How does CBT work?

The cognitive part of CBT teaches you to look for and change beliefs that affect your ability to sleep. This type of therapy can help you control or get rid of negative thoughts and worries that keep you awake. The behavioral part of CBT helps you develop good sleep habits and avoid behaviors that keep you from sleeping well.

Depending on your needs, your sleep specialist may recommend that you:

• Change your routine. This can help you sleep better. Set a consistent bedtime and wake time. Avoid naps. Use the bed only for sleep and sex.
• Set sleep limits. Lying in bed when you're awake can become a habit that leads to poor sleep. If you can't fall asleep within 20 minutes, get up and don't go back to bed until you're sleepy. But don't change your wake-up time. This makes you more tired the next night. But once your sleep gets better, your time in bed is slowly increased.
• Change certain lifestyle habits. Change habits that lead to poor sleep, such as smoking, drinking too much caffeine late in the day and drinking too much alcohol. Not getting regular physical activity also can lead to poor sleep. You may learn tips that can help you sleep better, such as ways to wind down an hour or two before bedtime.
• Improve your sleep area. Create a comfortable sleep area. Keep your bedroom quiet, dark and cool. Don't have a TV in the bedroom. Hide the clock from view.
• Learn relaxation techniques. These techniques help you calm your mind and body. Approaches include meditation, imagery and muscle relaxation.
• Remain passively awake. With this method, once you're in bed, you try not to think about falling asleep. That's because worrying that you can't sleep can keep you awake. Letting go of this worry can help you relax and make it easier to fall asleep.
• Use biofeedback. This technique involves using a device that shows signs such as your heart rate and muscle tension. Then you learn how to help manage them. Your sleep specialist may ask you to take a biofeedback device home to record your daily patterns. This information can show patterns that affect sleep.

The most effective treatment approach may combine several of these methods.