It’s a difficult routine. You get back from work; you complete all your chores and get into bed. You wish you could just instantly fall asleep, but your mind starts racing as soon as you close your eyes. You’re thinking about rent, that problem at work, or your chores for tomorrow. When some time goes by, you look at the clock only to realize it’s getting late, and it’s unclear whether you’re anxious because you can’t fall asleep, or you can’t fall asleep because you’re anxious. The cycle is vicious: anxiety can cause sleep difficulties, which can lead back to anxiety.
Asking yourself ‘why can’t I sleep’? you should know that Insomnia is a common condition that you probably have experienced when your mind has been full of thoughts. But when sleep deprivation (which is caused by anxiety) becomes an ongoing problem, thorough analysis and reconstruction of the sleep foundations are required.
Cognitive behavioral psychotherapy in insomnia (CBT-I) is a treatment that combines several methods to change patterns of thinking or behavior that contribute to the development of insomnia. The treatment starts with the daily filling in of a sleep diary, recording data such as what time you went to bed, how long it took to fall asleep, how many times you woke up during the night, and the quality of your sleep. All this creates a realistic picture of sleep, rather than how it is perceived to be by the patient, who may not see it accurately. In addition to discussion based on the data in the diary, various treatment tools are integrated into the treatment.
This method examines your habits, daily routines, and the repetitive actions you perform, which may be the source of insomnia, and aims to serve as a kind of monitoring of the various stimuli that prevent you from sleeping. The method is designed to shatter negative associations and to create positive conditioning for rituals that occur prior to sleep. Many solutions are offered, such as going to bed only when tired, or using the bedroom only for rest and intimacy.
One of the oldest methods for treating sleep problems includes advice to ‘cleanse’ sleep of various habits, such as avoiding exposure to blue light screens, not sleeping during the day, and refraining from consuming beverages, foods or substances that disrupt sleep (e.g. caffeine and alcohol). Moreover, there are certain herbs and spices that might help us relax our way to better sleep, such as turmeric curcumin supplements which have been shown to reduce anxiety and depression by modulating levels of serotonin and dopamine.
Sleep restriction therapy works to get maximum actual sleep time out of the time spent in bed. The idea is to reduce the range of sleep hours allowed, and by that creating fatigue and an urge to sleep, thereby increasing your chances of falling asleep more quickly. For example, if you sleep only 7 hours out of 9 that you spend in bed, the new time range allowed in bed will be only 7 hours. Over time, you’ll gradually increase the amount of sleep, usually by about 15 minutes to half an hour each week, until the amount and timing of sleep that are appropriate for you is achieved. The data being monitored is called the measure of ‘sleep efficiency’.
As part of this method, you set a specific time in the evening in which you contemplate the fears and anxieties that may have overwhelmed you during the day, and focus on relaxation and positive thinking, in order to avoid excessive thoughts near the time of falling asleep.
A key component of the CBT-I method is to help maintain habits acquired during treatment to prevent recurrence of the problem. In fact, after treatment you must remember the triggers that caused your insomnia and the key methods you used to treat the phenomenon.
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