About one in three Australians has trouble sleeping, whether they struggle to fall asleep or are waking during the night and unable to go back to sleep.
Designed to help change behaviours that are having a negative impact on our lives, cognitive behavioural therapy (CBT) is the gold standard treatment for a range of mental health conditions, including depression, anxiety and obsessive-compulsive disorder (OCD).
CBT-i is a targeted version of the therapy, developed specifically to combat insomnia, and it has been shown to be highly effective.
However, while a number of psychologists offer some level of support for insomnia, the Sleep Health Foundation has estimated that only about 30 full-time psychologists in the country are trained to deliver CBT-i.
To help meet the shortfall, Macquarie University psychologists have developed the Sleep Course, which is now being offered by the University's digital mental health service, MindSpot.
In an eight-week, self-paced course, participants work through a series of lessons, with the option of weekly check-ins with a therapist.
Help for everyone
Clinical psychologist and researcher Dr Amelia Scott is the lead course developer and led the clinical trial to examine its effectiveness.
"Something that was important to us was ensuring the course could help a sample of real people who might present to GPs with insomnia, not just people who meet the relatively narrow criteria to be allowed into a clinical trial," Dr Scott says.
"Many clinical trials for insomnia treatment exclude people on the grounds that they might not have had a severe enough score when they were screened, or they might have other mental or physical health conditions, or other sleep conditions like sleep apnoea. They might be shift-workers, or they could be taking some type of prescribed sleep medication.
"We didn't exclude anyone from our trial, and we found that everyone benefitted, on average reporting their sleep quality had improved by 40 per cent.
"We found the group of people who were taking sleeping medications during the treatment showed less improvement than other participants, but they did still benefit from the course.
"Our oldest participant was an 85-year-old lady who she said she had gone from decades of insomnia to getting a consolidated, seven-hour block of sleep each night."
While the total amount of sleep participants got did not change dramatically, the big difference was that they were sleeping in longer blocks and spending less time awake in bed.
Another key benefit was a 35 per cent improvement in symptoms of depression and a 23 per cent improvement in symptoms of anxiety across the trial group – an important finding, as sleep disturbance is common among people with depression and anxiety.
About 40 per cent of trial participants also opted to receive telephone support with a psychologist alongside the course.
Building a different relationship with sleep
Dr Scott says the course encourages people to look at their sleep differently: less in terms of the number of hours they are getting, but how much of their time in bed is spent sleeping.
One of the key ingredients of CBT-I is sleep restriction therapy, which involves temporarily shortening the amount of time someone allow themselves to sleep.
"Many people believe they need eight uninterrupted hours every night, but most of us don't sleep that way, and don't need to.
This might involve waiting until midnight to go to bed and getting up at 6am on the dot the next morning.
While it sounds tough, it is an effective process, Dr Scott says. The brain learns to fill a smaller window of time with more continuous and better-quality sleep, and importantly, it results in less time spent in bed awake.
Once it has worked, you gradually give yourself a larger sleep window.
"People with insomnia often find themselves lying awake for hours, trying hard to fall asleep and becoming increasingly frustrated or anxious," Dr Scott says.
"We know that putting effort into falling sleep has the opposite effect. The course helps people shift how they think about this time, so it's no longer a battleground, but something they can respond to more calmly and constructively.
"Many people believe they need eight uninterrupted hours every night, but most of us don't sleep that way, and don't need to. We all wake up many times overnight.
"What matters more is how you respond to those wakeful moments. I think the course helps people feel less panicked and more in control."
Tips for a better night's sleep
- When trying to break the insomnia cycle, wait to go to bed until you feel sleepy, even if this is later than your normal bedtime.
- If you have noticed you have been awake for some time and you have become frustrated, don't lie in bed trying to go back to sleep. Get up and do something else.
- Get up at a regular time, even if you feel you have not slept enough the night before.
- Avoid sleeping in or napping during the day to try to make up for lost sleep.
- Make sure you get plenty of sunshine during the day, particularly first thing in the morning.
- If you are prone to worrying at night, try scheduling 'worry time' during the day or earlier in the evening, where you spend half an hour writing down everything that is worrying you to get it out of your head.
The Sleep Course is now available free of charge at MindSpot. MindSpot offers digital mental health assistance for a range of conditions, including depression, anxiety, OCD and chronic pain.
Dr Amelia Scott is a Macquarie University Research Fellow in the School of Psychological Sciences, and a member of the Macquarie University Lifespan Health and Wellbeing Research Centre.
