Cognitive Behavioral Therapy for Insomnia (CBT-I)

Cognitive behavioral therapy for insomnia (CBT-I) is an approach to help patients change their actions and/or thoughts that hurt their ability to sleep well. Provided by Dr. Kelly Krietsch and Dr. Bret Ringdahl at The Insomnia and Sleep Institute of Arizona, this therapy is an effective treatment for chronic sleep conditions and is usually recommended as the first line of treatment.

Cognitive behavioral therapy for insomnia is a structured program that helps identify and replace thoughts and behaviors that lead to sleep problems. It is a means of developing habits that encourage healthy sleep patterns. Unlike sleeping pills, CBT-I helps patients overcome the underlying causes of sleep trouble with a natural, non-pharmaceutical strategy.

Principles of Cognitive Behavioral Therapy for Insomnia

Stimulus Control

A stimulus can be anything that triggers a response. Stimulus control in CBT-I is aimed at helping patients have positive responses when preparing for bed at night. This can be an effective tool for those who have trouble falling asleep, often tossing and turning. Dreading bedtime because you expect to struggle to fall asleep is a negative response. CBT-I changes your thinking to only associate bed with sleep and sex, which means there can’t be any looking at screens, reading, or doing anything else in bed. Stimulus control also dictates that you should only go to bed when you are sleepy, and if sleep doesn’t occur after 20 minutes then it’s time to shift to a relaxing, non-bed activity. Ultimately, stimulus control leads to positive responses when going to bed.

Sleep Restriction

This CBT-I method creates stringent limits on how much time is spent in bed. Initially, the limit might be the current average amount of time a person sleeps each night. An example is a person who spends eight hours in bed but only sleeps for six. In this scenario, their initial limit is six hours. This can make patients feel more tired at first but encourages falling asleep faster with fewer disruptions throughout the night.

Relaxation Training and Biofeedback

These CBT-I techniques train patients to relax physically and mentally. The result is a reduction of tension and anxiety that can make falling and staying asleep easier. Strategies include breathing, muscle relaxation, and mental focusing, which can all be practiced throughout the day and at bedtime. Biofeedback can complement relaxation training, and it focuses on breath, brain, heart, and muscles. Biofeedback makes you more aware of how your body is functioning so you can better “listen” to its indicators related to brain waves, muscle tension, body temperature, heart rate, and more.

Cognitive Control and Psychotherapy

These CBT-I methods help patients pinpoint beliefs that can disrupt sleep. Negative thoughts tend to keep sleep at bay, but processing those thoughts helps you overcome them. An example of this approach is to schedule a “worry time” in the afternoon so these negative thoughts don’t enter your mind at bedtime. Guided imagery can be another highly useful tool and works by keeping your mind from worrying and wandering.

Sleep Hygiene Training

Everyone has sleep hygiene for better or worse, just like everyone has some kind of diet. Adopting proper sleep hygiene best practices and habits while removing poor habits can be critical in creating a healthy sleep pattern. An example of good sleep hygiene avoiding screens at least two hours before bedtime or to take a relaxing bath before bed with sleep-inducing aromas such as lavender. An example of poor sleep hygiene is eating a heavy meal directly before bed or to go on a nightly run that energizes you.

By Anonymous -

“Working with the team at the institute and especially working with Dr. Krietsch has been an absolutely amazing life-changing experience. If someone had told me I’d be sleeping through the night AND getting up at 5:30 am every morning a few months ago… I would have told them they were crazy. My life is 100% better, I am keeping the institutes cards on hand and have handed them out to people who say they have insomnia.”

By Dena Deal -

“Professional and efficient from my first call to schedule and all the way to the end of my first appointment. Each office member you come in contact with will be courteous and kind. It didn’t take long to go back and see the doctor. Dr. Ramalingam was so thorough and calming. I highly recommend this caring office.”

By Angela Zavala -

“I had the best experience at The Insomnia and Sleep and Sleep Institute. The technicians are very friendly. I was very nervous and the technician was very patient and explained everything to me. She communicated to me every step of the way. Made feel at ease. I recommend this place.”

By Gail Wiens -

“I had the best experience at The Insomnia and Sleep and Sleep Institute. The technicians are very friendly. I was very nervous and the technician was vI love the people at this office! Everyone from Dr. Patel, the sleep study technician, the respiratory therapist, the lady from billing, and the office staff were all nice, helpful and pleasant. They took time to explain the results from the sleep study, which was very helpful.”

By William Riley -

“The staff is friendly and patient oriented. They seem interested in helping to overcome obstacles when they come up. There is a patient portal and all questions of mine have been answered quickly. The doctor is friendly, attentive, on time, and seems both up to date and knowledgeable in his field. This is, frankly, one of the few places I often contact about which I have no complaints. I’m happy to recommend this facility enthusiastically.”

By Anonymous -

“I have too much experience with sleep clinics so it’s easy for me to rate the clinic. Dr. Gunn is an excellent sleep doctor. The facility is clean, the rooms are spartan with a comfortable bed which it conducive for sleeping. My tech was Brandon and he was professional and a pleasure to work with. I strongly recommend this sleep clinic.”

By Anonymous -

“A great doctor. My long-term doctor had retired. I was referred to Dr. Patel. I was exceptionally pleased. He gave me a couple of pointers and even though I was doing well things got better. I will see him annually for sure.”

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Learn More About CBT-I Today

CBT-I therapy is a conservative, non-invasive, and yet highly effective approach for treating sleep disorders such as insomnia. It works from the inside out by identifying the root causes of poor sleep and actively corrects them in a patient-led approach. It also helps patients wean away from or avoid dependency on sleep medications whenever possible.

The Insomnia and Sleep Institute of Arizona is home to multiple MD sleep specialists who have undergone extensive sleep medicine training via fellowships and continuous education, two clinical psychologists focused on behavioral sleep medicine and insomnia, a physician assistant with a Masters in Sleep Medicine, and two nurse practitioners trained in sleep medicine. We treat every person of every age, with 10 – 15 percent of patients being as young as the age of two. Better sleep is possible when you work with the official Face of Sleep Medicine in the Phoenix Area.