Counseling for Insomnia

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What is insomnia?

Insomnia is the inability to get enough sleep or good quality sleep. See the Integrative Health handout “Hints for Encouraging Healthy Sleep” for more information on insomnia.

What can I do to sleep better?

Many people find they can get better sleep through small changes in their lifestyle choices and habits.^1-3 These allow your sleep and rest hormones to come into balance. For many Americans, knowing these healthy sleep habits is not enough. Many people find that they are not able to make all these changes alone. Also, if you have a major stress in your life, such as PTSD, that makes it hard to sleep, it’s a good idea to talk first with a mental health professional about this stressor. Research tells us that one of the most helpful ways to fight insomnia is to get professional help.^3-7 Sleep-related counseling is called Cognitive Behavioral Therapy for Insomnia (or CBT-I).^2-7

I am interested in professional help to treat insomnia. Where do I start?

If you want help with your sleep, ask your health care team for help finding a counselor familiar with CBT-I who can work with you. CBT-I is widely used in the VA health care system to help treat insomnia.^8-10 It includes having several appointments with a professional counselor who can help you with sleep assessments and a plan of new things to try.^2-7 Some of the methods that may be used are

• Sleep Hygiene Education. Healthy lifestyle habits will help you sleep better and longer.^2,11 There are lots of ways to raise your melatonin (sleep hormone) level at night and lower your cortisol (stress hormone) level during the day. Changing some habits can help you improve your chance of sleeping better. See the Whole Health handouts “Change Your Habits to Sleep Better” and “Hints for Encouraging Healthy Sleep” for more information.
• Sleep Restriction Therapy. Those who take naps during the day often do not sleep well at night. This therapy works by having you stay awake during the day. Then you are only allowed to sleep during certain hours at night.
• Stimulus Control. This method uses individualized recommendations. A counselor finds ways you can avoid things that can make you restless, stressed, or anxious. By not doing these things, you can more easily rest and fall asleep (and stay asleep).
• Relaxation Training. There are many mind-body methods to help train the mind and body to stay calm. This helps the body get ready to sleep well.
• Relapse Prevention. This is important because it helps predict future sleep problems. You work with a counselor to find ways to get back on track in case you have insomnia again later in life.

What can I do if there are no professional counselors in my area who use CBT-I?

In case there are no counselors in your area who know about CBT-I, there are a few online resources that can help. One to consider is the following:

• The Integrative Restoration Institute (iRest) hosts information about mind-body methods (like meditation) and movement methods (like yoga) to help bring about inner calm. These methods can help insomnia as well as other medical problems like PTSD, depression, anxiety, and panic.

For you to consider:

• Are you interested in working with a counselor using CBT-I?
• Do you need help finding a counselor who uses CBT-I?
• Would you rather try one of the websites to help you sleep better?
• Don’t hesitate to get help from your health care team if you are not sleeping well.

The information in this handout is general. Please work with your health care team to use the information in the best way possible to promote your health and happiness.

What we know about integrative health care has come to us thanks to the efforts, experiences, and collective wisdom of people from many cultures and backgrounds. We wish to acknowledge all the healers, researchers, patients, and peoples who have informed the content of this tool.

Author(s)

This handout was adapted for the Osher Center for Integrative Health at the University of Wisconsin-Madison from the original by Taryn Lawler, DO. It is based in part on a tool for clinicians, Hints for Encouraging Healthy Sleep, written by John W. McBurney, MD.

Date Created: February 2017

References

1. 1. Naiman R. Insomnia. In: Rakel D, ed. Integr Med. 3rd ed. Elsevier Saunders; 2012:65-76.
2. 2. Buysee D. Insomnia. JAMA. 2013;309(7):706-16. doi:10.1001/jama.2013.193
3. 3. Treatment for insomnia. Accessed May 18, 2016, https://sleepfoundation.org/insomnia/home
4. 4. Vitiello M. Cognitive behavioural therapy for insomnia: effective, long-lasting, and safe. Evid Based Ment Health. 2015;19(1):e2. doi:10.1136/eb-2015-102181
5. 5. Pilar Martinez M, Miro E, Sanchez A, et al. Cognitive-behavioral therapy for insomnia and sleep hygiene in fibromyalgia: a randomized controlled trial. J Behav Med. 2014;37(4):683-97. doi:10.1007/s10865-013-9520-y
6. 6. Trauer J, Qian M, Doyle J, Rajaratnam S, Cunnington D. Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-anaylsis. Annals of Internal Medicine. 2015;163(3):191-204. doi:10.7326/M14-2841
7. 7. Cognitive behavioral therapy for insomnia. Accessed May 18, 2016, https://sleepfoundation.org/sleep-news/cognitive-behavioral-therapy-insomnia
8. 8. McBurney J. A natural approach to sleep, stress, and insomnia: clinical tools. Whole Health: Change the Conversation. A joint project of the University of Wisconsin-Madison Integrative Medicine Program, Pacific Institute for Research and Evaluation, and the U.S. Department of Veterans Affairs Office of Patient Centered Care and Cultural Transformation. 2014;
9. 9. McBurney J. Hints for encouraging healthy sleep: clinical tool. Whole Health: Change the Conversation A joint project of the University of Wisconsin-Madison Integrative Medicine Program, Pacific Institute for Research and Evaluation, and the U.S. Department of Veterans Affairs Office of Patient Centered Care and Cultural Transformation. 2014;
10. 10. McBurney J. Recharge: educational overview. Whole Health: Change the Conversation. A joint project of the University of Wisconsin-Madison Integrative Medicine Program, Pacific Institute for Research and Evaluation, and the U.S. Department of Veterans Affairs Office of Patient Centered Care and Cultural Transformation. 2014;
11. 11. The International Classification of Sleep Disorders: Diagnostic and Coding Manual. 2nd ed. American Sleep Disorders Association Diagnostic Classification Steering Committee. American Academy of Sleep Medicine; 2005.