Sleep & insomnia – the role of psychotherapy

tips for great sleep

Sleep problems are one of the most common issues that people experience. In this article, Clinical Psychologist Ms. Velda Chen introduces us to what Insomnia is about and the role of psychological intervention in improving the quality of life. Velda practices at Mind Care Therapy Suites, where she helps patients with a broad range of emotional health conditions. Velda also specialises in Insomnia and non-medication treatment (psychotherapy) for this common condition, including Cognitive Behavioral Therapy for Insomnia (CBT-I). 

About Insomnia

Insomnia is a common sleep disorder that affects one’s physical, mental health, and daytime functioning.  It is surprisingly common, as up to one-third of the population may experience symptoms of insomnia at any point [1].  The most strongly supported risk factors associated with insomnia include increasing age, female gender, shift work and co-existing medical and psychiatric disorders. 

People with insomnia experience difficulties initiating or maintaining sleep, early awakening (with an inability to return to sleep) or non-restorative sleep (poor quality, unrefreshing sleep). These sleep difficulties affect daytime functioning, such as fatigue, impaired concentration, poor memory, low mood, or even one’s occupation, relationship or social functioning. It is often these daytime concerns that that drives people to seek treatment.

Why is treating sleep issues important?

Insomnia has been associated with an increased risk for physical illnesses such as cardiovascular disease and high blood pressure [2, 3]. Emotional health issues are particularly common in those with insomnia, with estimates of 40% of patients with insomnia experiencing a psychiatric condition, with depression and anxiety being the most common [4].

Cognitive Behavioral Therapy for Insomnia (CBT-I)

Cognitive Behaviour Therapy for Insomnia (CBT-I) has been consistently found to be an effective treatment treatment for insomnia. It is the recommended first-line treatment for chronic insomnia in adults, with short-term medications recommended only if CBT-I is not available or ineffective. 

Multi-component CBT-I combines cognitive therapy strategies with education about sleep regulation, stimulus control and sometimes sleep restriction therapy if indicated. Typically, treatment progress is monitored by using information gathered with sleep diaries completed by the patient throughout the course of the treatment. The relaxation strategies and counter-arousal methods are included as part of CBT-I to address symptoms of worrying and rumination typically observed in patients with insomnia.  The cognitive therapy strategies are typically targeted on the over-attention on sleep and maladaptive beliefs of sleep, such as worries about not sleeping or the consequences of poor sleep, which heightens anxiety about sleep, thus perpetuating the insomnia. In addition, stimulus control is designed to restore the helpful association of the bed/bedroom with sleep. 

[1] Yeo, B. K. ., Perera, I. S., Kok, L. P., & Tsoi, W. F. (1996). Insomina in the community. Singapore Medical Journal, 37(3), 282–284.
[2] Spiegelhalder, K., Scholtes, C., & Riemann, D. (2010). The association between insomnia and cardiovascular diseases. Nature and Science of Sleep, 2, 71.
[3] Vgontzas, A. N., Liao, D., Bixler, E. O., Chrousos, G. P., & Vela-Bueno, A. (2009). Insomnia with Objective Short Sleep Duration is Associated with a High Risk for Hypertension. Sleep, 32(4), 491. 
[4] Taylor, D. J., Lichstein, K. L., Durrence, H. H., Reidel, B. W., & Bush, A. J. (2005). Epidemiology of
Insomnia, Depression, and Anxiety. Sleep, 28(11), 1457–1464. 

About the Author

Velda is a Clinical Psychologist at Mind Care Therapy Suites. She has a special interest in psychotherapy for insomnia and sleep problems, and also helps patients with depressive and anxiety disorders, relationship difficulties, grief, and other health-related issues.