Home » Patients » Cognitive Behavioral Therapy
October 2020 |  Reviewed by:  Reeba Mathew, MD and Shelley Hershner, MD

What is cognitive behavioral therapy?

Cognitive behavioral therapy (CBT) helps you change actions or thoughts that can keep you from sleeping well. It helps you develop habits that promote a healthy pattern of sleep. CBT is most often used to treat insomnia. Talk to your medical provider or a sleep doctor to see if one of these methods might improve your sleep.

What are the types of cognitive behavioral therapy?

Stimulus Control

A stimulus is anything that causes a response. The goal of this method is for you to have a positive response when you get into bed at night. It is used for people who toss and turn in bed, unable to fall asleep. When this happens for many nights, you begin to get frustrated. You may even dread bedtime, expecting to toss and turn for hours. Bedtime, and even your bed itself, can then cause you to have a negative response.

This method teaches you to use the bed only for sleep and for sex. You are not to read, watch TV, or do anything else in bed. You are also taught to go to bed only when you feel very sleepy. If you are not asleep after about 20 minutes, then you are to get out of bed to do something else relaxing. When you feel sleepy again, you return to bed.

Over time, this method helps you to fall asleep more quickly. You begin to have a positive response toward going to bed at night. Instead of being frustrating, it becomes relaxing and restful.

Sleep restriction

This method sets strict limits on the time you spend in bed. The initial limit used is the same as the amount of sleep you tend to get on a nightly basis. For example, you may only get five hours of sleep even though you spend seven hours in bed at night. Two hours in bed are spent trying to fall asleep or go back to sleep after waking up. In this case, your initial limit would be set so that you spend only five hours in bed at night. This means that you are likely to get less than five hours of sleep.

This sleep loss will make you even more tired at first. However, it will also help you fall asleep faster and wake up fewer times in the night. This will allow a solid period of sleep and a more stable sleep pattern. As your sleep improves, the limit on your time in bed is slowly increased. The goal is to reach the point where you get the amount of sleep you need without reducing the quality of your sleep.

Relaxation training and biofeedback

Relaxation training teaches you how to relax both your mind and your body. This helps you to reduce any anxiety or tension that keeps you awake in bed. This method can be used during the day and at bedtime. It involves training you to better control the following functions:

  • Muscle relaxation
  • Breathing
  • Mental focusing

Biofeedback may be used along with relaxation training. The process of sleep is more complex than it seems. It involves your brain, your breathing, your heart and your muscles. Biofeedback teaches you how to control certain functions of the body by receiving feedback from the body itself. Biofeedback can provide details on:

  • Muscle tension
  • Brain waves
  • Blood pressure
  • Heart rate
  • Body temperature

In order to sleep better, you are taught how to change either your muscle tension or your brain waves. You wear a device that signals to you the level of your muscle tension or brain wave frequency. You then try to change that level in a way that will help you sleep. The device uses a gauge, visual images or sounds to tell you how your level is changing.

These methods require you to focus and concentrate in order to see results. Some people may learn the methods in just a few sessions. Others may need many sessions to master the techniques.

Cognitive control and psychotherapy

These methods are used to help you identify attitudes and beliefs that hinder your sleep. These negative thoughts i