What we’ve said about CBT-I

“to me, that one requires that there is no more than mild axis one condition that can be identified. Then I will be more willing to say this is likely psychological. For that, the, in my opinion, appropriate intervention is CBTI and sleep hygiene”

“I think chronic insomnia is the people that have this short-term insomnia and then start to develop beliefs and behaviors that create a feedback loop that worsens the insomnia”

“mindfulness, like anything else, is an intervention that, in my opinion, you should be reaching for, thinking about, and counseling about, similar to, for example, CBT-I or behavioral activation. Your options are not just medication prescriptions. You should and can prescribe treatments like mindfulness”

“But everyone wants to regulate the sleep onset. And there are good reasons for that. There's a lot of distress, psychiatric distress and symptoms associated with the sleep onset period at the beginning of the night. But then they don't regulate the sleep offset, the waking time”

“Think of your bed as an association machine. If you're playing video games, working on your computer, watching television, your brain no longer associates the bed with sleep. And you want to protect that association so that when you're in the bed, the only thing your brain knows is sleep”

“Yes, part of CBTI and part of the treatment of sleep is to try to reduce or stop the level of metacognitive anxiety about the sleep itself, that sleep process. Having distress about your distress certainly does not help your distress”

“Same thing with CBTI. You probably have to use an app or you have to teach it piecemeal within your sessions to really get it there. But it's actually not that complicated. What's complicated is getting it done, just like CBT”