Cognitive Behavioral Therapy for Insomnia: What It Is and Why to Consider It

Insomnia is a common issue when you live with rheumatoid arthritis. Fifty to seventy-five percent of everyone living with RA today will have a hard time sleeping tonight; sadly, I’m one of them. Which is why I’ve spent a lot of time trying to figure out how to help myself sleep better. About ten years ago I attended a week-long course on mind-body medicine where I learned that a technique called cognitive behavioral therapy, or CBT, is more effective that sleep medicine long-term for chronic insomnia. That day I was suffering from horribly itchy knees, after discovering too late that I was allergic to the pain relieving cream I had started using, and my insomnia was worse than ever. I was actually secretly relieved I had an excuse to take Benadryl that night for the itch because I knew it helped me to sleep. So, as I was trying not to yawn, I heard the word insomnia and perked up. The presenter was talking about how by learning to change your thinking, and applying techniques to “condition” your physiology to sleep at night, you can affect sleep without side-effects and the real dangers that comes with sleep medicine. I stopped being sleepy and listened.

The sleep tips I learned

What I learned that day has helped me immensely, and even though I continue to deal with chronic insomnia I don’t have as much anxiety that comes with it, and I have more tools to bring out when I need them. If you choose to work with a therapist who uses this technique for insomnia you will most likely be put through a six or eight week program that involves working with your sleep habits, incorporating sleep hygiene techniques, which are ways to help your body become ready for sleep, restricting your time in bed, psychological re-framing, and relaxation training. The course I went to focused on the latter two, operating on the theory that chronic stress alters your body’s physiology to the extent that it forgets how to relax enough to sleep. All CBT inspired insomnia treatments work in a more holistic way than a mere drug ever could, and since it takes the time it does, you are able to learn and ingrain new habits for long-term change. The CBT program works to help you change in two ways, changing your physiological responses and changing your cognitive responses, or thoughts. That is why you do things like guided imagery, and biofeedback along with focused talk therapy.

Concrete steps for improving sleep

When I feel myself tense up and get frustrated at night now, I remind myself that what I’m dealing with isn’t fatal, and I begin to focus on breathing deeper as I change my thoughts to other topics. This is why I always break one rule of sleep hygiene- no reading in bed- and read a light book before nodding off. If I find myself unable to sleep I think about my book, a topic that won’t excite me or produce anxiety. I have a bedtime ritual that I know encourages sleep, and when I’m going through an extra stressful time, I make sure to incorporate relaxation techniques into my day so that I don’t tense up too much during the day. I also have become better at being aware of my pain levels and doing what I can to bring them down in the evening. These changes to my life haven’t been that hard, and even if they were it wouldn’t matter, because they work.

An improvement in my sleep

Again, my insomnia isn’t cured, and even with my CBT tips, it isn’t always managed, but it is immensely better and I’m happy with that. There are apps now that can help, both with relaxation, and with a full CBT program, and although I haven’t tried any of them, I do use youtube to find mediation music and imagery. I think that apps can be an affordable way to begin helping yourself sleep. So, if you are dealing with insomnia, especially if is affecting your waking hours on a regular basis, I highly recommend you look into CBT. If your doctor can’t help, find someone who can, and don’t hesitate to ask for a referral. If you want to start working on improving your sleep immediately, start looking into sleep hygiene- you can find an article entitled,  The Magic of Sleep Hygiene and Where it Fails for People With RA, that I wrote for for more information or simply do a web search. You can also practice relaxation techniques right away, again, on youtube there are plenty of options for guided imagery and music to help relax the body. And finally, try not to worry too much. You have dealt with plenty of hard issues since you were diagnosed with RA, you will be able to handle this one as well.

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