Rewiring Sleep: New Therapy Counters Intuition
Behavioral Approach Offers Lasting Relief From Insomnia
Millions struggle with sleepless nights, but a surprising treatment gaining traction involves *less* time in bed. Experts are challenging conventional wisdom, offering a path to better rest through a carefully structured approach.
The CBTi Method
Justin Thomas, Ph.D., a sleep specialist at the University of Alabama at Birmingham, frequently encounters skepticism when recommending sleep restriction. “They cannot get to sleep and have difficulty functioning during the day, and I tell them to spend less time in bed,”
he explains. “That is so counterintuitive, but it works.”
This technique is a core component of cognitive behavioral therapy for insomnia (CBTi), now considered the gold standard for treating the widespread sleep disorder.
The Centers for Disease Control and Prevention estimates that over 35% of U.S. adults report insufficient sleep or excessive daytime sleepiness. A recent study by the Sleep Foundation found that 48% of Americans experience symptoms of insomnia at least a few nights per week. (Sleep Foundation, 2024)
Four Steps to Restful Nights
Thomas, also president of the Society of Behavioral Sleep Medicine, outlines the four key elements of CBTi. The first involves learning relaxation techniques – diaphragmatic breathing, muscle relaxation, and positive self-talk – to calm the mind before bed. “There is a roughly 20-minute routine that we teach and that our patients practice every day until they get good enough to do it themselves,”
he says. “I tell patients, ‘It is not like Ambien.’ The goal is to get you to relax and calm down and move yourself closer to sleep.”
Stimulus Control and Sleep Restriction
Next is stimulus control, associating the bed solely with sleep and intimacy. “That is a set of rules to keep people from associating their beds and bedrooms with anything other than sleep and sex,”
Thomas clarifies. “Many people with insomnia lie there and toss and turn and get frustrated. The brain learns to associate the bed with wakefulness.”
Patients are advised to only go to bed when sleepy and to leave the bed if sleep doesn’t come within a reasonable timeframe.
The often-surprising sleep restriction step aims to align time in bed with actual sleep duration. “We are not really restricting sleep but reducing time in bed to match how much sleep you are actually getting,”
Thomas explains. “If a person is sleeping for six hours but they are lying in bed for nine hours, we get them to only spend six hours in bed. Most people do the opposite.”
Avoiding increased time in bed after a poor night, and resisting naps, helps break the cycle of insomnia.
Cognitive Restructuring for Better Sleep
Finally, cognitive therapy addresses unhelpful thought patterns. “Cognitive therapy helps people identify the connection between thoughts and emotions, challenge those thoughts, and help people come up with more helpful and realistic thoughts,”
Thomas states. “We tell people, ‘Do not look at the clock.’ They are lying in bed and telling themselves, ‘It is 2 a.m. I need to fall asleep right now or I will not be able to function.’
This creates performance anxiety, so patients learn to reframe these thoughts.
Treatment and Beyond
CBTi typically involves four to five sessions, equipping patients with self-management skills. “And they do not have to take a sleeping pill for the rest of their life,”
Thomas adds. He even suggests that CBTi should be taught as a life skill, potentially preventing mental health issues.
Thomas also researches circadian rhythm sleep-wake disorders, recognizing that some cases of perceived insomnia are actually misaligned internal clocks. He uses light therapy and melatonin to help “night owls” adjust their sleep schedules to better fit societal demands.
