Don't Know How to Fall Asleep? The Answer May Be on Your Computer

Some people who have insomnia just can't fall asleep. For them, beating their sleep disorder can be as simple as avoiding distractions when they are getting ready for bed and remembering that if you have insomnia, coffee is a no-no at bedtime.

Other people who have insomnia are unusually sensitive to blue light, the natural rays of the sunrise. Blue light is great in the early morning when you want to be up and around, but it has to be blocked from the bedroom for good sleep.

And some insomniacs can't sleep because of something doctors call a sleep maintenance disorder. When their head hits the pillow, they are so tired that it's lights out. After a few hours, however, they wake up in the middle of the night and can't get back to sleep, so that they are constantly sleep-deprived and tired all the time.

For treating sleep-maintenance disorders, modern medicine has a new prescription: Think happy thoughts. To help people avoid the negative thinking that can keep them awake, there is now cognitive behavioral therapy for insomnia or C.B.T.-I. Many doctors recommend it as the first thing that should be tried, even before sleep medication.

What Is C.B.T.-I.?

Cognitive therapy is a form of psychotherapy in which negative thoughts about self and world are challenged to alter unwanted patterns of thinking and doing. Cognitive behavioral therapy is specifically a form of psychotherapy that aims to change unwanted behaviors, such as getting up in the middle of the night. Cognitive behavior therapy for insomnia is targeted at stopping the behaviors that interfere with sleep.

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Cognitive behavioral therapy for insomnia helps people avoid getting up too early. Oddly enough, like the little engine that made it up the hill saying "I think I can, I think I can, I think I can," when people think they can get a full night's sleep, they actually can. 

C.B.T.-I. isn't like taking a sleeping pill. It doesn't "knock you out." It doesn't work perfectly.

• Instead of waking up too early every morning, you might wake up too early just one day a week.
• Instead of taking half an hour to get to sleep, you might only need 10 minutes.
• Instead of being awake for a couple of hours when you wake up in the middle of the night, you might only stay awake for one hour.

This method isn't a miracle, but it doesn't have serious side effects, either. There is no next day hangover from C.B.T.-I.

Therapist or Computer-Based Program?

Since cognitive behavioral therapy for insomnia is a form of psychotherapy, ordinarily it is something you would get from a psychotherapist. The problem is that psychotherapy is not inexpensive, and there are limits for insurance coverage. Access to treatment is further complicated by the fact that relatively few psychotherapists have been trained in the technique.

With computer-based C.B.T.-I., there is still feedback (after all, you can report your success face-to-face to a psychotherapist or to yourself on a computer). There's no need to schedule an appointment and make a trip to the therapist's office. The method is available any time and anywhere. And the cost of treatment is low. The questions are how do you access the therapy, and does it really work?

How to Re-Learn How to Fall Asleep with Computer-Based Cognitive Behavioral Therapy for Insomnia

All you need to access computer-based cognitive behavioral therapy for your own sleep disorder is a computer and access to the Internet. Here are some of the most popular programs, how to find them, and how well they work.

• RESTORE is the best-studied sleep program. It has been available since 2006 in Canada and since 2011 in the United States. Instruction is available in English, French, and Spanish. The multiple clinical trials of RESTORE show that it results in improvements in "the time it takes to fall asleep, the time they are awake in the middle of the night, the amount of sleep they get, and their productivity at work" for about 80 percent of users. Cost of the program varies.
• SHUTi is another well-documented computer program for correcting insomnia developed by researchers at the University of Virginia. About 70 percent of users complete the program and achieve "mild or no clinical insomnia." There is a one-time $135 fee for self-help users to access the program for sixteen weeks, or a one-time fee of $150 for users to access the program with the direction of a sleep doctor for twenty weeks.

• Sleepio is an app developed by experimental psychologist insomnia suffer Peter Hames and sleep expert Colin Espie, clinical and scientific director and professor at the Sleep & Circadian Neuroscience Institute, University of Oxford, author of 200 scientific papers on sleep. Designed to function like a video game, this app can be used with other computer-based tracking sleep tracking programs. Your physician can get a license to the program for as many patients as desired for $1000 a year.
• Sleep Tutor is a collection of eight on-line lessons on sleep written by Dutch sleep expert Winni Hoffman. Your physician pays $149 for your one-time access to the lessons. The program can not be directly accessed by patients.
• CBT-i Coach is a program designed to be used with the supervision of your physician. Developed at Veterans Administration hospitals in the USA, it requires your constant attention to teaching points designed to improve your attitude toward sleep, and it gives meticulous reports of your sleep data to your doctor. It may be available at VA clinics and hospitals, but it cannot be accessed by patients independently.
• Conquering Insomnia is not as well researched, but it is available online for $40, and it gets generally good user reviews.

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Cognitive behavioral therapy for insomnia is generally a no-nonsense approach to solving the problems of getting to sleep. There is no soul searching or in-depth psychoanalysis. And nearly all the programs will reinforce these rules:

• Use your bed for sleeping and for sex, nothing else.
• Go to bed and get up at the same time every day, even weekends.
• Never sleep in more than half an hour.

Getting used to these rules may be the hardest part of recovery for some people who fight insomnia but for any kind of therapy to work, you will have to make at least these changes. Once you do, computer programs can help you get restful sleep every night.