What is primary insomnia?
Primary insomnia is diagnosed when a person has difficulty falling asleep, staying asleep, or waking up too early at least three times per week for a period of three months or longer, without any underlying medical, psychiatric, or environmental cause. It is considered a diagnosis of exclusion, meaning other potential causes of insomnia—such as medication side effects, substance use, mental health disorders (like anxiety or depression), or medical conditions (like sleep apnea or chronic pain)—must first be ruled out. A thorough evaluation by a healthcare provider, often including a sleep history, sleep diary, and sometimes overnight sleep studies, helps confirm the diagnosis.
In primary insomnia, the sleep difficulties are seen as independent and persistent, not caused by other health problems.
Cognitive Behavioral Therapy for Insomnia (CBT-I) helps people sleep by teaching better sleep habits, such as maintaining a consistent sleep schedule, creating a sleep-friendly environment, and avoiding behaviors that interfere with sleep (like napping or using screens before bed). By changing these cognitive and behavioral patterns, people can improve their ability to fall and stay asleep. CBT-I also addresses the thoughts and behaviors that disrupt healthy sleep patterns—this is known as cognitive restructuring. It focuses on identifying negative sleep-related thoughts (like worry about not sleeping) and replacing them with more positive, realistic ones.
Stimulus control is one key behavioral technique used in CBT-I to strengthen the association between the bed and sleep. It involves creating specific guidelines to limit time spent in bed awake and reduce activities that promote wakefulness. For instance, individuals are encouraged to go to bed only when sleepy, use the bed solely for sleep (or intimacy), and get out of bed if they can't fall asleep within about 20 minutes. By consistently following these steps, the brain begins to associate the bed with sleep rather than wakefulness or frustration, which can improve sleep quality over time.
Sleep restriction is another technique used in CBT-I to improve sleep efficiency by limiting the amount of time spent in bed to the actual time a person is sleeping. The idea is to reduce the time in bed to match the average time the person currently sleeps, even if it results in temporarily less sleep. This controlled reduction of time in bed builds a stronger drive for sleep, leading to quicker sleep onset and more consolidated, restful sleep. Gradually, as sleep improves, the time allowed in bed is increased until a healthy sleep duration is reached. This process helps regulate sleep patterns and reduces fragmented or restless nights.
Looking for someone to help you sleep? CBT-I might be for you if:
- other sleep disorders have been ruled out by you and your doctor.
- you have a diagnosis of primary or unspecified insomnia from your PCP or sleep specialist.
- other disorders that contribute to poor sleep have been ruled out (anxiety, stress, other medical conditions)
- your sleep opportunity is not a factor.
Looking for a cognitive behavioral therapy for insomnia treatment provider near you? I provide effective treatment is available via telehealth in the Seattle, Olympic Peninsula, and Surrounding areas and throughout Washington state. I also provide treatment client clients in Albuquerque, and throughout New Mexico.
