If you need a little help getting started in your CBT for insomnia practice, you may find the following examples useful. Sometimes people need examples to get inspired. Once you get the hang of the process, it is easy to develop your own statements and answers to customize your own therapy program.
The examples below include a quick review of the CBT process, which I like to refer to as an inner dialogue or mental conversation with yourself, as mentioned in this article.
Note: You can write your exercises with pen and paper, or you can type or text on a computer or handheld device, and save or print out your results to read over. Once you get into the groove, you will naturally begin to have these inner conversations with yourself while going about your daily business, but that’s not how it starts. It begins with the written or typed word.
Sometimes people ask me if they need to write down new thoughts each time they practice CBT or if they can use the statements they’ve already written during previous sessions. I advise writing original thoughts whenever possible. It doesn’t matter if they sound the same as yesterday’s or last week’s thoughts—it doesn’t even matter if they turn out to be word-for-word identical.
Process is what counts. Nudging your brain to create new statements keeps you engaged in the process and avoids turning it into a rote practice, like writing “I will not talk in class” 50 times on a blackboard. It is easy to lose focus and just go through the motions, but you’ll soon realize that doesn’t work as well.
OK, we’ve straightened all that out! Now let’s get started…
For example: “I am desperate to get some sleep. My life will be ruined by insomnia and sleep anxiety. What if it never goes away? This is terrible!”
In structured CBT, the kind that you might read in a book by Dr. Burns or Dr. Aaron Beck, you would be asked to classify or label your statement in one of several different ways. This can be helpful, but it takes a little more precious time. I’ve found it’s not necessary for good results, so I have omitted this step. It’s enough for me just to review it briefly. (If you want to learn more about general CBT, please see one of these books by Dr. David Burns
Example: “If I keep working at changing my thoughts about sleep and take steps to solve the problem instead of stressing over it, it will eventually go away. It may take some time to get into a new habit of thinking, but it can definitely be done. I’ll start now and keep working on it patiently.”
Here is another example (a few days later): “This CBT method just doesn’t seem to be working – I’m still not sleeping well at all. What if I’m wasting my time?”
Response: “I haven’t really given it enough time. These changes don’t happen overnight. I need to be more patient with my brain. It takes a long time to change a mental habit like sleep anxiety. It is worth experimenting to see what happens.”
If you are frustrated about having a relapse and having to start over at the beginning, use that as well, like:
“I’m so upset that I had a relapse and have to start over again. What if my insomnia gets even worse? What if it never ends?”Response: “Relapses are very normal. It takes time to change the habit of getting upset when I can’t sleep, so I’ll just keep working on it and soon I’ll be able to relax on the whole subject of sleep. It won’t seem so important to me anymore.”
Then another one: “I am so tired of this fatigue. I can’t afford to feel so bad when I have a baby and a job (or insert responsibility here) to take care of. I’m starting to panic. What if this never goes away? What if I feel exhausted for the rest of my life?”
Response: “I am doing the best I can to work on this. It is normal to feel anxious when I can’t sleep, but beating myself up about it doesn’t help. I will just give myself a chance to find out what does help. It takes time to find what will work best to help me relax so I can sleep better again. Many people do get over insomnia and so can I, but it won’t happen overnight.”
Another one: The more I think about my insomnia, the more anxious and obsessive I get. What if doing this CBT makes my insomnia worse? What do I do then?
Response: Just take it day by day. I don’t have to do these exercises if I don’t want to. I am only experimenting to see what might work. It takes a while to learn how to calm myself, but it is a skill that I can learn. But there is no rush and I can always take a break if it makes me anxious.
As you keep practicing, this inner conversation will become more habitual and natural. That’s usually when you’ll see a real improvement in your sleep.
Also, you can use this method on any anxious thoughts you have that are keeping you awake (not sleep-related).
For example: “My boss is such a jerk, but I can’t leave my job right now. How will I ever manage to get through my tortuous days? I am so miserable I can hardly stand it.
Response: A crappy job is upsetting, but I can still do the best I can one day at a time. It will be easier to look for a new job if I feel calm and confident. I can make a list of coping strategies to help get me through each day. I will leave as soon as I can, but while I’m still there, I’ll try harder to take things less seriously.”
As mentioned previously, give yourself at least 15-30 minutes per each session, and at least once a day, though twice is better. You don’t need to overdo it however. Review the other articles in this category, and stay tuned for more to come!