Cognitive Behavioral Therapy for Insomnia

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which in many instances need to be customized for the patient."

When a clinician looks at your assessments and diaries, he or she will find the elements of your lifestyle that may prohibit you from falling or staying asleep. One common problem that affected Christine is clock watching. Many people who have a sleepless night here or there can relate to the obsession with staring at the clock and watching the sleepless hours go by. For someone with insomnia, watching the clock can become a routine. Dr. Posner told Christine to stop using clocks, so she covered her bedroom clock and only used it for the alarm. Dr. Perlis often tells his patient's to put their alarm clocks under their bed. He explained, "If the alarm is set, there's no need to know in the middle of the night what time it is. That and, more importantly, clock watching can only lead to worry and frustration and if nothing else worry and frustration are 'wind to the flame' of insomnia."

Avoiding naps was the most challenging item on Christine's list. Dr. Posner also informed Christine that she needed to stop working close to bed time because she was revving herself up instead of winding down. She stopped bringing work home and started reading, painting and focusing on relaxing. Spending a lot of time in your bedroom working, watching TV, surfing the internet and other stimulating activities can rev you up and condition you to stay awake. You can inadvertently train yourself to associate your bedroom with wakefulness.

Relapse Prevention is an important element of cognitive behavioral therapy. The patient needs to learn how to maintain what they've learned and prepare for the possibility of a future flare up. Dr. Perlis explained, "The patient needs to be reminded that lots of things may trigger a bout of insomnia and the main things one can do to protect against a new onset episode of chronic insomnia are:

1. Don't compensate for sleep loss

2. Start stimulus control procedures immediately

3. Re-engage sleep restriction should the insomnia persist beyond a few days."


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