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CBT-Insomnia Treatment: How to Fall Asleep Faster

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Hi, everyone. I’m Emma McAdam. I’m a licensed marriage and family therapist, and I make mental-health education videos. Today we’re going to talk about how to overcome insomnia.

What’s Causing Your Insomnia?

If you were to ask someone, “What’s causing your insomnia?” they might say something like, “Oh, my stress, my anxiety, my brain won’t shut off.” Maybe they think it’s their cat waking them up or they drank too much coffee or watched a scary movie before bed.

And granted, all of these things can mess with your sleep for a night or two or more, but they aren’t the thing that causes chronic insomnia. 

In most cases, chronic insomnia is caused by one bad habit where you accidentally trained your brain not to sleep. The bad habit is staying in bed awake. This is the worst thing you can do for your insomnia, and it’s key to one of the most effective treatments for insomnia, CBT-I, an evidence-based treatment for insomnia that has shown up to 80% effectiveness at relieving insomnia. 

You see, when you lie in bed awake — maybe you went to bed too early or you’re trying to force yourself to sleep — and you’re worrying about all the things, like what you said that day and what’s going to happen with your job and whether that one guy likes you or any of any number of other things, you’re basically training your brain that the bed is the place for worrying and lying there awake. 

This is a paired association. It’s like Pavlov’s dogs — they learned to salivate when the bell rang, even when there wasn’t any food around. 

When you lay in bed awake, your brain learns that the bed is the place for worrying, for thinking, for watching shows, for doing homework, whatever it is that you’re doing. You lay down in bed, and your brain thinks, “Oh, I know this place. This is the thinking place.” So without realizing it you trigger that worry reaction, and then it takes hours to fall asleep.

What Can You Do About It?

So one aspect of the most effective treatment for insomnia is if you can’t sleep, get out of bed. If you can’t sleep and it’s been more than 15 minutes, get out of bed. Do something that’s not too stimulating, and then when you start to feel drowsy, go lay back down. 

Now, I know this sounds miserable. You’re probably thinking, “I’m just gonna be so tired, and this will just make it worse.” And yes, that’s true. You may be more tired in the short term. But within a week or so it’s most likely going to improve your sleep efficiency. So that’s the percentage of time that you spend in bed actually sleeping. 

So just remember this: get up, hang out, try again. Get up, go sit quietly in another room, hang out, do nothing or read a soothing book. If you lay there for more than 15 minutes, get back up, hang out, and then try again when you feel sleepy. 

Now, while this feels miserable, it works really well. You may feel sleep-deprived for a couple of days, but in the long run it’s very effective at treating insomnia. 

Getting out of bed does two things: it retrains your brain that the bed is for sleeping and not other stuff, and then it also builds up this sleep pressure, that tired feeling, so that when you do lay down you’ve got more internal drive to sleep and you fall asleep faster. And again, that retrains your brain that the bed is for sleeping. 

So as you retrain your brain, you’ll fall asleep faster, you’ll stay asleep longer, and you’ll spend less time lying awake getting angry that you’re not sleeping. 

And again, this is a core principle of CBT-I: it literally rewires the brain to sleep better. They have imaging studies showing that after CBT-I, people have improved cognitive functioning, decreased stress, and improved memory. And most importantly, you sleep better. 

Okay. Thanks for watching, and take care.

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Sources (1) https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.157.10.1552 (2)https://www.nature.com/articles/s41398-022-01868-3 https://www.researchgate.net/figure/Heritability-estimates-of-selected-psychiatric-disorders, https://www.nimh.nih.gov/health/publications/looking-at-my-genes, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6421104/ https://jamanetwork.com/journals/jamapsychiatry/fullarticle/204765 https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2018.18070789 https://www.news-medical.net/health/The-Genetics-of-Mental-Disorder.aspxhttps://jamanetwork.com/journals/jamapsychiatry/fullarticle/204765 (3) https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2018.18070789 (4)https://www.nimh.nih.gov/health/publications/looking-at-my-genes

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