Man in therapist office getting counseling for sleep disorders

Can counseling for sleep disorders really help? – What we know and practical tips

By Jason Wooden, PhD | August 31, 2020

Counseling for sleep disorders has been shown to be helpful in studies.  The most common approach, cognitive behavioral therapy, uses various techniques to change thoughts and behaviors that affect sleep.  For more effective treatment, it’s important to actively collaborate with your therapist and to commit to doing your part.

Why counseling for sleep disorders is a worth a try

According to the World Sleep Society, 35% of people feel they don’t get enough sleep.  In the US, 50 to 70 million adults are living with a sleep disorder.

The most common sleep disorder is basic insomnia, but maybe you’re one of the millions suffering from untreated sleep apnea or shift work related sleep problems.  Most of us are at least familiar with narcolepsy and night time restless leg issues.

Regardless, poor sleep makes for tough nights and miserable days.  It’s hard to focus and get things done.

It’s bad for relationships too.

Poor sleep can also increase your risk for depression and other mood disorders.  It can increase your risk for other health issues, including heart disease, diabetes, and dementia.

Given all that’s at stake, it’s really important to do whatever you can to improve your sleep.

You may be wondering if there’s anything else you can do besides pills and devices to help you manage the symptoms of your sleep disorder.

Sleeping pills have their place, but they don’t address the underlying reasons many people find it harder to sleep.  Often, it’s what’s going on in your head – patterns of thinking and daily behaviors.

Sleeping pills also come with serious downsides, including drug dependence, withdrawal symptoms, and rebound insomnia.

It turns out counseling for sleep disorders is a safe and drug free alternative that more people should really be taking a look at.

Wondering whether it can really help your sleep?

Curious what’s involved if you go for sleep counseling?

Well, it’s not exactly what you think – that classic image of someone laying down in a therapist’s office, getting badgered with questions, and spilling out their inner most thoughts.

It’s actually pretty low key and practical.

Let’s take a look at what counseling for sleep disorders can do, how we know it works, and some practical things to keep in mind so you get the most out of it.

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How does counseling help sleep?

The most commonly used type of counseling for sleep disorders is cognitive behavioral therapy (CBT for short).  It’s been widely used for many other things, including depression, anxiety, substance abuse problems, and marital problems.

Typically, the patient works collaboratively with a therapist to change thinking patterns and behaviors that are at the root of the problem.  Research has shown that it can be just as effective as other types of psychological therapy and medication.

So, how does it help sleep?

Too often, people develop bad attitudes, habits, and associations that make it harder to fall asleep and stay asleep.

Cognitive behavior therapy can help identify and change thoughts and behaviors surrounding sleep.  Using various techniques, it can help you develop healthier ways of thinking and habits to keep your sleep on track.

Here are some of the techniques and how they help sleep:

Stimulus control – helps you have a more positive response to your bed at night

Sleep restriction – matches the time you spend in bed to how long you sleep

Relaxation training – teaches you how to prepare your mind and body for sleep

Biofeedback – uses sensors to help you recognize and manage the effects of stress and anxiety on the body

Cognitive psychotherapy – helps you identity attitudes and beliefs that affect sleep

Sleep hygiene training – helps you change daily habits that affect sleep

As I mentioned earlier, sleeping pills come with side effects. They can actually make things worse in the long-term.

Besides being drug-free, CBT counseling for has other advantages:

  • Therapy is tailored to you
  • It can help with other issues such as depression that make it harder to sleep
  • You may be able to reduce or avoid reliance on sleeping pills
  • You can get help from the comfort of your home via online teletherapy

Can CBT counseling help insomnia?

Insomnia is the most common sleep disorder that people struggle with.  It affects up to a third of people worldwide.

People with insomnia have trouble falling asleep, staying asleep, or getting quality sleep.  It can be short-term (a few days or weeks) or long-term.

Numerous studies have shown that CBT counseling for sleep disorders can help insomnia.  In a recent meta study in which researchers looked at the data from 87 different studies, they confirmed the effectiveness CBT counseling.

It’s now recommended as the first the line of treatment for patients by both the European Sleep Research Society and the American Academy of Sleep Medicine

Can CBT counseling help sleep apnea?

Sleep apnea is the second most common sleep disorder affecting over 22 million adults in the US and 100 million worldwide.

People with sleep apnea have their breathing repeatedly interrupted during the night. (You can learn more about this here.)  This causes them to repeatedly fall into a lighter sleep and in the morning they wake up feeling as if they didn’t sleep at all.

It probably doesn’t surprise you that many sleep apnea patients also struggle with insomnia symptoms.

So, can counseling do anything for this sleep disorder?

In a recent study involving 145 people, sleep patients were given CBT therapy before starting CPAP, the most common treatment for sleep apnea.

The CBT counseling led to fewer insomnia symptoms.  They were also more likely to stick with their CPAP treatment which is a big plus as some people have a hard time with the CPAP face mask setup.

Altogether, this means CBT counseling really is useful for sleep apnea patients since they experience less insomnia and they’re more likely to continue their CPAP treatment.

Can CBT counseling help shift work sleep disorder?

Okay, let’s talk about whether counseling can help another sleep disorder that plagues millions of people…

We all know someone who works night shift or rotating shifts.  They always seem to be behind the eight ball on sleep.  They’re likely dealing with shift work sleep disorder which occurs in individuals who work nontraditional hours.

This sleep disorder plays havoc with a person’s natural sleep-wake clock making it harder to sleep and wake at the desired times.

In the western world, roughly one in six employees work in shifts.  Besides increasing your chance for a sleep disorder, shift work is also associated with increased risks for cardiovascular disease, gastrointestinal disorders, and breast cancer.

According to the National Sleep Foundation, it estimated that 30% of shift workers fight excessive sleepiness or insomnia and 10% are thought to actually have shift work disorder.

That’s a lot of people with sleep troubles.

Can CBT counseling help shift workers?

While this hasn’t been as well studies as for other sleep disorders, recent research has shown that CBT can be effective for treating insomnia in these individuals.

A 2019 study in Germany treated patients with either online or in person CBT counseling.  After four weeks, both were found to help patients.

They had fewer insomnia symptoms and slept better.  The counseling also helped with depression and improved their sense of well being.

Can CBT counseling help Restless Legs Syndrome?

Up to 10 percent of the US population is that to have Restless Leg Syndrome.

It’s a sleep disorder where people get an uncontrollable urge to move their legs. Unfortunately, it’s worse at night which can lead to insomnia.  It can also disturb the sleep of a bed mate.

If this is you or someone you know, new research has shown that CBT counseling can help people with this sleep disorder too.

In study invovling 25 Restless Leg Syndrome patients, people were given four sessions of behavioral therapy.  It improved their insomnia and sleep quality.  They also had less anxiety.

And three months later, they were still sleeping better.

Can CBT counseling help Narcolepsy?

While you may not know someone personally who has narcolepsy, we’ve all either heard stories of people who suddenly fall asleep in the middle of talking or even driving.

Narcolepsy is a neurological sleep disorder that affects the brain’s ability to control the body’s sleep-wake cycle.  It’s less frequent than the other disorders already mentioned.  (It’s estimated to affect 1 in 2000 individuals.)

Many people with narcolepsy sleep poorly, often waking up frequently during the night and feeling sleepy throughout the day.  They also deal with mental fogginess, poor memory, and hallucinations.

Fortunately, it’s a manageable condition and CBT counseling can help.

It turns out that sleep hygiene is really important for narcolepsy treatment which is one of the areas of focus for CBT counseling.

CBT can also help patients stick to their meds and experience less depression.  In fact, multiple studies have confirmed the effectiveness of CBT for narcolepsy.

VIDEO:  Cognitive Behavioral Therapy for Narcolepsy (Dr. David O’Regan)

How to get the most out of counseling for sleep disorders

So, now that we’ve talked about the science and evidence behind counseling for sleep disorders, let’s talk about how to get the most out of it.

To make CBT counseling more useful for you, you should:

Ask questions – make sure you understand what’s going on so you’re doing what you need to

Keep in mind it’s a collaboration – your therapist is a guide to help you along the way to better sleep

Do your part – you need to commit to attending your sessions, doing your homework, and following through on your therapist’s recommendations.

Talk freely – you never know what can give your therapist insight

Meet at a good time – schedule your sessions at time where there will be minimal distractions

Sleep counseling isn’t the only thing you should do

As mentioned earlier, one of areas of focus for CBT sleep counseling is sleep hygiene.  It’ really important as your daily habits can set the stage for poor sleep or restful sleep.

A therapist will help identify and change behaviros that are hurting your sleep.

However, there may be sleep hygiene habits you can start working on today.

For better sleep, experts recommend:

  •  go to sleep and wake up at same time every day
  • avoid naps
  • exercise
  • avoid large meals, alcohol, or stimulants such as caffeine before bedtime
  • maintain a bedtime routine
  • avoid using TVs, laptops, or other electronics before sleep
  • keep your bedroom dark, cool, quiet, & relaxing

Also, if you haven’t already, you may want to get a check from your doctor.  There are many other things that can cause or worsen sleep problems.

Some of them are mental like depression, anxiety, and mood disorders.  Physical health issues have been linked to poor sleep, including chronic pain, heartburn, diabetes, cancer, dementia, and asthma.

doctor talking about medical issues with woman who’s also getting counseling for sleep disorders

Tips for finding a sleep therapist

Okay, now that you know what it can do, you’re probably wondering how you can get started with counseling for your sleep disorder.

You can check an online listing:
Find a Sleep or Insomnia Therapist (PsychologyToday.com)
Association for Behavioral and Cognitive Therapies directory
Society of Behavioral Sleep Medicine directory

You can also ask your doctor or someone you know about sleep therapists.

It’s also important to do your homework.

Some things to look for:

  • credentials
  • licensing
  • experience
  • insurance
  • check for complaints filed against a therapist
  • fees
  • free initial consultation where you can test the waters
cartoon with therapist on computer screen depicting online counseling for sleep disorders

Sources:

1. “World Sleep Day Talking Points”, 2020, World Sleep Society website

2. “Sleep and Sleep Disorder Statistics”, American Sleep Association website

3. “What Is Cognitive Behavioral Therapy?”, 2017, American Psychological Association

4. “Cognitive Behavioral Therapy”, American Academy of Sleep Medicine website
http://sleepeducation.org/treatment-therapy/cognitive-behavioral-therapy

5. Insomnia and cognitive behavioural therapy—how to assess your patient and why it should be a standard part of care, J Thorac Dis. 2018 Jan;10(Suppl 1):S94-S102.

6. Prevalence of chronic insomnia in adult patients and its correlation with medical comorbidities, J Family Med Prim Care. Oct-Dec 2016;5(4):780-784.

7. “Insomnia”, National Institutes of Health website

8. Cognitive and behavioral therapies in the treatment of insomnia: A meta-analysis, Sleep Med Rev. 2018 Apr;38:3-16.

9. “Sleep apnea information for clinicians”, American Sleep Apnea Association website

10. “Sleep Apnea Statistics”, 2018, cheapcpapsupplies.com

11. Comorbid insomnia and obstructive sleep apnea: challenges for clinical practice and research, J Clin Sleep Med. 2010 Apr 15;6(2):196-204.

12. Cognitive and behavioral therapy for insomnia increases the use of continuous positive airway pressure therapy in obstructive sleep apnea participants with comorbid insomnia: a randomized clinical trial, Sleep. 2019 Dec 24;42(12):zsz178.

13. “What is Shift Work Disorder?”, 2020, National Sleep Foundation website

14. Effectiveness of an Online CBT-I Intervention and a Face-to-Face Treatment for Shift Work Sleep Disorder: A Comparison of Sleep Diary Data, Int J Environ Res Public Health. 2019 Aug 24;16(17):3081.

15. “Facts about Shift Work Disorder”, 2020, National Sleep Foundation website

16. “Effectiveness of an Online CBT-I Intervention and a Face-to-Face Treatment for Shift Work Sleep Disorder: A Comparison of Sleep Diary Data”, Int J Environ Res Public Health. 2019 Aug 24;16(17):3081.

17. “Restless Legs Syndrome Fact Sheet”, National Institute of Neurological Disorders and Stroke website

18. Cognitive behavioral therapy for insomnia in restless legs syndrome patients, Sleep Medicine
Volume 74, October 2020, Pages 227-234.

19. “Narcolepsy Fact Sheet”, National Institute of Neurological Disorders and Stroke website

20. From wakefulness to excessive sleepiness: what we know and still need to know, Sleep Med Rev. 2008 Apr;12(2):129-41.

21. “Narcolepsy: A review amongst sleep disorders”, Khan S (2018), Glob Med Therap 1: DOI: 10.15761/GMT.1000115

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