The CBT formula for good sleep

Brendan Street Clinical Lead, Cognitive Behavioural Therapy More by this author
These cognitive behavioural therapy techniques retrain your body and mind to sleep well at night. Brendan Street explains the basic formula.

Most of us will experience a lack of quality sleep at some time, and for some this endures over the long term. Whether you’re a new parent, a shift worker, or feeling the effects of stress and anxiety, sleep is often one of the first things to suffer and it can have severe effects on your overall health.

Getting to the root of the problem is important, and small adaptions to your lifestyle can make a big difference to your sleep too. But there’s also a formula that is used by cognitive behavioural therapists to tackle the majority of sleep-disturbing factors.

There are two main interventions that cognitive behaviour therapy (CBT) utilises in order to help an individual to tackle sleep difficulties. These interventions are sleep hygiene and stimulus control. Sleep hygiene is about forming good sleep habits and stimulus control works to strengthen the connection between the bed and sleep behaviour.

Implementing the key aspects of these two interventions will help individuals to unwind more quickly when they go to bed and so be ‘sound asleep’. The aspects of the two interventions fit conveniently into this acronym:

Stimulus control


S – Sleep – The bed should be reserved for sleep and sex only. In order to strengthen the connection with the bed and sleeping you need to associate it with sleeping. The more additional things that you do in bed (read, eat, use smartphone, watch TV) the weaker, more diluted, the connection between sleep and the bed.

O – Observe - Whilst in bed observe the feel of the mattress beneath you, the comfort of the pillows, the sense of being ‘absorbed’ into the mattress. Try to make all the sensations associated with the bed and sleep as vivid as possible.

U – Unable to get to sleep - If you can't sleep after 15 to 20 minutes, apply the quarter of an hour rule. Get up, get out of bed and go to a different room and do something not stimulating for 20 to 30 minutes, then return to bed. If you are still unable to get to sleep after 20 to 30 minutes get up again. Repeat until you sleep. This is hard but necessary. If you lie in bed unable to sleep for long periods you start to associate your bed with wakefulness and maybe agitation. The only way to break the cycle is by re aligning the bed-sleep association.

N – No napping - In order to strengthen the connection between night-time sleep behaviour and the bed, you need to ban any daytime napping. It's essential to associate both the night (and the bed) with sleep and the day with wakefulness.

D – Decide your routine and stick to it -  If you go to bed at 11:00 pm – always have a fixed rising time no matter how well you sleep. The amount of sleep we need differs from person to person but if you don’t have fixed bed time and rising time the risk is that sleep starts to ‘seep’ into the day and you lose that valuable association between sleep behaviour and night-time/the bed.

Sleep Hygiene

A – Alcohol and nicotine - Both will interfere with sleep so limit these before bed

S – Sleep environment – Make sure the bedroom is dark enough, comfy enough (pillows, mattress), quiet enough with good air quality and appropriate temperature for sleep

L – Leave it out - Leave laptops, smart phones, TV’s, paperwork out of the bedroom

E – Exercise regularly - Around an hour's exercise a day will help, but leave a ‘buffer’ period of at least 2 hours before bed

E - Eat a balanced diet - Wakefulness can be caused by hunger, but going to bed too full can also cause wakefulness. As such, make sure you consume a balanced diet throughout the day and aim to have a ‘buffer’ period of at least 2 hours before going to bed after eating a large meal. If you’re up late and haven’t eaten for four to five hours a small snack before bed might prevent wakefulness due to hunger.

P – Plan for sleep – have a pre-bedtime wind down. Think of it as your very own – bath, story, bed. Children sleep well when they have a specific routine associated with bed time, and…so do we. As such, try to develop a ‘wind-down’ routine at least 60 minutes before you go to bed. This period should involve ceasing doing stimulating activities (e.g. paperwork) and instead engaging in more relaxing activities – e.g. having a bath, listening to relaxing music etc.

Wednesday 5 October 2016

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