How Does CBT-I Work for Insomnia?

CBT-I, Cognitive Behavioral Therapy for Insomnia, is a lasting cure for insomnia that works for most people. It is a research-based, methodical approach to making changes in sleep patterns and neurological systems that govern sleep. CBT-I is an approach to insomnia that retrains and optimizes our bodies’ natural sleep systems, and avoids the use of medications. You learn how to make incremental changes in your daily life, which become changes in your biological sleep system. The changes you make help you naturally fall asleep without medication, sleep through the night, and provide you with natural sleep that restores your health.

People with insomnia may have trouble falling asleep at bedtime (sleep onset), trouble staying asleep through the night (sleep maintenance), or both. Insomnia itself is a problem with many causes. CBT-I is a reliable solution because it addresses each of the numerous causes of insomnia in ways that promote health, and do not cause harm. Usually there are several causal factors that contribute to an individual’s insomnia, and many of these are easily resolved. For this reason, one-size-fits-all treatments like medication, are often unreliable and can cause problems.

Rest Assured Sleep Seminars show you how to retrain the systems of your body to fall asleep naturally, and sleep through the night without medication. Our CBT-I program features teleseminars with Dr. James Rainwater, as well as several additional types of support. In six 90-minute seminars we coach you on how to tailor this research-based program to meet your own needs for improving your sleep naturally.

Decades of research at the world’s top institutions have produced solutions for the causes of insomnia that do not involve medications or devices. These solutions were developed through a wide range of research and clinical practices. CBT-I was pioneered by Dr. Gregg Jacobs in association with the Harvard Medical School and Massachusetts General Hospital. Dr. Jacobs and his colleagues distilled a great body of knowledge regarding insomnia into a number of simple actions and activities. When done consistently, these can correct and reset your biological sleep system, mostly through changing routines, habits, and certain aspects of daily living. In this way, insomnia is overcome naturally. CBT-I teaches you an organized approach to correcting every factor that contributes to your insomnia.

CBT-I is the best first-line remedy for insomnia. First-line treatments are the least invasive, have the lowest potential for harm, and are diagnostic. At Rest Assured Sleep Seminars, we look at all of the factors that can affect your sleep and address them one-by-one. Many of these can be corrected with the tools you will learn in our program. For example, a primary tool is a method for putting yourself on a consistent sleep schedule. We also investigate factors that contribute to insomnia that might involve further medical investigation. For example, we explain the signs of sleep apnea, and tell you what questions to ask your doctor in order to get an accurate diagnosis and treatment. Our program empowers you by giving you a thorough understanding of the factors that contribute to your insomnia, and teaching you numerous tools for resolving them.

Natural Sleep: Sleep is Not Sedation

Natural sleep is a system of changes in the brain and body that restore our health. Sleep research shows us that mental and physical recovery during sleep is an intricate process. When we are asleep our bodies are busy repairing themselves, we are not simply conked out. Sleeping pills sedate our brains and bodies, which interferes with the restoration that natural sleep provides.

A night of normal, natural sleep consists of 4 to 6 five-stage sleep cycle where our brains and body systems transition through many different states. Each of these stages involves different kinds of brain waves, as well as organ, neurotransmitter, gland and hormone activity. For example, stages 3 and 4 of a normal sleep cycle help our bodies recover from daily activity by redirecting blood flow to restore muscles, and switching on the immune system.

Research finds that sleep medications send people prematurely to REM sleep, or stage 5 of the sleep cycle...skipping or reducing the restorative-deep sleep of stages 3 and 4. This is one way that medications alter the natural sleep cycle. As a practitioner I find that most patients feel healthier and sleep better once they are off of these drugs. If you’re curious about the adverse effects of the medications prescribed for sleep and insomnia you can see my brief article on the history and problems of sleeping pills (link), or read numerous research-based discussions online.

For a few generations, the medical establishment has encouraged the use of medication to treat insomnia. People who use these drugs often find they cause a host of problems, and are not safe or reliable for long-term use. A great deal of research says that at safe doses, sleep medications do not improve sleeping through the night, known as sleep maintenance, and they only add a few minutes to overall sleep time.

In Cognitive Behavioral Therapy for Insomnia, CBT-I, we teach those with insomnia how to track their sleep. This is similar to how people track their daily workouts, or their personal finances. In their data we usually find that long-term use of these drugs has not improved their sleep. When medicated, many people report feeling exhausted and strung-out, whether they are sleeping enough hours or not. Happily though, we find that when people wean off of sleeping pills, sleep on consistent schedules, and improve aspects of life that cause anxiety, their sleep improves in a lasting way, and they report feeling well-rested. CBT-I works.

Science does not yet describe the complexity of sleep with precision, but as our knowledge grows, we understand more about how sleep restores, organizes, and resets the systems of our bodies. Since our knowledge of the neurobiology of sleep is rudimentary, we believe we should be skeptical about chemical interference. Our program repairs the body’s natural sleep system by making our habits and behavior patterns more healthy.  

Sedation is different than the restoration of natural sleep cycles. Sedation simply slows brain activity.


A Brief History of the Trouble with Sleep Medication: Sedation

Sleeping pills are rebranded versions of the barbiturates that first appeared on the market a century ago, with slight modifications. From their inception, these drugs have been prescribed as remedies for insomnia and anxiety, along with sedatives, muscle relaxants, and anticonvulsants. Barbiturates were found to cause dependency, a high risk of overdose, amnesia, and other unpleasant adverse effects.

These medications are generally known as sedatives. Like alcohol and anesthetics, they work by triggering the brain’s main inhibitory system, which slows the brain down. They facilitate the binding of the neurotransmitter GABA (gamma-aminobutyric acid) to its receptor sites. This hinders various aspects of brain function.

A major problem with these drugs is that the human body builds tolerance to them. This means that the drug becomes less effective over time. When a drug initially has a powerful effect, then weakens in the days and weeks that follow, it leads to wanting more of the drug. A cycle of dependency and overdosing starts in this way.

The second generation of these drugs came along in the 1970s and 80s. These are the benzodiazepines such as: Valium, Librium, Dalmane, and Halcion. Ativan and Lorazepam and others have followed. While they were marketed as safer than barbiturates, evidence mounted that patients quickly built tolerance, became addicted, and risked overdose, along with a range of other adverse effects. Patients admitted to hospital programs with “benzo-dependency” go through painful and dangerous withdrawal that is accompanied with the risk of life-threatening seizures.

Ambien, or Zolpidem, is a third generation of these drugs which also work by activating GABA. Marketing campaigns have told us that these medications are safer than the benzodiazepines, and evidence suggests that the risk of dangerous overdose is much lower. Still, a leading authority on the safety of these drugs, Daniel Kripke, professor emeritus at the University of California Medical School, says that, “My best guess is that drugs like Ambien are killing as many people as cigarettes,” around four hundred thousand Americans per year as of 2013.

None of these drugs produce a significant, reliable effect on sleep, without the risks and adverse effects of the original chemical sedatives. Kripke’s data shows that Ambien behaves just like a benzodiazepine when taken at an effective dose. Ironically, if you are taking these drugs, one of the best things you can do for your sleep is to get off of them.

WARNING! Ask your doctor about how to safely taper off of these drugs BEFORE attempting to do so. Sudden discontinuation of these drugs can be dangerous.


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