Dr. Levy's CBT Blog
Insights on Well-Being, Contentment, and Cognitive Behavioral Therapy
Beyond its devastating cost in human lives, the COVID-19 pandemic has had a profound negative effect on mental health for a large number of people. Besides anxiety and depression from social isolation, insomnia is probably the largest new behavioral health problem that many are navigating during this global health crisis.
Insomnia is a clinical term that applies when an individual has had problems sleeping for at least 3 nights per week for a period of at least 3 months. Further, those problems are not secondary to other mental health conditions such as depression, anxiety, or PTSD. In reality, many people suffer from sleep issues that don't fully qualify for an insomnia diagnosis, but that impair their lives nonetheless. Some struggle with sleep-onset insomnia ("I can't fall asleep when I go to bed") while others have sleep-maintenance insomnia ("I can't stay asleep once I fall asleep").
There are three important factors at play when someone finds themselves facing insomnia. They are commonly referred to as the three "p"s:
1) Predisposing factors: some of us are just genetically wired for lighter, shorter sleep than others.
2) Precipitating factors: Yet, there are stressful events in our lives that can literally cause us to lose sleep. For example, a medical crisis, a job loss, a sick child. Those types of situations can cause sleep disturbances that, in most cases, will resolve themselves after a while.
3) Perpetuating factors: For chronic insomnia to kick in, some new factors come into play. Those are the factors that maintain the disrupted sleep patterns. Most commonly, they will be things like worrying about getting the 'right' amount of sleep, thinking that tomorrow will be a bad day if we don't sleep enough, spending more time in bed wanting to sleep longer, tossing and turning awake in bed, using electronics in bed, turning the bed into office space (working from the bed), etc. Those well-intentioned moves actually perpetuate the cycle of insomnia by making it harder to fall and stay asleep.
Treatments for insomnia abound. The easiest is to pop a pill. That will work - for a couple of nights. And then, it doesn't anymore. Most prescribed sleep medications are habit-forming, which means that your body will need more of it over time to achieve the same result. While at times the pills may help you fall asleep faster, they will also lead you to wake up more often in the middle of the night. You might not remember it, because you're sedated. But your actual sleep quality will not really improve in a sustainable way.
Instead of taking the shortcut, the best long-term solution to sleep disturbances is a full course of CBT for insomnia (called CBT-I). In this treatment modality, you will learn how to change your inner dialogue to actually invite sleep, rather than keep it away. With the help of your therapist, you will also develop a healthier sleep schedule that will allow you to actually enjoy the time you spend in bed. With more time, you can also learn relaxation techniques and anxiety management interventions that will prevent the insomnia from recurring. And voila, you can finally sleep tight!
Dr. Daniele Levy is a licensed psychologist offering CBT via Teletherapy from Menlo Park, CA. Her background uniquely combines leading edge training in behavioral sciences with deep expertise coaching and mentoring working professionals in dynamic organizations.