CBT for Insomnia: Where to Find the Help You Need

Here’s a question that often comes my way: “I’d like to try cognitive behavioral therapy for insomnia [CBT-I], so where can I find a sleep therapist?”

The availability of CBT-I providers varies depending on where you live. Here’s where you’re likely to find help and where you’re not, and alternative ways to get the insomnia treatment you’re looking for.

Where to find a therapist who does CBT for insomniaHere’s a question that often comes my way: “I’d like to try cognitive behavioral therapy for insomnia [CBT-I], so where can I find a sleep therapist?”

The availability of CBT-I providers varies depending on where you live. Here’s where you’re likely to find help and where you’re not, and alternative ways to get the insomnia treatment you’re looking for.

Why CBT for Insomnia?

It’s the most effective insomnia treatment known at this time, improving sleep for 70 to 80 percent of the people who try it. CBT-I is more effective and long lasting than treatment with sleeping pills, and it’s effective for many people with chronic insomnia who also have other health problems such as depression, anxiety, or sleep apnea.

For more information on CBT-I, take a quick look at this blog post I wrote at the beginning of last year.

Where Can I Find Treatment?

It depends on where you live, say authors of a paper published last year in Behavioral Sleep Medicine. If you live in New York or California, insomnia therapy is likely close at hand. If you live in Hawaii, South Dakota, Wyoming, or New Hampshire, you’ll have no luck in finding a doctor, psychologist, or nurse practitioner trained in behavioral sleep medicine. Authors of the paper were unable to find a single provider practicing in those states.*

Here’s a chart showing the number of behavioral sleep medicine providers in the US by state:

No. of providers States
73–33 CA, NY, PA, IL, MA, TX
27–22 FL, OH, CO, MN, MI, WA
17–10 MD, NC, TN, AZ, MO, DC
9–6 CT, VA, WI, AL, OR, AR, SC, WV, IN, ME, NJ
5–3 AK, DE, GA, KS, LA, NE, RI, KY, NM, NV, OK, UT, MS
2–0 ID, ND, IA, MT, VT, HI, NH, SD, WY

 

Canada has 37 behavioral sleep medicine providers, but no other country outside the US has more than 7.

Do I Really Need a Sleep Therapist for CBT-I?

There are alternatives to working with a doctor or therapist trained in behavioral sleep medicine. But working with a professional—someone with a clear grasp of the protocol who can lead you through it step by step, motivating you to continue if the going gets rough—is probably the best way to ensure success and maximize the gains you’re going to make.

“Having somebody who’s experienced with this telling me that, if I do this, there’s a good chance everything will turn around is very inspiring,” said a man I interviewed for my book, The Savvy Insomniac, after we finished a group course in CBT-I.

Find a professional trained to administer CBT-I by clicking on this provider directory.

What If I Can’t Get Insomnia Therapy Nearby?

Your next best bet is to take an online course in CBT-I. These interactive courses have been found to be as effective as the face-to-face coaching you’d receive from a sleep therapist, the only downside being that research shows people going through an online course are more likely to drop out. Check these programs out:

  • CBT for insomnia is a 5-week course developed by sleep specialist Gregg D. Jacobs at Harvard Medical School. The cost is $49.95.
  • SHUTi sells its 6-week course, developed by Canadian sleep specialist Charles Morin, for $149. The price includes access to the site for 26 weeks. The extended access might appeal to you if (1) you’re not ready to jump right into the course, (2) something unforeseen happens during therapy and you have to start all over again, or (3) you feel you might like to continue tracking your sleep after the course ends.
  • Sleepio, developed by UK sleep specialist Colin Espie, offers a 6-week course plus a year’s access to the website and a host of supplementary materials for the hefty price of $400. What you’d gain from a whole year’s access to the website isn’t clear to me. But you may be able to access Sleepio for free by agreeing to take part in a research study.

Couldn’t I Just Read a Book?

You could. Stephanie Silberman’s book, The Insomnia Workbook: A Comprehensive Guide to Getting the Sleep You Need, leads you step by step through everything you need to know to go through CBT-I using the book as your guide. But here’s a warning: while I know it’s possible to succeed in self-administering CBT-I using only a book as a guide (I did), I hear some people complain of failure. Make sure you succeed by starting out right:

  1. Read all you can about the CBT-I protocol before starting therapy. It’s important to understand the process before you begin.
  2. For 1 to 2 weeks before you start therapy, keep a sleep diary (download a sleep diary here), recording bed and rise times and relevant habitual activities.
  3. From the data you’ve gathered, calculate your average nightly total sleep time and set your initial sleep window accordingly. (But if you sleep less than 5 hours a night, set your sleep window at 5 hours.)

Stick closely to the protocol and hang tight. Your sleep should start to improve in a couple of weeks.

If you’ve found this blog post helpful, please like and share on social media. Thanks!

*To gather data, the authors consulted a directory of professionals certified in behavioral sleep medicine, BSM provider lists, and BSM listservs.

New Technology May Help Insomniacs Sleep

I don’t often write about technology developed to improve sleep. I’m frankly skeptical that most products could help me any more than the daily exercise I do and the habits I changed after going through CBT for insomnia.

But a few items have caught my attention recently because they sound like they have genuine potential to help—two I’ve blogged about before and one brand new. See if you agree.

Trouble sleeping alleviated with new devices and an appI don’t often write about technology developed to improve sleep. I’m frankly skeptical that most products (e.g., sleep trackers) could help me any more than the daily exercise I do and the habits I changed after going through CBT for insomnia.

But a few items have caught my attention recently because they sound like they have genuine potential to help—two I’ve blogged about before and one brand new. See if you agree.

High-Tech Earplugs

QuietOn Sleep earplugs were designed specifically to block out noises such as snoring and the droning of plane engines.

Earplugs—these or any others—may not interest you if you’re a homebody and/or you share a bed with a quiet sleeper. But if your sleep is often disturbed by a snoring partner or unpleasant, droning noises, these earplugs could be a real boon.

How They Work

QuietOn earplugs contain a microphone that continually samples sound in the environment. They then create a phase-shifted sound that’s played through a speaker, cancelling the exterior noise out. The earplugs are battery powered and come with a carrying case that functions as a charger.

You might not imagine all this technology could fit inside a gadget so small. Apparently, it does. Twenty-one of these earplugs can fit on a single credit card. Encased in soft material, they fit inside the ear canal, neither big enough to hurt you nor small enough to pop out.

The one downside is the price. While limited numbers are available via an Indiegogo campaign at $149 a pair (2 pairs for $199), the full price after product launch will be $239.

A Brain-Calming Headband

At last Ebb Therapeutics has come out with its novel insomnia therapy device, a headband that cools—and so calms—busy brains at night. Here’s why it might improve your sleep.

The brains of normal sleepers are quiet during sleep but insomniac brains are not. In neuroimaging studies, scientists have found evidence of excessive metabolic activity occurring in our brains at night. Some of it occurs in the frontal cortex, located behind the forehead. By cooling the forehead, Ebb Insomnia Therapy reduces activity in the front part of the brain and in turn makes it easier to fall asleep.

How It Works

The headband has a special pad that rests against the forehead. This pad is continuously supplied with cooling fluid via a tube connecting the headband to a temperature regulator that sits on your bedside table.

The circulating fluid eventually evaporates and, after about three months, the temperature regulator alerts you to the fact that the fluid cartridge needs to be replaced. The replacement kit contains a forehead pad and a fluid cartridge.

How and Where to Get One

You need a prescription to get one; they’re not sold over the counter. However, Ebb Therapeutics, planning to market the devices widely, says they’re now available at sleep centers in these cities:

  • Atlanta, GA
  • Clayton, NC
  • Fargo, ND
  • Newark, DE
  • Pittsburgh, PA
  • Raleigh, NC
  • Rehobeth Beach, DE
  • St. Louis, MO
  • St. Petersburg, FL
  • Wilmington, DE
  • Wilson, NC

For a review of how this device may improve sleep and the tests that went into its development, see my earlier post on Ebb Insomnia Therapy. Contact the company directly to find out how much the device (and replacement kit) costs.

A Sleep Training Smartphone App

You might not think sleep could improve with training. Michael Schwartz thinks otherwise, based on years of work as a sleep technologist and sleep educator. He’s developed an inexpensive smartphone app called Sleep On Cue that can help people fall asleep and fall back to sleep more quickly.

The idea behind the app is this: Chronic insomnia often gives rise to anxiety about sleep, lack of confidence in sleep ability, negative beliefs about sleep, and increased brain activity at night. So it’s easy to lose touch with the feeling of falling asleep. The app essentially retrains you to recognize what falling asleep feels like, alleviating anxiety about sleep and restoring your confidence in your sleep ability.

How the App Works

You conduct your sleep training sessions late in the afternoon or early in the evening after a poor night’s sleep. Lie in bed holding your smartphone. Via a simple call-and-response procedure involving soft tones and movement, the app detects when you’re falling asleep (although you may not).

To the question “Do you think you fell asleep?” you press “yes” or “no.” Then, you leave the bed a few minutes, awaiting the next sleep trial. When you decide to end your session, your phone displays a graph with feedback about your sleep ability and your awareness of your sleep. Gradually you get better at recognizing the feeling of falling asleep.

For details about the procedure and the testing behind it, see my earlier post about Sleep On Cue or go directly to the product website.

Cerêve Sleep Device Approved for Treatment of Insomnia

Would you wear a cap at night if it helped you fall asleep faster?

You may soon have the opportunity: the cap, a medical device for the treatment of insomnia, has received approval from the FDA, clearing the way for it to come to market.

new insomnia treatment approved by FDAWould you wear a cap at night if it helped you fall asleep faster?

You may soon have the opportunity: the cap, a medical device for the treatment of insomnia, has received approval from the FDA, clearing the way for it to come to market.

“We are thrilled that the FDA has cleared the Cerêve Sleep System for treating people with insomnia,” sleep specialist and company founder Eric Nofzinger was quoted as saying in a press release. “The Cerêve System offers a clinically proven and safe alternative to pills, with the potential to help millions of Americans get to sleep fast.”

A Novel Insomnia Therapy

It isn’t just any old cap. This cap, made of soft plastic, comes with a software-controlled bedside device that continuously pumps fluid to a pad that rests against your forehead and cools the brain. You wear it all night.

I found out about the cap and the cooling process—called frontal cerebral thermal transfer—at a conference on sleep and sleep disorders in 2011. My first reaction was disbelief. Really? I said to myself. Now they’re proposing to cure my insomnia by sticking an ice pack on my brain? No way!

Despite my skepticism, I showed up for a poster session where Nofzinger was talking about results of clinical trials conducted on insomniacs who used the device at night. Patients responded positively, he said. “They describe it as sort of like a spa treatment.”

But what did wearing a cooling cap have to do with insomnia? I asked him. What was the relationship between the two?

“Insomniacs have too much metabolic activity in the frontal cortex,” Nofzinger said. “It’s very soothing to be able to settle that brain activity” by cooling the frontal region of the brain. “It’s as if your grandmother put a washcloth on your forehead.”

Something cold against my forehead sounded unappealing, I told him. I can’t sleep when I’m cold.

The temperature can be adjusted within a comfortable range of coolness, was Nofzinger’s response.

Origin of the Concept

Formerly, Nofzinger directed the Sleep Neuroimaging Research Program at the University of Pittsburgh School of Medicine. He and his colleagues studied neural activity in the human brain. What they knew from past studies was that the brains of normal sleepers are largely quiet at night: there’s not much metabolizing of glucose. But in functional brain imaging studies of insomnia patients, the researchers saw something different.

In insomniacs at night, quite a bit of glucose was being metabolized in certain areas of the brain, especially the frontal cortex (the part responsible for thinking, planning, and other executive functions). Excessive activity in the frontal cortex might be a biomarker of the hyperarousal believed to underlie insomnia, and decreasing this activity by gently cooling the frontal lobe might lead to sounder sleep.

Testing the Device

Once the device was created, it had to be tested for safety and efficacy on insomnia patients. The first two studies were small and the main results were as follows:

  • The devices reduced brain metabolism during sleep, especially in the frontal cortex.
  • They also reduced participants’ core body temperature (also favorable to sleep).
  • The cooler the setting, the greater was the benefit.
  • Worn all night at the coolest setting, the devices enabled insomnia patients to get to sleep as quickly and sleep as efficiently as normal sleepers.

A third much larger clinical trial—randomized and placebo controlled—was conducted with funding from the National Institutes of Health. The caps were found to reduce the time it took insomniacs to reach Stage 1 and Stage 2 sleep, effectively helping them fall asleep faster. Regarding safety, Cerêve Sleep System was classified by the FDA as a novel, low-risk device.

Now that the FDA has granted its approval, what remains to be done is to ramp up production and roll out a marketing campaign. These things always take more time than you’d like them to, but as of now Cerêve expects to launch the product in the second half of 2017.

Does this sleeping cap sound like something that might help your sleep? Why or why not?