CBT for insomnia is effective but its recommendations are hard to follow

Cognitive behavioural therapy for insomnia (CBT for insomnia) can be a very effective treatment for chronic insomnia.

However, the recommendations of CBT for insomnia can be somewhat difficult to adhere to: keeping to a regular bed and wake schedule (meaning no sleeping in on weekends), no napping, no reading in bed before sleeping, and getting out of bed when sleep is not coming.

This can be a problem for some because some of these behaviours may be ones that they really enjoy: many of us love cozying up in a warm blanket in the morning! And for others, especially those with difficulty sleeping, they may worry that getting out of bed could mean that they won’t fall back asleep.

Therefore, adherence to following CBT for insomnia rules can be tough at times.

To combat this, we as clinicians like to say that these rules are not forever. They are just done during treatment until you feel confident about your sleep again – then you can go back to these behaviours after treatment. This often makes people feel a lot more comfortable testing these rules out to see how they affect their sleep, with the knowledge that they aren’t forever.

But is that true? Can you really have your cake and then eat it too?

Testing this question with research

In our lab, we often conduct clinical trial research and provide CBT for insomnia to the broader community. As part of my own unique interest, I wanted to see whether people who got better after CBT for insomnia were able to go back to the things they enjoyed in terms of their sleep behaviours after treatment.

After all, insomnia is a bit of a subjective disorder. We can objectively have bad sleep, but if we don’t feel worried about our sleep and know how to get our sleep back on track, then it’s not a problem. Insomnia is only an issue when we are concerned about our sleep and worry excessively about not getting enough.

Therefore, I was interested in whether insomnia severity would stay low after treatment and whether these other sleep habits would go back to how they were after successful treatment.

Methods of the research study

We had 137 participants in the study, recruited from the Greater Toronto Area, who received 4 sessions of CBT for insomnia and successfully become good sleepers by the end of it (for those that are interested, that’s about 77% of all participants who completed the treatment).

We then followed these participants for 1 year after treatment to see what their sleep habits and insomnia severity was like to see if people stayed good sleepers once treatment was over. Most – if not all – continued to stay good sleepers.

Findings of our study

What we found was pretty consistent with our hypotheses for the study. People’s sleep habits and insomnia symptoms tended to reduce significantly after treatment, but during the 1-year follow-up, people were spending more time in bed in the morning and at night doing things they enjoy (e.g., reading, cozying in bed) while insomnia symptoms remained low.

We also found that ‘worsenings’ of these sleep habits didn’t really predict our insomnia symptoms very much, which is a very hopeful finding.

You can have your cake and eat it too

Overall, my findings suggest that you can have your cake and it too. You can follow the recommendations of CBT for insomnia, benefit from it, and then take only what you think is a good addition to your life to stick with. You can read a book in bed without it having catastrophic disruptions in your sleep again.

If you’re interested in the full study, here’s the manuscript that I published with my peers in the lab (I’m somewhat proud of it myself): https://www.tandfonline.com/eprint/EGZS4SR6PTZ4IATKGBUP/full?target=10.1080/15402002.2022.2124993 

If you found this article interesting, please consider subscribing to the mailing list for more evidence-based information on mental health!

Best wishes,