Understanding and Managing Sleep Anxiety with CBT-I

Clinical psychologist Steve Orma experienced insomnia in his early 40s. He couldn’t stop worrying, thinking, ‘Is something wrong with me?’ This fear, known as ‘sleep anxiety,’ can severely impact sleep, says Orma, who later became an insomnia treatment expert. Left unaddressed, this anxiety can make falling asleep even harder.

Orma highlights the importance of cognitive behavioral therapy for insomnia (CBT-I) as a solution. Testing shows CBT-I to be effective for those suffering from clinical insomnia. Instead of using sleep medications, CBT-I becomes an approach to reset behaviors and thought patterns around rest. Orma successfully used it to improve his sleep and now focuses his therapy practice on this method.

A typical CBT-I program runs for six to eight weeks. It involves weekly sessions where you and a provider work on strategies for sleep behavior correction and changing the mental approach to sleep.

Benefiting from CBT-I Practices

You don’t need to be part of a formal program to benefit. Here are some CBT-I practices you can try:

• Wake up at the same time every day: Aric Prather, a sleep scientist, emphasizes consistency in wake-up times. This regular schedule aligns with your body’s internal clock, helping you feel sleepy at the right time. Imagine your sleepiness accumulating like air filling a balloon throughout the day. Sticking to a set time, even on weekends, helps this process.
• Focus on a wind-down time, not a bedtime: Dr. Ravi Aysola, director of the Sleep Disorders Center at UCLA, advises focusing on winding down rather than forcing bedtime. Transition from daytime activities to night routines, like unplugging screens and dimming lights. Setting a wind-down period can alleviate the pressure of having to fall asleep immediately.
• Schedule your ‘worry time’: Set aside time during daylight for worrying, suggests Prather. Doing this when you’re rested means less stress at bedtime. Spend 10 to 15 minutes a day writing out concerns so you can mentally release them when going to bed.
• Be mindful when tracking sleep: Over-tracking can lead to orthosomnia, a form of insomnia from worrying about perfect sleep data, warns Aysola. While trackers provide insights, consider if the data is beneficial or causing more stress. If focusing too much on numbers, try a simple pen and paper log based on feelings rather than metrics.

Adjusting sleep habits and mindset are both crucial. Occasional poor sleep is normal. Managing expectations positively alters your sleep outlook, says Orma.

This piece was edited by Malaka Gharib, under the art direction of Beck Harlan.

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