a behavioral treatment for insomnia that we have developed based on Mindful Awareness Practices program (MAPs). In MBBT-I, patients learn the principles and practices of mindfulness, develop their personal mindfulness practices, apply mindfulness principles in their daily lives, learn skills to improve their sleep and gain support through interactions with therapists. We have extensively studied MBBT-I and, our research has demonstrated that this behavioral treatment is effective in improving insomnia. Our MBBT-I sessions are facilitated by licensed clinical psychologists who have intensive training and experience in teaching mindfulness and providing psychotherapy.
What is mindfulness?
Mindfulness is paying attention to our present moment experience with openness, curiosity, and a willingness to be with what is. As we do this, we will begin to understand our bodies and minds better and not be so reactive in our daily life to thoughts, emotions, and physical sensations. We will have more space or choice in our life. Mindfulness is not about feeling a particular state or having a specific kind of experience. With mindfulness, we develop a quality of attention that can be present no matter what is happening. This will help us to have more peace, ease, and balance in our lives. In MBBT-I, we start with awareness of our breathing, and each week, we open our awareness more and more to all of our experiences, including sounds, bodily sensations, emotions, thoughts, and mental states. In addition to learning the practice of mindfulness, we will also learn tools to improve the quality of sleep.
How does mindfulness help with insomnia or sleep?
Recent researches have shown promising results in improving quality of sleep in patients who practice mindfulness. To date, the exact mechanism of how mindfulness help with sleep is unclear. However, insomnia is often associated with stress, anxiety, depression and other chronic illnesses, such as chronic pain and hypertension. Research has shown that mindfulness can help improve these conditions, which may explain how it alleviates insomnia symptoms in those who practice mindfulness.
Furthermore, many patients with insomnia often feel they have little control over their sleep. They may find themselves feeling stuck in this endless cycle of having expectations around sleep, putting a lot of efforts in getting a good night of sleep, worrying about the consequences of not getting enough sleep, and making falling asleep more difficult. Mindful awareness practices can help you learn to work with these feelings, gain awareness of unhelpful thinking patterns, learn to let them go, and cultivate a more open and accepting stance to the sleeping process. In essence, through mindfulness practice, you are changing your relationship with sleep and, in turn, it will help improve your quality of sleep.