How psychotherapy can support you in treating insomnia

Aug 11

Insomnia can make life much harder. When I hit my 40s, sleeping well became my biggest struggle, affecting everything I wanted to do and my overall health. I later realized my sleep is highly sensitive to the environment I am in and to stress, in general. This became a chronic problem during perimenopause. Managing this alongside chronic pain and hormonal changes was especially challenging.

This experience led me to seek help. I worked with a naturopathic doctor who introduced me to Cognitive Behavioural Therapy for Insomnia (CBT-I) as we treated my insomnia and other perimenopause symptoms. CBT-I helped me understand my sleep patterns, restructure my routine, and prioritize sleep. Having a positive outcome inspired me to learn more, get training, and offer these strategies to clients.

In my practice, I have witnessed how combining CBT-I with Psychodynamic therapy is helpful for individuals to create a routine that fosters good sleep and understand underlying factors like anxiety, thoughts, behaviours, and emotions.

Before applying these approaches, it is crucial to note that there are different types of sleep disturbances. Therefore, a thorough assessment is needed to ensure that CBT-I is the first-line treatment for you.

Next, a foundational question: what is insomnia?

Insomnia is a sleep condition caused by difficulty falling asleep, staying asleep and/or waking up too early. The American Psychiatric Association considers insomnia a sleep disorder along with obstructive sleep apnea, parasomnias, narcolepsy, and restless leg syndrome. Having access to a specialized professional who can provide an assessment is crucial to receiving the appropriate support.

Insomnia can be acute or chronic. Acute insomnia lasts less than three months, often due to situational stressors. Chronic insomnia occurs when sleep problems happen three times per week for three months or longer. It is common for people with mood problems and those navigating peri/menopause to experience sleep difficulties. Psychotherapy can help with both mood and sleep issues.

Possible causes of insomnia

Possible causes of insomnia include:

Environmental: Stress, room temperature, uncomfortable bedding, and noise.

Behavioural: Substance use, alcohol, and caffeine—especially late in the day—can disrupt sleep. Intense evening exercise may make falling asleep harder. The individual context varies. If you are experiencing addiction, specialized support is recommended.

Biological: Hormonal fluctuations (menstrual cycle, pregnancy, menopause), certain medications, and conditions like depression, thyroid disorders, and chronic pain.

Understanding insomnia requires a systemic perspective, as multiple factors may play a role in your sleep. Here is where having a circle of care in place can make a difference. Your circle of care is a group of specialized professionals who, with your consent, may communicate to ensure your treatment is aligned with your needs. It may include your family doctor or your sleep specialist, your pharmacist, and a psychotherapist. Psychotherapy helps you manage stressors in a way that fits your unique context. By identifying and leveraging your resources, you can feel encouraged and regain hope.

How to assess and treat insomnia

Though we will review your symptoms as part of the intake process, and you may know your overall health well, as a Psychotherapist in Ontario, I cannot give a diagnosis. To ensure all possible causes of sleep problems and other medical conditions that might impact your sleep are considered, you need to see a doctor. This step also helps ensure you have a circle of care in place.

It's important to note that, although some guidelines recommend adults get between 7 and 9 hours of sleep per night, you have unique needs. Also, as you age, your sleep tends to change. Thus, the importance of individualized care.

The impact of insomnia

Understanding the impact of insomnia is essential. The lack of sleep can alter your life and hinder thriving. Chronic sleep problems can harm mental and physical health, increase accident risk, and raise the chances of metabolic and cardiovascular diseases.

How psychotherapy can support you in treating insomnia

Having support and guidance as you navigate insomnia treatment makes a difference.

Depression, mood swings, and anxiety can be both cause and result from insomnia. Psychotherapy can help you address these issues and support you through difficulties.

Cognitive Behavioural Therapy for Insomnia (CBT-I)

CBT-I is the first-line treatment for insomnia. Its structured stages address the main stressors linked to cognitive, behavioural, and emotional patterns.

When working with CBT-I, we have key processes which are:

Sleep restriction therapy: Temporarily limiting time in bed to consolidate sleep and build a stronger sleep drive. This initial phase can be challenging, and individualized support makes a difference.
Stimulus Control Therapy: Strengthening the association between your bed and sleep by using it only for sleep and intimacy. Though behaviour adjustment is required here, this phase of the treatment can also be fun. You can use this moment to explore new hobbies or reconnect with activities from childhood.
Cognitive restructuring: Identifying and gently challenging unhelpful thoughts and beliefs about sleep. Exploring the messages you carry about resting can be insightful.
Relaxation training: Here we learn techniques to calm the mind and body in preparation for rest. Not general advice. Strategies that make sense to you.

If you're new to CBT-I, terms like "restriction" and "control" may seem daunting. Davidson (2021) explains that sleep restriction therapy may cause “excessive sleepiness, reduced vigilance, and slowed reaction time,” but the author clarifies that these side effects are most likely to happen at the beginning of treatment and are temporary. Sleep restriction is not the same as sleep deprivation (Davidson, 2021).

Once integrated into your routine and with the guidance of a professional, CBT-I's flexible, collaborative approach can empower you in your care. You can be surprised by your capacity to adapt and how well your body and brain respond to consistency.

CBT-I as an ally in your process of safely de-prescribing sleep pills

At times, you may have needed sleep medication to function. Later, as situations improve, some people continue medication while others consider stopping. If you are thinking about stopping sleep pills and are concerned about withdrawal side effects, CBT-I can support you during this process.

Before taking action, be sure to discuss your plans with your physician and pharmacist. They must understand that doses should be decreased slowly and that this requires long-term planning. Since this is not a short-term process, having a supportive care team is essential.

As you consider stopping sleep pills, you may feel emotions like excitement, fear, insecurity, anxiety, or doubt. CBT-I can help you navigate these feelings and thoughts. The goal is to collaborate and ease the process while respecting your unique needs.

Limitations of CBT-I

Although CBT-I is effective for insomnia, it has limits. It is not recommended as a first-line treatment for restless leg syndrome, sleep apnea, or bipolar disorder, which require other protocols and specialized professionals.

Additionally, for shift workers, the CBT-I protocol alone might not be as effective. Here, a conversation with your physician or sleep specialist is key to ensure the treatment includes strategies tailored to your unique context.

Psychodynamic therapy

After improving sleep, deeper work using psychodynamic therapy, with a trauma-informed and culture-sensitive approach, can further support long-term wellness.

Midlife and menopause can trigger emotional challenges due to hormonal changes and life upheavals. Hormonal fluctuations affect how we process emotions and store memories. Constant biological shifts may bring unexpected changes to your inner world, where old memories and trauma can resurface, straining an already overwhelmed system.

Psychodynamic therapy is relational at its core. It helps you explore what else is present alongside your thoughts and behaviours. It guides you in understanding what your body might be carrying, while asking what needs to be released. In other words, it helps you explore what is working under the surface, impacting your life, and requesting your attention, curiosity, and compassion.

In working with psychodynamic therapy, part of the mission is befriending your emotions, increasing your emotional capacity (i.e. window of tolerance), and improving how you engage with yourself and others.

We also must consider how systemic oppression and culture play a role in how we feel. The way you respond to life stressors is not created in a vacuum, so we should analyze it in your context.

Even though psychodynamic therapy was originally thought to be a long-term treatment, we can adjust it and focus on a specific issue if you prefer a short-term treatment. The work is collaborative, and the treatment plan is a co-creation by the two of us.

Read suggestion: Sink Into Sleep

This book is a simple read which also offers hope for those suffering from insomnia.

Key takeaways

Sleep is crucial for your overall health, so do not underestimate its importance.

It is important to note that sleep disruptions, such as acute insomnia during life upheavals, are natural. We will all experience moments of stress and loss, which may affect our sleep. Knowing and incorporating CBT-I strategies in your sleep routine can help you navigate life’s difficult moments.

Cognitive Behavioural Therapy for Insomnia (CBT-I) is the first line of treatment for insomnia. However, it has limitations in certain cases, and your therapist must assess your case individually.

Psychodynamic psychotherapy is an effective tool in helping you address some of the causes and complications of insomnia, such as depression, anxiety, and mood swings.

Treatment for insomnia may require a multidisciplinary and holistic approach. At the same time, there is a lot you can do for yourself with small and simple adjustments in your routine.

Finally, take action by seeking specialized guidance for all aspects of your life affected by hormonal changes. Prioritize your mental health and consider incorporating psychotherapy as a key part of your care.

Navigating perimenopause is not a process meant for you to experience it alone. Having support can make a difference. If what you've read today resonates with you, and you're ready to explore how psychotherapy can support your sleep and overall wellbeing, I'd love to connect.

Whether you're looking for short-term focused support or longer-term deeper work, and whether you prefer the intimacy of individual therapy or the shared experience of group support, there is a path that fits where you are right now.

If you feel ready to start receiving individualized care, click here to book a free 30-minute consultation and let's talk about what that looks like for you.