Sleep Therapy: Cognitive Behavioral Therapy For Sleep Disorders And Mental Health

Along with eating and drinking, sleeping is critical for survival. It helps our body repair itself, fortifies our immune system, and cleanses the brain of toxins. It's also essential to memory, problem-solving, and emotional regulation. When we don't get enough quality sleep, it can have far-reaching impacts on our health and functioning in daily life. However, recent data from the National Sleep Foundation suggests between 10% and 30% of adults have insomnia, and 2% - 9% are affected by obstructive sleep apnea (OSA). Roughly 35% of the adult population in the US say they typically sleep less than seven hours per night. 

Although sleeping pills and medications are still a popular form of treatment, people with sleep disorders are increasingly turning to drug-free solutions for their sleeping issues. Sleep therapy is one of the most common—and effective—of these. This post explores sleep therapy, the types of conditions it treats, how it works, and when to seek professional guidance for sleep issues. 

Having trouble sleeping? Sleep and mental health are closely connected.

Sleep therapy can help

What is sleep therapy? 

Sleep therapy refers to therapies within the behavioral sleep medicine (BSM) field directed at treating sleep disorders and helping people improve their sleep quality. It involves various techniques and interventions designed to help individuals identify and address the factors contributing to their sleep issues. By changing one’s sleep habits and addressing underlying mental health or medical conditions, sleep therapy can significantly enhance overall wellbeing and quality of life. 

What types of issues does sleep therapy treat?

Sleep therapy treats various sleep-related issues, ranging from sleep deprivation to apnea to disorders affecting sleep timing. Sleep issues that can be treated with therapy include (but aren’t limited to):  

• Insomnia: A common sleep disorder characterized by trouble falling asleep, staying asleep, early morning awakenings, daytime fatigue, and drowsiness despite getting enough hours of sleep. 
• Restless legs syndrome (RLS): Characterized by an overwhelming urge to move the legs, usually accompanied by sensations like aching, throbbing, tingling, and burning. RLS is considered a sleep disorder because it typically gets worse at night and significantly interferes with sleep. 
  
• Circadian rhythm sleep disorders (CRSDs): These disorders disrupt the body’s circadian functioning, leading to sleeplessness, sleeping and waking at unusual times, and extreme fatigue. CRSDs include delayed sleep phase disorder, advanced sleep phase disorder, shift work disorder, and jet lag. 
• Sleep Apnea (Behavioral Support) Typically treated with CPAP machines, but therapy can help with adherence and lifestyle changes. Behavioral interventions, weight management strategies, positional therapy  

Cognitive behavioral therapy and other types of sleep therapies

Several types of sleep therapies help treat sleep disorders and improve sleep quality. Depending on the sleep issue, these therapies can be behavioral, psychological, or physiological. Each therapy method is tailored to different sleep disorders, but a combination of approaches is sometimes used. 

Cognitive behavioral therapy (CBT)

CBT is a type of psychotherapy that helps people manage a variety of issues, such as mental health conditions, tinnitus, insomnia, and others. It works by identifying and changing negative thought patterns and behaviors, focusing on the connection between thoughts, feelings, and actions to develop healthier coping mechanisms and responses to challenging situations. CBT is considered the "gold standard" for treating several mental health conditions and, for some people, can be more effective than sleep medication. 

Relaxation therapy

Sleep hygiene training  

Sleep hygiene refers to practices that cultivate quality sleep. It often includes establishing a consistent sleep environment and healthy sleep habits through lifestyle and behavioral adjustments. Key strategies include adhering to strict waking and sleeping times, keeping an optimal sleep environment, and avoiding caffeine, alcohol, and screen time before bed, among other things. For some, changing their behaviors around sleep can be challenging and may require lifestyle changes in different areas. 

How sleep therapy works for insomnia

Cognitive behavioral therapy for insomnia (CBT-I) is the most common form of therapy used to treat insomnia symptoms. It is a form of CBT specifically designed to treat insomnia by addressing negative thoughts and behaviors associated with sleep. It includes techniques like sleep restriction therapy (setting specific parameters around time spent in bed), stimulus control therapy (restricting bed use to sleep and sex), relaxation techniques, and consistent sleep schedules to train the body to associate the bed with sleep and reduce anxiety around bedtime, ultimately leading to better sleep quality. 

Sleep therapy for sleep apnea and other sleep disorders 

Sleep apnea, insomnia, and other sleep disorders share many of the same treatments. They're often complementary treatments with CBT, oral appliances, CPAP, and/or medications. These include relaxation therapy, sleep hygiene therapy, and psychoeducation. 

Behavioral therapy for sleep apnea 

While CPAP (continuous positive airway pressure) therapy is the primary treatment for sleep apnea, behavioral therapies can be used as a complementary treatment to enhance effectiveness. With early intervention, behavioral therapy may help individuals avoid CPAP therapy entirely. It works by addressing the lifestyle factors that contribute to sleep apnea, such as weight management, alcohol consumption, smoking cessation, and sleep hygiene practices. 

How sleep benefits physical and mental health

Getting enough quality sleep can help individuals keep a healthy weight, lower their risk of heart disease and diabetes, and strengthen the immune system. It’s essential for healing the body, cleansing the nervous system, and storing energy. Research shows that getting enough quality sleep can boost athletic performance and play a critical role in hormone regulation. Regarding mental health, sleep can help you feel less stressed and more energetic. It's essential to successful mood regulation, memory functioning, learning, problem-solving, and decision-making. 

When you can’t fall asleep because of pain: Sleep therapy for chronic pain and sleep disorders

Unlike acute pain, chronic pain (CP) often lacks a physical cause. CP and sleep problems often cooccur in a cycle in which pain causes sleep problems that increase sensitivity to pain stimuli. CBT is the most used psychological approach to treating sleep disorders like insomnia and chronic pain, and several studies and meta-analyses indicate it's a highly effective treatment option for people with comorbid CP and insomnia. 

Who can benefit from sleep therapy?

Anyone experiencing sleep issues that impact their daily life and wellbeing can benefit from sleep therapy. People with chronic insomnia, shift workers, and individuals with stress-related sleep issues may find sleep therapy to be effective. Individuals with sleep apnea may benefit from modified behavioral therapy if the apnea is caused by lifestyle factors like obesity or smoking. Individuals with anxiety and PTSD-related sleep disturbances, such as frequent nightmares or difficulty falling asleep and staying asleep, may benefit from modified trauma-focused therapy, relaxation training, and imagery rehearsal therapy to cope with nightmares. 

Can’t fall asleep or stay asleep? When to seek professional help

You should seek professional help for sleep problems if they're chronic (persisting for about three months), severe, or affecting your quality of life. You should also seek help if you've tried changing your sleep habits unsuccessfully. Here are a few other signs that it might be time to seek professional guidance for your sleep issues: 

• You're excessively sleepy during the day
• You're dozing off involuntarily
• You're having trouble concentrating or remembering things
• You're snoring loudly
• You're waking up in the middle of the night
• You're struggling to stay awake while driving or at work

Finding a mental health professional for sleep issues

To find a mental health professional specializing in sleep issues, contact your primary care physician for a referral or check with your insurance provider for in-network specialists. You may also consult an online directory through organizations like the American Psychological Association or Society of Behavioral Sleep Medicine or contact a local sleep clinic for guidance. When considering a therapist, look for a mental health professional who specializes explicitly in CBT-I and sleep disorders or has experience treating insomnia, as not all therapists will have extensive knowledge in this area. 

Some online therapy platforms can also provide users with access to a wide variety of therapists experienced in treating sleep dysfunction using CBT-I. Virtual therapy allows clients to receive professional guidance from home on a schedule that fits their needs, which can be helpful for some people with sleep trouble, as it eliminates travel to and from appointments. Online platforms also provide flexible modality options, including asynchronous messaging, video sessions, and sleep-tracking tools, allowing therapists to tailor treatment to the client’s unique needs. 

Multiple studies suggest that online CBT-I is as effective as in-person therapy in improving sleep quality, reducing nighttime awakenings, and addressing underlying issues such as anxiety or stress. For example, preliminary findings from an ongoing American Academy of Sleep Medicine study reveal that internet-delivered CBT-I and traditional CBT-I methods were equally effective at improving sleep outcomes, and there were no differences in participants’ satisfaction with treatment and therapeutic alliance between modalities.