Chronic Insomnia – Do You Need Counseling?

Psychological counseling offers a safe, proven strategy for beating insomnia. Find out if this treatment is right for you.

People with insomnia have an unexpected and powerful ally at their disposal in the quest for a good night’s sleep — psychological counseling.

“It’s pretty clear from the evidence that a type of counseling called cognitive-behavioral therapy (CBT) has proven efficacy in the treatment of insomnia,” says Russell Rosenberg, PhD, founder and director of the Atlanta School of Sleep Medicine, and a board member of the National Sleep Foundation.

“In fact, it’s underutilized for the treatment of insomnia,” Rosenberg says. He estimates that about 7 to 10 percent of the U.S. population has insomnia and suggests that the vast majority of these people would benefit from CBT to address their condition.

Using Psychological Counseling to Treat Insomnia

As the name implies, cognitive behavioral therapy is a blend of cognitive approaches, exploring people’s rational beliefs about a subject, and behaviors. For example, a therapist may analyze a patient’s belief that insomnia is causing his depression. In addition, a therapist may also help a patient with certain behaviors connected to restful sleep (such as getting out of bed when sleep won’t come).

People seeking treatment for chronic insomnia might access CBT in various ways. A patient may be referred to this type of therapy by a family physician or sleep specialist or simply may approach a trained psychologist directly.

The Pros of Counseling for Insomnia

Counseling can help treat the cause of the insomnia, rather than just the symptoms. This can lead to a long-term fix, making chronic sleeplessness a thing of the past. Other positives of therapy for insomnia include:

  • Solution to chronic problems. Cognitive-behavioral therapy is particularly appropriate for people who have trouble with sleeping that has persisted for a month or more, Rosenberg says.
  • Assistance with psychological issues. Patients with insomnia frequently have psychological conditions such as depression or anxiety. While such conditions are considered separate, they may contribute to a person’s insomnia. CBT can simultaneously address these issues during insomnia treatment.
  • Results may be quick. CBT is usually time-limited, with patients reporting some results in six weeks or less. This time period is very brief when compared to other types of counseling.
  • No medication required. CBT is ideal for patients who do not wish to undergo a drug regimen for the treatment of insomnia.

The Cons of Counseling for Insomnia

Opening up about one’s inner feelings and thoughts can be difficult for some patients. It may take many visits to multiple therapists in order to find one who makes you feel completely at ease to talk about your insomnia-related issues. Other reasons not to rely on counseling include:

  • Medical conditions can go ignored. CBT does not treat the medical conditions that may cause insomnia, so any underlying physiological causes must be ruled out before counseling begins.
  • Not great for short-term insomnia. An acute sleeping problem or insomnia triggered by a sudden, time-limited emotional shock, for example, probably is not the best candidate for CBT, Rosenberg says.
  • Results may not be quick enough. A six-week course of treatment is typical for CBT but can seem like an eternity for someone dealing with insomnia. For that reason, this form of counseling can be used in conjunction with pharmaceutical sleeping aids, particularly if the insomnia is so debilitating that a patient might otherwise have trouble getting the maximum benefit from counseling. On the plus side, a good night’s sleep, courtesy of a sleeping aid, can help a patient see that insomnia and other related conditions may have an end in sight. “Sometimes, just getting their confidence back that they can sleep again gives them hope,” Rosenberg says.
  • Hard-to-find therapists. While CBT has been shown to be successful in treating insomnia, it may be difficult outside urban areas to find a therapist trained and experienced in this type of treatment. Rosenberg suggests that people with sleeping problems look for a CBT-trained counselor through the National Sleep Foundation or the American Academy of Sleep Medicine. Three years ago, Sheilagh Weymouth, DC, a chiropractor who provides holistic care in New York City, had insomnia when she was relocating her practice. “Everything that could go wrong did — I became too tired to sleep.” Eventually, she took her own professional advice and viewed the insomnia as a symptom of an underlying problem — in this case, the stress of a major professional upheaval.

She encourages people to enter counseling for insomnia with an open mind and the same willingness to examine the underlying causes of the issue.

Weymouth says, “A holistic approach will encourage a person not to shy away from the insomnia. I think for many whose tests have come back normal, this is a very helpful way to view the problem.”

By Elizabeth Connor – Medically reviewed by Pat F. Bass III, MD, MPH