QUESTION
I've read that online cognitive behavioral therapy can help with insomnia, but I'd like to know how well it works before I make the investment in one of these programs. (I've never tried any kind of therapy before.)
ANSWER
With so much self-help available online for free, it can be hard to know when paying for a program makes sense. But the effectiveness of Internet-based cognitive behavioral therapy for insomnia, or Internet-based CBTI, backed by more than a decade of research, makes it valuable for many people who struggle to get needed sleep. In fact, these programs can be downright economical compared to office visits with a therapist—should you be fortunate enough to even have a therapist nearby who practices CBTI. Researchers in the field began to develop Internet-based programs starting in the early 2000s precisely because there aren't enough therapists trained in CBTI to care for the millions of people with insomnia who could benefit from it. Two expert-created programs in particular have been studied extensively: SHUTi, which starts at $149 for 26 weeks of access, and Sleepio, which costs $400 for a year. (Some insurance plans will cover the costs—check with your provider.) Each program guides you through a CBTI course similar to what you’d experience in one-on-one therapy sessions that help you get rid of your insomnia naturally, safely and effectively.
HOW IT WORKS
Internet-based programs focus on core CBTI techniques like…- Sleep restriction: Confining sleep to a set number of nighttime hours
- Stimulus control: Improving your environment to weed out distractions like electronic devices
- Sleep hygiene: Developing habits that encourage restorative sleep
- Cognitive restructuring: Changing any negative thoughts you have about sleep
- Relapse prevention: Keeping insomnia from coming back.
- Stay up later and get up earlier. For example, if you typically turn in around 10 pm, you might be instructed to stay up until midnight and then wake up at 5 am. This is a part of sleep restriction therapy designed to increase your “drive” for sleep so that you’ll be able to fall asleep more quickly and stay asleep.
- Avoid napping, again to make you more tired at bedtime.
- Use your bed for sleep and sex only. This is part of stimulus control designed to help you connect your bed in your mind as a place mainly for sleep.
- Keep a regular sleep and wake schedule—getting up and going to sleep at the same times each day, weekends included. Other good sleep hygiene habits include avoiding caffeine and alcohol before bedtime and keeping your bedroom cool (between 60 and 67 degrees).
- Get out of bed and do something relaxing if after 20 or 30 minutes you’re still awake—even if it’s 3 am.