Get your sleep back
To help you get your sleep back, we have pulled together our favourite resources that you can use to learn about insomnia an its treatments. You will see that we focus on something called CBTi, which is short for cognitive behavioural therapy. When compared with sleeping pills for the treatment of persistent and recurring types of insomnia, CBTi has been shown to be more effective and safer in the long-term.
Here are a few things that we know about CBTi:
- CBTi teaches you different techniques that encourage a return of normal, satisfying sleep.
- It takes a bit of time and effort on your part to learn these techniques and put them into use.
- The return of normal sleep comes over time. It doesn’t happen on the first night. But the benefits are long lasting and worth the effort up front.
- There are different ways to access CBTi: 1-on-1 or in groups with a therapist or do-it-yourself using books, apps, or online programs.
Check out our resources below. To help you quickly find what you are looking for we give you a brief description about each resource when you click on it. We have also created comparison charts that let you quickly compare the different online CBTi programs and the workbooks you can purchase.
Insomnia: General Info, Sleep Logs, & Management Strategies
There are many online resources to help you better understand insomnia and how you can manage it. We have summarized the ones we like in a simple table. To see it, click view pdf.
CBTi: General Information
Looking to get more time in bed actually asleep rather than wishing for sleep? Cognitive behavioural therapy for insomnia provides a structured treatment approach that improves sleep quality and satisfaction with sleep. There are 5 main components to CBTi:
- Sleep restriction therapy
- Stimulus control
- Sleep hygiene education
- Relaxation techniques
- Cognitive therapy
To be using CBTi as your therapeutic approach to treating your insomnia you do not need to engage in all 5 components for it to work but for many people learning about each component is important and helpful.
Cognitive therapy offers education about sleep in order to change beliefs and attitudes that add to poor sleep. In many cases, insomnia starts with an outside cause, such as a stressful event, but continues beyond the initial cause due to fretting about not being able to sleep. Often it is decided in advance that sleep will be poor, the following day will be tiring and there is nothing that can be done about it. The cognitive component of CBTi questions the logical basis of these beliefs and points out their flaws.
The behavioral component of CBTi focuses on poor sleep habits and irregular sleep schedules that contribute to continuing poor sleep over time. These habits disrupt healthy sleep and cause us to feel that we are not in control – it seems our habits are in control of us. But habits are simply beliefs and thoughts that serve us or destroy us. You can replace a bad habit with a good one. Therefore, education is provided about healthy sleep behaviors. Being aware of the behaviors that promote healthy sleep gives direction on how you can replace your bad sleep habits with new and healthy ones.
CBTi can take time and effort to get the techniques working for you. Many people have their sleep improve within 2 weeks. However, a 6-week structured approach is recommended to help fully develop the techniques that can become your new sleep habit.
CBTi: Online/Mobile Programs
There are a several online insomnia management programs with important differences among them. In general, you get what you pay for, which is to say that the more expensive programs provide more individualized care than the less expensive and free options. Mid-priced programs offer automated messages from therapists via texts or emails. The more expensive programs provide two-way communications between clients and therapists. This can include telephone conversations, email or text exchanges, or live chats online 1-on-1 or as part of a group.
Click on each program listed below to see a brief description of what is offered. For a comparison of all the programs listed, see “CBTi: Get the program that’s right for you”.
CBT-I Coach
A free mobile app available from the iTunes store. It was developed by the US Department of Veterans Affairs. It covers all aspects of CBTi and provides structured assessment questionnaires and a sleep restriction program. Rather than being text-heavy, it utilizes interactive screens to create an individualized plan. There is no support from a therapist.
Available from Apple App Store and Google Play Store
Conquering Insomnia (CI)
Its methodology was developed by a U.S. sleep researcher and psychologist (Dr. Gregg Jacobs) and is available in various formats (CD, MP3). It offers individualized interactive CBT guidance based on personal needs identified through weekly sleep diaries. Various packages are available, some of which are listed here, which range in cost (<$50 USD):
- CI plus relaxation techniques (RT)
- CI plus RT and Email Q&A
- CI plus Email Q&A
- 20 minute phone consults with Dr. Jacobs
No high quality research was identified that has evaluated this specific approach. A related in-person CBT vs. sleeping pills study has been started by the program’s developer.
Go! To Sleep
A 6 week program developed by sleep psychologist Dr. Michelle Drerup that is available through Cleveland Clinic Wellness. For optimal results users are encouraged to login daily to complete the sleep diary. There are weekly lessons and activities. Progress is tracked graphically. Emails with motivational tips are sent by the program coach daily to enhance adherence. A mobile app is also available through the iTunes store. The app download is free but access to the program using your mobile device requires the $40 upgrade.
iSelfHelp Insomnia
This is a mobile app available at the iTunes store. Developed in Sweden, the program is primarily text based. It is up to the individual to complete the program and apply the skills learned. It is not individualized. There is no sleep diary and no interactions with therapists or coaches. The user sets their own goals and action plans with the lessons learned from the program. The user has unlimited access to the program once downloaded. The program touches briefly on the core components of a CBT program for insomnia offering general suggestions and techniques on how to implement them.
Available from Apple App Store
Online-Therapy Insomnia
Offers 8 sessions in 8 weeks and connects users with one of over 300 therapists located globally. Therapists provide daily feedback and live chat is available weekdays. Users work through various worksheets that are monitored and commented on by therapists. There is an online forum where participants can seek encouragement and help from other participants and/or therapists. Mobile apps for smart phones and tablets are available. This program appears to have the most support and interaction with therapists and is, fittingly, the most costly online program.
SHUTi
Developed by a group of U.S. psychologists, it provides tailored guidance, graphical progress reports, and online diaries to be completed throughout the program. Participants are provided with tailored feedback at the beginning of each new core component. To advance through the program requires completion of each component. Emails are provided to support participation. This program also covers relapse prevention strategies. SHUTi has been evaluated in 2 randomized trials, one involving adults with primary insomnia (n=45) and the other cancer survivors with insomnia (n=28). Waitlisted patients served as controls in both. Insomnia severity index (ISI) scores dropped from ~16 to 7 over 9 weeks of online CBT and remained there at 6 month follow up. ISI scores in the control groups were essentially unchanged. 73% (16/22) achieved insomnia remission (ISI score less than 8) after completing SHUTi whereas no person in the control group achieved remission. Findings were similar in the study of cancer survivors.
Sleep Training System
A 6 week online program that provides a step-by-step manual, sleep tips, and encouragement for the participant. Access to a printer is required for the participant to print out sleep logs. While the program schedule does not emphasize relaxation techniques the program offers additional modules on controlling stress and managing anxiety. The program also focuses on long-term maintenance and participants have full access to the program for 1 year. Personalized feedback is available for an additional $25. No formal research has independently evaluated its effectiveness.
Sleeping Tips, Using CBTi
A free mobile app available from the iTunes store. It summarizes CBTi, and focuses on sleep education, sleep hygiene, and stimulus control in a text format. There is no support from therapists.
Available from Apple App Store
Sleepio
A 6 week online program developed by Colin Espie in Scotland. It has been studied in an RCT with 164 participants randomized to either Sleepio, an online placebo program, or a waitlist. Participants randomized to the Sleepio program had decreased time to fall asleep, decreased time spent awake during the night, and ranked the quality of their sleep as higher than the other two groups. The benefits were maintained at a 2 month follow up. This program requires the participant to log-in weekly for 20 minutes and track their sleep habits daily with a sleep diary. Once a week there is a live group session with a sleep expert available via live chat. The participant can use this program on a personal computer or iPad, and they can access tools and relaxation audio on smart phones.
SlumberPRO
A self-help program based out of Queensland, Australia that requires about 30 minutes to an hour each day. Trained practitioners are able to track the client’s progress and they are available for questions by way of comment boxes. The program is currently in the early planning stages for a RCT.
CBTi: Get the program that’s right for you
Choosing the CBTi program that’s best for you requires knowledge of what each program can offer. To help you better understand these programs we have created a comparison chart that highlights the features of each program. Click here to find out which CBTi program is right for you.
CBTi: Books
For many, a preferred approach to managing insomnia is to independently work through your sleep issues using an insomnia management workbook. Before purchasing one of these books it is important to understand what each can offer so you can choose the one that’s best for you. We have summarized the contents of several of these books and workbooks here, which are available from your local bookstore or online.
CBTi: Therapists
Several different health providers provide psychological therapy for sleep problems including insomnia. A challenge is finding one, especially for people living in smaller towns or more rurally. In Nova Scotia, a good place to start looking for a therapist is by visiting the Association of Psychologists of Nova Scotia's website. You can call them or use their "find a psychologist" online tool.
If a there are no therapists easily available to you, refer to our suggested online/mobile programs for alternatives.
Sleepwell's Sleep Kit
We created Sleepwell Nova Scotia sleep kits to help you get your sleep back without relying on medications. The sleep kits contain information about the program, tips for treating insomnia, information about CBTi, the role of excercise and healthy eating, a Sleepwell diary, and ear plugs. The real ingredients that help you get your sleep back are not actually in the kits, they are in what the kits and this website promote - namely education about insomnia treatment optins and the sleep promotion techniques of CBTi.
Sleepwell Nova Scotia A 2-sided card briefly describes the program as well as what we know about sleeping pills and CBTi.
Online CBT for Insomnia This pamphlet is available online at Medication Infoshare. It describes CBTi and reviews the various online programs.
Getting a good night's sleep This educational resource was developed by the BC branch of the Canadian Mental Health Association in collaboration with Anxiety BC. It features 10 tips for getting a good night's sleep. Most tips relate to sleep hygiene. Here To Help, which is a very rich resource for people looking for information (in multiple languages) on mental illness and addictions and their treatments, provides an online copy of this brochure.
Sleepwell bookmark Use our bookmark in your favourite bedtime reading. We'll spread it around, at conferences, pharmacies, and other locations to help get the word out about the program.
Earplugs Tune out the noises that are disturbing your sleep, such as your partner’s snoring or traffic on the street. White noise (a constant soft background noise such as from a fan or a recording of rain or ocean waves) is another way to promote and maintain sleep.
Activity Guide Physical activity is not only good for your physical health, but also for your mental health and sleep. Physical activity serves many purposes for sleep. It will tire you out making it easier to fall and stay asleep and can help lessen restless leg syndrome. Just don't do intensive physical exercise close to bedtime.
Food Guide There are certain eating habits that are known to interfere with sleep, like a heavy meal late in the evening or drinking caffeinated beverages late in the day. The kit provides sensible information about good eating habits based on Canada’s Food Guide.
Diary The Sleepwell diary (the little black book) can be used in many ways. We recommend that you use it when using a CBTi workbook or online program for jotting notes and keeping your records about your sleep experiences.