In essence, Insomnia refers to the inability to effectively get enough good sleep. Insomnia can be caused by many reasons. We can compare insomnia to fever, which can be caused by many reasons, and insomnia is also a symptom caused by many factors. When we go to the hospital with illness and fever, the doctor will not only prescribe aspirin for high fever. Similarly, insomnia cannot be treated simply by taking sleeping pills.
For the treatment of insomnia, besides drug therapy, the most effective and long-term method is to change the behavior and cognition that lead to insomnia. This method is called cognitive-behavioral therapy (CBT). The purpose of CBT therapy is to help insomniacs obtain satisfactory sleep by changing the bad habits that affect sleep.
Cognitive behavioral therapy for insomnia mainly includes the following ways.
1. Stimulus control
Stimulus control(timuluscontrol)It is used to help patients with psychological and physiological insomnia.
These patients will find that when they feel sleepy near sleep time, they will immediately become alert and unable to fall asleep once they enter the sleep environment. This reflex connection between the inability to fall asleep and the sleep environment may need to be interrupted by instructing patients to avoid [trying to fall asleep].
The following process can be repeated many times and for a long time as needed until the conditioned reflex that wakes up when entering the bedroom disappears.
A only go to bed when you feel sleepy and plan to go to bed.
B. If you find yourself still unable to sleep for 10 ~ 20 minutes after lying in bed, you should get up and leave the bedroom and return to bed when you are sleepy.
C the bed is only used for sleeping and sexual behavior. Do not watch TV, read, work, talk on the phone or engage in other activities unrelated to sleep.
D. Get up regularly with the alarm clock every morning.
Step 2: Relaxation training
Relaxation training(relaxationtherapy)It is a kind of technical training that can reduce the awakening degree during sleep and improve the sleep quality at night, and is especially helpful for patients with insomnia with difficulty in falling asleep.
A. Practice relaxing muscles every day and do relaxation training step by step. The same effect can also be achieved through Biofeedback.
B. Abdominal breathing, breathing with the diaphragm, develops a relatively slow and relaxed breathing frequency while helping to divert attention.
C under the guidance of the therapist, symbolic imagination can help divert attention, stop paying attention to the awake state all the time, and stop producing negative thoughts such as [I just can’t sleep], thus reducing the patient’s repeated thinking before going to bed.
Step 3: Sleep restrictions
Sleep restriction is applied to patients with severe persistent insomnia. It is a set of sleep exercises that make people want to sleep more and fall asleep more easily. The purpose is to improve sleep efficiency by limiting the time in bed to the actual sleep time.
Many insomniacs spend more time in bed in order to get enough sleep. As a result, a large amount of time spent in bed is awake time rather than sleep time. Sleep restriction aims to change this pattern.
A. Limit the awakening time in bed, calculate the average actual sleep hours per day according to the sleep diary, and make a strict schedule in bed based on this.
B Because sleep time will decrease over a period of time, when drowsiness strikes, bed time will be used more for sleep.
C when the sleep efficiency (actual total sleep time/bed rest time * 100%) is not less than 85%, the bed rest time can be increased 15-30 minutes in advance.
D every additional bed rest time must be maintained for at least 5 days before it can be increased again.
E. If the sleep efficiency is less than 85% after 10 days of treatment, postpone the sleep time by 15-30 minutes.
F how long you sleep in a night, you need to get up regularly.
Step 4 Maintain circadian rhythms
Maintain circadian rhythm (Circadianrhythm maintenance) is especially effective in treating patients with chronic insomnia and difficulty falling asleep.
To establish and maintain effective sleep, one needs to fall asleep and wake up at the same time every day. Irregular sleep times will lead to a decline in sleep quality.
A. Maintain a regular sleep-awake cycle every day, even on weekends and holidays-it is a good habit to sleep regularly. Choose the right time to ensure that you sleep 8 hours a night (increase or decrease according to your sleep needs).
B. Don’t take a long nap: A nap at noon (about 20 minutes) will restore your energy. Beyond this period of time, you will have problems sleeping that night.
C. If you exercise, finish it as much as possible before 4 hours of sleep time.
D. Avoid bright lights at night.
E.Early morningIlluminate with light.
5. Reconstruction of Sleep Positive Belief
Some unreasonable beliefs about sleep will improve the body’s awakening level, increase muscle tension, and are not conducive to sleep. By adjusting these unreasonable beliefs, sleep quality can be improved.
These irrational beliefs include:
A. Sleep cannot be controlled. If people lose sleep, they will not be able to sleep.
B. Overestimate the number of hours required for adequate sleep.
C. Fear of leaving the bed, worry that I will not lie in bed now and will not be able to sleep when I want to sleep for a while.
6. Sleep hygiene
The quality of sleep can be improved by limiting behaviors that are unfavorable to sleep.
A. Develop a habit of keeping calm before going to bed, distinguishing sleeping from activities when awake: the habit of keeping calm before going to bed, such as bathing, brushing teeth, reading, praying, etc.
B. Avoid strenuous activities and aerobic exercise before going to bed: Some ordinary exercises in the evening may be beneficial to sleep that night.
C don’t eat caffeine-containing things for a few hours before going to bed. If you are especially sensitive to caffeine, it will take longer. Don’t drink alcohol before going to bed, especially don’t use alcohol to help sleep. Don’t smoke for a few hours before going to bed.
D. Avoid drinking a lot of water at night. Holding urine will make people unable to sleep soundly and easily cause us to wake up in order to go to the toilet.
E. If you feel anxious after going to bed, tell yourself to save the anxious things until tomorrow, and then recall or imagine other calm and relaxing things. If you feel anxious during sleep, usually write down the problems you may have earlier in the day and write down possible solutions.
F. Make sure your body temperature is not too high and your quilt is not too heavy. The bedroom layout should help you sleep. Dark and quiet bedrooms and comfortable beds can greatly promote sleep with comfortable temperature and humidity.
Many treatment steps seem to be completed by individuals alone. In fact, whether individuals or groups are guided by trained professionals, the treatment effect will be much better.
Professionals will be better able to develop treatment plans for them, Determine the treatment procedure, It can also provide more support and encouragement for patients. Moreover, Professionals are also good at finding problems and will make appropriate adjustments. During the treatment process of cognitive behavioral therapy, therapists need to observe and record the treatment compliance status and progress of patients, and make timely adjustments. After the treatment, they need to give relevant guidance to patients to maintain the effect and prevent recurrence.
In terms of short-term efficacy, Cognitive behavioral therapy is as effective as sleeping pills, but if it lasts for several months or years, the curative effect of cognitive behavioral therapy is better than sleeping pills. It can obviously shorten the sleep time, reduce the awakening time after sleep starts, and increase the total sleep time. For most insomnia patients, CBT can be effective and can be used as an auxiliary means of other psychotherapy.