The thinking side of insomnia
The sleep window and stimulus control work on what you do. The cognitive part of CBT-I works on what you think and expect about sleep. It matters because those thoughts can keep the brain alert at night, and because they push people toward the very habits that keep insomnia going.
The loop
Allison Harvey’s cognitive model of insomnia describes a loop that many people with insomnia will recognize.
- Worry. At night, or during the day, thoughts turn to sleep and what a bad night will cost. “If I don’t sleep, tomorrow is ruined.”
- Watching. Worry makes you watch for signs of trouble. You check the clock, notice every bit of tiredness, and read a heavy head in the afternoon as proof the night went badly.
- Seeing more than is there. Watching that closely makes problems look bigger. People with insomnia often believe they slept less than they did.
- Coping in ways that backfire. To protect themselves, people cancel plans, nap, sleep in, go to bed early, or lie in bed to rest. Each makes sense. Each also keeps the worry from ever being tested, and several of them make the next night harder.
Then the next night arrives with more riding on it, and the loop turns again.
Beliefs about sleep
Charles Morin and his colleagues developed a questionnaire on the beliefs about sleep that tend to keep insomnia going. Some of the ones it asks about:
- Needing eight hours, every night, to function.
- A bad night ruining the next day.
- Feeling that sleep is out of your control.
- Needing to catch up on lost sleep.
None of these is silly. Most grow out of real bad nights. The trouble is that they turn every night into a test, and a test is hard to sleep through.
What works on the thinking side
Looking at the evidence. A belief is easier to loosen when you check it against what actually happened. In “Thoughts about sleep,” each common belief comes with another way to see it and a question to ask yourself, and most show what your own diary says about them.
Experiments. Testing a belief is often stronger than arguing with it. You write down what you expect, do something different for a few nights, and see what happens. “Sleep experiments” has four ready to try, like turning the clock away or keeping your plans after a poor night.
Giving worry a time. Worry time, early in the evening, gives the day’s concerns a place that isn’t your pillow.
Stepping back from thoughts. Instead of arguing with a thought at 3 AM, you notice it as a thought and let it pass. “Leaves on a stream” practices this.
Letting go of effort. Trying hard to sleep keeps the mind alert. “Let sleep come” turns that around.
How it fits with the rest
In a trial by Harvey, Morin, and colleagues, the behavioral parts of CBT-I worked faster, and the cognitive parts took longer but kept improving over the next six months. Together they did best. That’s why Sleep Toolbox has both.
If thoughts about sleep come with worry that fills your days, or with low mood that lasts more than a couple of weeks, talk with a doctor or therapist. For a thought that isn’t about sleep, the Thought Record app from Everyday Insight walks through it step by step.
References
- Harvey, A. G. (2002). A cognitive model of insomnia. Behaviour Research and Therapy, 40(8), 869–893. doi.org/10.1016/S0005-7967(01)00061-4
- Morin, C. M., Vallières, A., & Ivers, H. (2007). Dysfunctional beliefs and attitudes about sleep (DBAS): Validation of a brief version (DBAS-16). Sleep, 30(11), 1547–1554. doi.org/10.1093/sleep/30.11.1547
- Harvey, A. G., Bélanger, L., Talbot, L., Eidelman, P., Beaulieu-Bonneau, S., Fortier-Brochu, É., Ivers, H., Lamy, M., Hein, K., Soehner, A. M., Mérette, C., & Morin, C. M. (2014). Comparative efficacy of behavior therapy, cognitive therapy, and cognitive behavior therapy for chronic insomnia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 82(4), 670–683. doi.org/10.1037/a0036606
Helpful links
Everyday Insight’s tools are for education and personal reflection. They are not therapy or medical care, and they are not for emergencies. In an emergency, call 911. If you are in crisis in the United States, call or text 988.