It is known that, to date, only a quarter of people suffer from insomnia they turn to a professional for help. This happens because insomnia is often considered a secondary symptom of other conditions, such as a medical or psychiatric disorder, or a consequence of general stressful situations.
In fact, insomnia is an independent disorderwith defined and specific symptoms, for which there are recognized treatments based on scientific evidence. Among the types of psychotherapy available, the cognitive-behavioral psychotherapy has proven to be the most suitable for reducing the symptoms ofinsomnia chronic.
Techniques used for sleep therapy in insomnia
There initial evaluation phase takes place through a clinical interview and the use of questionnaires, such as:
- the semi-structured interview on Morin’s insomnia;
- there Dysfunctional beliefs and Attitudes about Sleep (DBAS);
- the compilation of sleep diarywhich helps to better understand the problem by indicating sleep times, time asleep and time spent awake.
In some cases, instrumental tests may also be scheduled such as:
- polysomnography (dynamic polygraphic recording of sleep), which measures sleep disorders and brain activity during rest;
- the use of the actigraph, an instrument to be worn on the wrist of the dominant hand for two weeks, which allows you to monitor your sleep-wake rhythm and provides valuable information useful for setting up a personalized sleep therapy.
In the second phase of cognitive-behavioral therapy for insomnia, the results obtained in the evaluation are returned, the diagnostic framework is composed and a conceptualization is carried out in cognitive-behavioral terms.
Psychoeducation on sleep and insomnia represents the third phase. At this time you are often invited to read the self-help book How to overcome insomnia and we start promoting correct sleep hygienesuggesting some simple rules such as:
- avoid naps during the day;
- do not practice physical activity before bed;
- limit the use of coffee, nicotine, alcohol, heavy foods and excessive amounts of liquids in the evening;
- dedicate 20-30 minutes, before or immediately after dinner, to slow down the activities of your mind and body and close the day.
There phase of the intervention involves the application of specific techniques and a cognitive restructuring of automatic negative and dysfunctional thoughts related to sleep, to replace them with more functional and rational thoughts. In the final stage we work on relapse prevention.
Diagnostic criteria and international guidelines
To better understand insomnia and its treatment, it is important to refer to the main diagnostic manuals and international guidelines.
According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), insomnia is classified as an independent disorder, characterized by difficulty falling asleep, staying asleep or early awakenings, which occur at least three times a week and persist for at least three months, causing clinically significant distress or impairment in social, occupational or other important areas of functioning.
Even theICSD-3 (International Classification of Sleep Disorders, third edition) defines insomnia as persistent difficulty sleeping, not attributable exclusively to environmental factors or other medical or psychiatric disorders.
These criteria help professionals to distinguish primary from secondary insomnia and to choose the most suitable therapeutic path.
Causes and theoretical models of insomnia
Insomnia can have different origins and is often the result of a combination of factors. One of the most recognized models to explain the development and maintenance of insomnia is the Spielman’s 3P model.
This model identifies three categories of factors:
- Predisposing factors: Individual characteristics that may increase vulnerability to insomnia, such as increased reactivity to stress, a family history of sleep disorders, or an anxious personality.
- Precipitating factors: events or situations that can trigger the onset of insomnia, such as periods of intense stress, life changes, illness or bereavement.
- Perpetuating factors: behaviors and thoughts that maintain the disorder over time, such as anticipatory anxiety related to sleep, poor habits (for example, spending a lot of time in bed awake) or attempts to compensate for the lack of sleep with daytime naps.
Understanding these factors can be fundamental to setting up an effective and personalized treatment.
The techniques used for the treatment of insomnia
To deal with and try to resolve insomnia disorder, some techniques are used:
- the technique of stimulus control;
- the technique of sleep restriction;
- the techniques of relaxation;
- the technique of paradoxical prescription.
The stimulus control technique
This technique aims to interrupt the association between bed and activities incompatible with sleep. It explains the importance of using the bedroom only for sleeping or sexual activity, of going there only when you are sleepy and of not staying in bed awake for more than 20 minutes.
The sleep restriction technique
This technique aims to regulate the sleep-wake rhythm, establishing a threshold time between waking up and sleeping. The goal is to reduce the time spent in bed through partial sleep deprivation.
Relaxation techniques
These techniques aim to reduce physiological activation. In the first week they should be practiced once a day, away from bedtime; subsequently, they can be carried out at bedtime and when waking up.
The technique of paradoxical prescription
This technique aims to reduce “performance” anxiety and attempts to force sleep. The person is invited to try not to fall asleep, but to do everything possible to stay awake, so as not to interfere with the natural process of falling asleep and create a paradox.
Summary of the phases and techniques of CBT-I
To better orient yourself in the therapeutic path, here is a summary of the main ones phases And techniques of CBT-I:
- Initial assessment: includes clinical interviews, questionnaires and sleep diaries to understand the nature of the disorder.
- Restitution and conceptualization: analysis of the results and definition of a personalized therapeutic plan.
- Psychoeducation and sleep hygiene: information on the rules of good sleep and habits to change.
- Intervention with specific techniques:
- Stimulus control: re-education in the use of the bed and bedroom.
- Sleep restriction: Adjusting schedules to improve sleep efficiency.
- Relaxation techniques: reduction of physical and mental activation.
- Paradoxical prescription: reduction of sleep-related anxiety.
- Relapse prevention: strategies to maintain results over time.
This framework helps to understand how CBT-I can address insomnia in a gradual and personalized way, offering practical tools supported by scientific evidence.
Epidemiological data on insomnia
Insomnia is a very common disorder globally. According to a review published in “Sleep Medicine Reviews” (Ohayon, 2002), approximately 10-15% of the adult population suffers from chronic insomnia, while until 30-35% reports occasional symptoms of insomnia.
These data underline how important it is to recognize and treat the disorder promptly, to reduce the risk that it becomes chronic and can have a negative impact on quality of life, psychological well-being and general health.
Effectiveness of CBT-I compared to drugs
There cognitive-behavioral psychotherapy for insomnia (CBT-I) it is considered the first choice treatment for chronic insomnia according to numerous international guidelines, including those of the American Academy of Sleep Medicine.
Several clinical studies and meta-analyses have shown that CBT-I is effective in improving the quality and duration of sleep, with benefits that are maintained over time even after the end of therapy. For example, a meta-analysis published in the “Annals of Internal Medicine” (Trauer et al., 2015) highlighted that CBT-I produces significant improvements in sleep latency and sleep quality compared to placebo and pharmacological treatments.
Unlike hypnotic medications, which may only be useful for short periods and pose risks of addiction or side effects, CBT-I can help change dysfunctional sleep-related behaviors and thoughts, offering tools that can contribute to longer-lasting management of insomnia.
Adaptations of CBT-I for specific populations
There CBT-I it can be adapted to meet the needs of different population groups or in the presence of other health conditions.
- Children and adolescents: in these age groups, therapy is often integrated with parental involvement and educational strategies aimed at promoting good sleep habits.
- Elderly people: CBT-I has also proven effective in the elderly population, where insomnia may be linked to physiological changes or chronic pathologies. Interventions are adapted to take into account specific needs and any comorbidities.
- Psychiatric or medical comorbidities: CBT-I can be integrated with other treatments when insomnia co-occurs with disorders such as depression, anxiety, or chronic illnesses. In these cases, collaboration between different health professionals is essential for a complete and personalized approach.
These adaptations allow us to offer more effective support even to those with particular needs or complex health conditions.
Do I need psychotherapy for insomnia?
If you think you may have insomnia, you can start exploring your symptoms with a screening test like the Insomnia Severity Index.
In any case, if you feel that your quality of life has worsened due to sleep problems, the advice is to contact a psychological health professional, such as those at Evidence Network, who can help you understand your difficulties and intervene effectively to return to a healthier lifestyle.
