Most people are aware that insomnia, or difficulty falling and staying asleep, can be one of the major symptoms of depression. Treatment for depression often relieves insomnia, but not always. And what many people don’t realize is that insomnia can come first: Losing sleep leads to fatigue and irritability, and when these symptoms persist, you may feel more and more depressed.
Sleep medications and herbal preparations can help, but many people are justifiably concerned about becoming dependent on pills for sleep. There is a new form of cognitive behavioral therapy, called CBT-I (the “I” is for insomnia), that can successfully treat 60% of patients without the addition of medications.
The key components of CBT-I are the following: The therapist teaches you to establish a regular wake-up time and stick to it as much as possible, and to avoid daytime napping, even for brief periods of time, in order to promote healthy nighttime sleep. You are taught to simply get out of bed when you are wide awake, rather than tossing and turning and trying to sleep. You learn how important it is to avoid eating, reading, watching TV or – heaven forbid – do work on your computer when you are in bed, because your mind needs to learn to associate your bed only with sleep (and perhaps with sex) rather than with other activities.
Of course, it’s also important to avoid caffeine and alcohol, both of which interfere with sleep, and to be sure your bedroom is sufficiently comfortable, dark and quiet.
Also, you will be encouraged to keep a sleep diary, where you will record what time you go to bed and wake up each day, as well as your perception of the quality of your sleep and number of awakenings, if any.
Finally, and perhaps most important, you will be taught to challenge un-helpful beliefs such as “If I don’t fall asleep I’ll be useless the next day,” or “Medication is the only thing that will help me sleep.” The sleep diary can help you challenge these beliefs as you review what happens after nights when you don’t sleep much – and yet still manage to function the next day. The purpose of this step is, at least in part, to counteract the “awfulizing” effect – if you lay in bed saying to yourself “it’s awful and terrible that I can’t sleep,” these anxious thoughts are likely to keep you awake at night.
For more information you may want to see this article in the New York Times (November 18, 2013).