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How to Manage Insomnia

March 13, 2023

Poster for video Managing Sleepless Nights with Susan Rubman, PhD

It’s a rare person who has not experienced at least an occasional night or two of tossing and turning in bed, feeling restless and having difficulty falling or asleep. But these once-in-a-while episodes of sleeplessness are not the same as having insomnia. The distinction is that insomnia involves persistent and consistent sleep difficulties, as well as a significant decline in performance and functioning during the day, explains Susan Rubman, PhD, a clinical psychologist in sleep medicine.

Part of the problem with insomnia is that you can become accustomed to restless sleep patterns. “That restlessness when trying to sleep is what our brains then learn,” Rubman says. “Through repeated pairings of being in bed and tossing and turning, we create a learned habit of arousal and awakening that, like any other habit, becomes persistent over time.”

CBT-I, or cognitive-behavioral therapy for insomnia, is considered one of the best treatments for insomnia and can improve sleep without medication. “CBT-I addresses both thoughts and expectations about sleep and behaviors around it, including at night when we can’t sleep,” Rubman says.

One key component of CBT-I is stimulus control therapy, which involves taking control of the association between being in bed and not sleeping. Stimulus control, Rubman explains, has two rules. The first is that beds are for sleep only. “We want to eliminate the association of being in bed, being unable to sleep, and being frustrated. So, we carve out the bedroom as a place for sleep,” she says.

The second rule is that when you are not sleeping, you should leave the bedroom, go somewhere else, and do another activity until you feel drowsy. Then, you can go back to your bedroom and sleep, she explains.

Another key tenet of CBT-I Is sleep restriction, which entails compressing the amount of sleep you get. For example, if you normally lie in bed for nine hours but only sleep for six of them, you should spend only six hours in bed to get one big “dose” of sleep, Rubman explains.

Ultimately, it’s important for people to know that it’s normal to have trouble sleeping, especially during times of stress. But if it becomes a persistent pattern, contact your primary care provider or a sleep disorder center for help.

In the video above, Rubman talks more about insomnia.