Cognitive Behavioural Therapy for Insomnia: Quick-Wins for a Longer, Healthier Life
You don’t need to be an insomniac to get the longevity benefits of CBT-I.
Cognitive Behavioural Therapy for Insomnia is a powerful first line treatment for sleeping disorders. Doctors in the USA prescribe it before sleeping pills – and it is gaining popularity worldwide.
After studying the science, I’m convinced that everyone can benefit.
If you suffer from insomnia or sleeping issues, then the ideas are proven. Everyone will benefit from better quality sleep. This is a bedrock of healthy ageing. By cherry picking the key concepts of CBT-I, you will start to improve your sleep quality right away.
This page dives into CBT-I for longevity. Firstly, you’ll find an overview of how it works – featuring the five pillars. After that I cherry-pick those areas which will improve the quality and duration of your sleep – both for short-term and longer-term longevity benefits.
A quick note for anyone suffering from severe insomnia – please contact your doctor or primary care provider. There are solutions, and they need to be discussed in relation to your personal situation coupled with your health needs.
Cognitive Behavioural Therapy for Insomnia: Overview
Insomnia takes several forms.
The classic version is that people can’t fall asleep. Other forms include waking up early (and then being unable to get back to sleep), or disruptive repeating sleep / wake cycles.
CBT-I addresses beliefs and behaviours around sleeping. It is a 4–to-8-week program with a trained psychologist. Because this treatment is so effective, it has replaced the prescription of sleeping pills as the first-line treatment for insomnia in multiple countries.
Five Pillars of CBT-I
There are five linked areas of CBT-I:
- Stimulus Control: Association of the bedroom with sleep only, breaking the link between being in bed and being awake.
- Sleep Restriction: Deliberately restricting the hours in bed to match your current sleep duration, then expanding that time slowly.
- Cognitive Restructuring: Reducing unwelcome thoughts, addressing anxiety about your performance the next day.
- Relaxation Training: Breathing techniques and deep muscle relaxation, including not associating them only with insomnia.
- Sleep Hygiene: Wide ranging practical measures like routines, dark and cool room, no alcohol or caffeine before bed.
Short-term discomfort is involved in many of these areas. Sleep restriction requires staying awake long after your regular bedtime to start. Stimulus control requires getting up, often multiple times, for the long-term benefit of breaking the mental link between your bedroom and insomnia.
Longevity Benefits: Quick Wins and Long-Term Habits from CBT-I
Most of what I called ‘longevity sleep habits,’ before studying CBT-I are in the sleep hygiene category.
These are the nuts and bolts of a million articles on improved sleep. They are:
- Firstly, get a regular routine, hitting the sack at the same time each night
- Make sure your bed is comfortable, and the room dark, quiet, and cool
- Avoid blue (artificial) lights from screens late at night
- Manage your caffeine intake, preferably mornings only
- Manage alcohol, which destroys sleep quality
- Get sunlight in the morning to reset your circadian rhythm
I found three more habits from CBT-I – all of which I’m working on right now.
CBT-I and Longevity: Relaxation Training, Sleep and Ageing
This sleeping tip comes with a twist.
Relaxation training is sequential muscle relaxation, slow breathing, and meditation techniques.
The things you do in bed when you want to sleep but can’t.
My take-away from CBT-I is that if you only do them in bed, when you can’t sleep – then you’ll closely associate them with insomnia, and all the anxiety that goes with it.
To benefit from relaxation training, you must do it in other settings, at other times and in other states of mind.
This ties in perfectly to what multiple scientists (hat tip to Dr Huberman and to Deepak Chopra) say about the importance of meditation to healthy ageing and longevity.
Best of all, this is easy to start. Simply take some time to mediate or learn progressive muscle relaxation for a break from work.
Stimulus Control: Short Term Pain, Long Term Gain
Associating your bedroom with anything other than sleeping causes problems.
CBT-I therapy recommends removing TVs and other distractions. Furthermore, if you can’t sleep for more than 15 minutes, you need to get out of bed completely. By finding another room for a quiet activity, and returning when you feel sleepy, your brain will associate the bedroom with sleep.
The problem with stimulus control is that it is disruptive in the short-term.
Some nights, you’ll be in and out of bed like a yo-yo.
What I learned from this therapy technique is that the benefits of stimulus control are long-term. And they are worth it after you get through the initial disruption.
Getting into the habit of cognitively associating your bedroom only with sleep requires some initial work. Once your neurones line up – the benefits are huge.
It got me focused on which longevity habits have a similar balance.
Cognitive Restructuring, CBT-I and Longevity
Anxiety about not being able to get to sleep creates a vicious cycle.
Once the anxiety kicks in, your chances of falling sleep plummet. This causes even more anxiety.
CBT-I tries to break this loop. Significantly, letting yourself off from peak performance the next day is recommended. You might not be at your finest (physically or cognitively), though you can still get your main tasks done. Even if it is a struggle, you’ll make that work deadline, or complete that essay.
I found a lot of take-aways in terms of linking CBT-I with longevity in this area.
It might be hard to work out effectively, to eat as healthily as you’d like or to resist those toxic sugar-packed snacks when you did not sleep well.
While this is far from ideal, the damage that worrying about it does (though anxiety stopping you from sleeping) is worse. If you find yourself in a spiral, with anxiety about missed health goals or alcohol disrupting a whole week of sleep – then you are better off taking the short-term hit.
My habit take-away is to plan for this situation.
Have a minimum acceptable ‘bad day.’
I’ll flesh this out in more detail soon – linking sleep deprived bad days to those days where life just gets us down.
Sleep Hygiene: Everyone has Room for Improvement
Sleep hygiene is the nuts and bolts of your routine and sleep environment.
Get this wrong and you are costing yourself dearly. Reduced quality of sleep is just as bad as reduced sleep duration. I will do a separate habits themed page covering sleep hygiene. For this CBT-I and longevity themed one, here is a list of things to act on:
- Avoid blue light before sleep
- No food too close to sleeping
- No exercise too close to sleeping
- Ensuring you have a regular routine
- Avoiding alcohol
- Get sunlight in the morning
- Managing caffeine
- Dark sleep environment
- Cool sleep environment
- Quiet sleep environment
- Make space for 7+ hours sleep each night
Wrapping Up: Cognitive Behavioural Therapy for Insomnia and Longevity Habits
I had three major take-aways from my deep dive into CBT-I which are directly applicable for longevity habit creation.
- Don’t associate habits with negative situations (example from CBT-I is only ever using muscle relaxation when you can’t sleep).
- Some habits work in the long term, at the expense of short-term disruption. Example is get out of bed when you can’t sleep, which boosts the association between your bed and sleeping over time.
- Planning for a bad day. Sleep deprivation is boosted by worry about performance the next day; this also applies to longevity habits – let’s make plans for those bad days in advance.
The best resources for sleep therapy are over in the US. Here are some pages and videos I enjoyed, which go into more detail:
- Video: Dr Virgina Runko explains CBT-I
- SleepFoundation.org have fact-checked resources on sleep disorders
More Popular Pages:
- Detailed Review of Why We Sleep by Matthew Walker
- Sauna Benefits for Longevity
- Life Extension and Ethics