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CBT-I: Breaking the Depression and Insomnia Cycle

Michael Rothbard

Science shows there’s a correlation between the quality of our rest and how we make it through our waking day. Weight gain, depression — those are just a couple of things that can lead to a lack of sleep, and a lack of sleep can lead to weight gain and depression. It’s a vicious cycle that feels virtually impossible to break, so we turn to pills to get us over it. Now we’ve added another layer of difficulty to our need to find a way to rest and relax, and it goes on and on. There are plenty of tips and tricks constantly shared on how to break that cycle of sleep difficulty, and something has come to light that I find intriguing — restricting outside stimulus and retraining yourself on how to actually sleep to achieve better more quality rest. Or something called Cognitive Behavioral Therapy for Insomnia or CBT-I.


What is Cognitive Behavioral Therapy (CBT)?

Cognitive Behavioral Therapy (CBT) is a common practice in the mental health profession. It works on the theory that your thoughts and behaviors are the basis for your anxiety and depression, and by focusing on those negative images, beliefs and attitudes and how they are processed, you can shift them to positive. You can change your thoughts by changing your behavior.

At its core, CBT-I works by having you use your bed more efficiently. Your body already knows how to rest  — it’s what is called our “sleep drive.” Babies and animals naturally give into that drive, but as we get older we forget how to do this. We have a tendency to use our beds for just about everything besides sleep. CBT-I therapists theorize that using your bed only for sleeping at night, you’ll manage your circadian rhythm and get yourself into a routine that then supports a well-rested night for an energized, non-drowsy day. It should be noted that therapists do not suggest eliminating sex for better rest. The stimuli they recommend getting rid of are simply those things your bed was not designed for. 

Your circadian rhythm is the 24-hour cycle that runs between sleep and waking. Building a consistent rhythm is the basis for getting the best rest you can hope for. CBT-I takes that rhythm and teaches you how to train it by helping you go to bed and wake up at the same time every day, including weekends.

Although there are a variety of steps involved — tracking your sleep with a sleep journal (preferably by hand) being one of them — CBT-I operates on two basic strategies: stimulus control and restricting sleep. You can use these either separately or together to achieve optimum sleep, but let’s look at them individually.


Stimulus Control — Rethinking your bed

The goal of stimulus control is just that — eliminate those things that get in the way of your ability to rest to your fullest in your bed. To do this, you go to your bed when you are drop-dead, eyes drooping, barely able to stand it sleepy — not just tired. When you slide under the covers, you fall asleep, nothing more. If you do wake in the night, you get out of bed and if after about 15 to 20 minutes you still can’t sleep, go into another room until you start feeling tired enough.

In addition to making sure you only sleep or have sex in your bed, stimulus control asks that you don’t sleep anywhere else OTHER than your bed. No napping in chairs, couches, etc., and eliminating caffeine.


Restricting Sleep — Rethinking your rest

Just as it’s important you only go to your bed when you’re ready to go to sleep at night — and as you can see from stimulus control, naps are not encouraged at all — understanding how you sleep in the night helps you set your rhythm. Restricting sleep is about using your sleep log to understand when you are actually sleeping, not just lying in bed. Once you discover that, you decide when you want to get up and based on how long you’re actually sleeping, you’ll know when you really need to go to bed. In the beginning, that can lead to some rather tired mornings because the length of time you’re actually may be far shorter than you think. For instance, if you want to wake up at 7:00 in the morning and you’re only really sleeping 4 hours a night, you’ll go to sleep at 3:00 a.m. in the beginning.

Now, I know that sounds like there’s no way you’ll feel rested and it’s true that as you start down this road you’ll be immensely tired at first, but remember what I said at the beginning — getting better sleep by laying in bed less. This is a process and restricting sleep helps you get to the point where the length of time you are in your bed actually sleeping becomes more efficient. When you are truly asleep for 90% of the time you’re in bed, you can add more time to when you crawl under the covers in 30-minute increments. The goal with sleep restriction is that you will soon find yourself genuinely sleepy earlier and earlier, which means if you stick with it you’ll ultimately be getting that 8 hours you’re seeking.


Sleep changing your life

Whether you’re engaging in one or both of these methods, shifting your circadian rhythm takes time, but once you’ve trained your behavior to sleep this way, maintaining it is fairly easy. Even if you regress at some point, studies show it’s easier to get yourself back on track because you’ve already gone through the process.

The benefits of CBT-I include curing depression and supporting a healthy weight, and retraining a long-held behavior to battle those and more is no easy feat. I recommend you consult a physician as you embark on this journey to get the support you need. Getting more quality rest makes you feel more energized, which leads you to be more willing to go out into the world and engage. As you involve yourself further in those activities you enjoy, you end up making more of your waking time than you did before.

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