A typical night for Shoshanna G. involves a lot of tossing and turning, a lot of staring at nothing and, much to her chagrin, very little sleeping.

“It feels like hours. … I lay there and I lay there,” Says the 39-year-old school teacher from Brooklyn, NY.

Like 35 million other Americans, Shoshanna suffers from insomnia. It’s a problem that goes well beyond the bedroom.

“I’m in a meeting and I can’t finish the thought because my brain is shut down,” Shoshanna said.

Shoshanna said she has tried taking vitamins, going to bed earlier, exercising and even taking sleeping pills but nothing has worked.

Getting the proper amount of sleep can affect the rest of your life because sleep could be connected to other activities neurologically.

“It’s likely that there’s some areas of the brain that are more activated and these areas might correlate to those complaints that someone with insomnia might have,” said sleep expert Claudia Toth of the Behavioral Sleep Medicine department at Sleep Health Centers in Weymouth, Mass.

Medicine, it turns out, isn’t necessarily the answer for insomnia, the most common sleeping disorder, Toth said.

“You don’t need to take medicine to deal with insomnia,” she said. “In the long run, Cognitive Behavioral Therapy (CBT) tends to be a more effective approach.”

Cognitive behavioral therapy retrains your brain in order to change your behavior.

It’s a therapy that Leah S. said worked wonders for her. Leah said she had been suffering with sleep problems off and on for over two years before she started CBT about three months ago.

“It was pretty clear from the outset that I was going to bed way too early,” Leah said. “I was spending all this time in bed where I wasn’t sleeping.”

Using sleep restriction and stimulus control, Leah said her sleep has now become “stable.”

“You know, I still have the occasional not-so-great night, but I sleep pretty much– I have a very regular sleep pattern now,” she said. “One of the best things about it is I just don’t worry about sleep as much… I really just have less anxiety and I think it frees my mind to do other things.”

Elements of Cognitive Behavioral Therapy


According to the Mayo Clinic, there are several parts to cognitive behavioral sleep therapy.

Cognitive Control and Psychotherapy

This technique involves getting rid of negative thoughts about sleeping or any worries that keep you awake at night, the Mayo Clinic said.

Sleep Restriction

“The sleep-restriction technique basically involves someone limiting time in bed closer to the amount of time that they estimate they’re actually sleeping”. “After getting into bed, we’ll have you get up and out of bed in about 15 minutes if you feel like you’re not sleepy. Move into another room, do puzzles, listen to music. I want you to wait until you get drowsy, no matter how long it takes. We want to help you build your hunger for sleep. … Avoid all activities other than sleep in bed.”

Another very important part of the therapy is making sure you wake up at the same time every day. “Initially you may get less sleep, but setting your alarm for the same time every day will help ensure you are tired at night”.

Remain Passively Awake

It may sound counter-intuitive, but the Mayo Clinic suggests you can alleviate anxiety about not sleeping by simply not making any effort to fall asleep.

Stimulus Control

The stimulus control method helps you control what your bed means to you and can help you get rid of any negative associations you may have with it. Use the bed only for sleeping and intimacy and ditch the television, reading, talking on the phone and other distractions.

Sleep Hygiene

This part of the therapy involves tempering or eliminating lifestyle habits that could interfere with sleep like smoking or drinking too much coffee or alcohol. It also involves a winding down period for an hour or two before bed.

Americans spend an estimated $2 billion every year on sleeping pills. But there are cheaper, more effective ways to combat the problem.

Get a bedtime routine. They’re not just for kids. Parents too can benefit from the routine, essentially warning your body it’s almost time for sleep.

Make sure the room is quiet and dark. Use eye shades if your room gets a lot of light.

Think positively. Saying things like, “I’m never going to fall asleep” can actually affect your ability to do just that. Don’t think self-defeating thoughts when you hit the sack. Keep it positive.

Cover your clock. Most people when they wake at night immediately look at the clock. Bad idea. Cover the clock or get it out of the bedroom.

Don’t hang out in bed. If you’re not sleeping or being intimate, don’t just lie around in bed.

Wake up the same time every day, even on the weekends. It may feel good to sleep in on the weekends after a week of hard work, but sleeping in on Saturday or Sunday morning is setting yourself up for trouble on Sunday night.

Relaxation Response

Try relaxation exercise No. 1: Progressive muscle relaxation. This method is based on the theory that an individual can learn to relax one muscle at a time until the entire body is relaxed. Beginning with the muscles in the face, the muscles are contracted gently for one or two seconds and then relaxed.

This is repeated several times and then the same technique is used for other muscle groups, usually in the following sequence: jaw and neck, upper arms, lower arms, fingers, chest, abdomen, buttocks, thighs, calves and feet. The cycle is repeated for approximately 45 minutes.

Try relaxation exercise No. 2: Relaxation response. This technique begins by lying or sitting comfortably with eyes closed. Allow relaxation to spread throughout the body. Establish a relaxed, abdominal breathing pattern and redirect thoughts away from everyday thoughts and toward a neutral mental focus device such as a peaceful word or image.

By Leon Goldberg

Strategic Intervention Specialist




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