CBT-I Session 6 Summary

CBT-I 6

This is a summary of the module CBT-I 6 for your reference.

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Did you know that some people with insomnia have an increase in brain activity?

__ Yes

__ No

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Do you feel as though you have an overactive mind?

__ Yes

__ No

__ Sometimes

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What kind of thoughts do you have when you are trying to sleep?

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Does your mind become consumed by any of the following as you're trying to fall asleep?

__ Thoughts related to planning your day

__ Thoughts about the past day

__ Stream of random thoughts (neutral emotions)

__ Negative thoughts (associated with sadness, frustration, worry)

__ None of the above

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An Overactive Mind

An overactive mind creates a state of hyperarousal, which makes it harder to fall asleep. Let's discuss some strategies to quiet your overactive mind.

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Leaving the Bedroom

When your mind is overactive and you are unable to fall asleep, leave your bedroom immediately.

Remember, pairing active thinking with your bed leads to conditioned arousal. You may need to leave the bedroom multiple times before you are truly able to shut off these thoughts. This practice may be challenging, but stick with it.

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Coping Self-statements 

These are calming, meaningful statements that you say to yourself when unhelpful thoughts keep you awake.

Here are some examples.

  • I am proud of myself for today. Tomorrow will be even better.

  • My mind and my body are resting, even if I'm not asleep just yet.

  • I have a great day planned, so I’ll get up right now.

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Counting Sheep 

When you get thoughts stuck in your mind, you may try to suppress your thoughts. The opposite often happens - the unwanted thoughts persist and you're awake in bed longer.

When this happens, try leaving the bedroom or replacing your thoughts. Counting sheep (or other thoughts you choose) takes up space and distracts you from thoughts that are keeping you awake. 

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Mental Wind-down 

​​You may be active until the moment you get into bed. It is not surprising, then, that thoughts of the activities stay with you at bedtime.

Create a period of time (general rule of thumb: at least an hour) before bed that allows you to shift from the demands of the day.

You might journal, meditate, take a walk, or take a shower. 

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Constructive Worrying

The least fitting place for you to worry is in bed.

Worrying is an adaptive attempt at problem-solving. But, worrying about things that are out of your control increases anxiety, interfering with sleep.

Set aside a time to think about your worries in the early evening, approximately 2 hours before bedtime. 

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Anxiety Management 

Constructive worrying may not work for you, especially when your thoughts promote strong negative emotions.

To help cope with the anxiety, we suggest you engage in relaxation techniques (upcoming lesson). Practice these techniques and select the ones that work best for you. Use them as part of your routine before going to bed.

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Select the strategies you have already tried.

__ Leaving the bedroom

__ Coping self-statements

__ Counting sheep

__ Mental wind-down

__ Constructive worrying

__ Relaxation techniques

__ None of the above

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Relaxation Techniques

Relaxation techniques can also help you quiet your overactive mind. In this section, we will learn about some common relaxation techniques.

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Breathing Exercises

Breathing exercises help reduce tension and relieve stress.

When you’re stressed, you tend to have short, shallow, irregular chest breaths, or, you might even hold your breath. Your heart rate and blood pressure are elevated.

Breathing exercises engage your mind and calm your nervous system. This results in a decrease in heart rate and blood pressure, as well as an overall sense of calm.

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Progressive Muscle Relaxation (PMR)

PMR is a deep relaxation technique effectively used to control stress and relieve insomnia.

While inhaling, contract one muscle group (for example your upper thighs) for 5 to 10 seconds, then exhale and suddenly release the tension in that muscle group. Give yourself 10 to 20 seconds to relax, then move to the next muscle group. Gradually work your way up the body.

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Guided Imagery Meditation

This is a relaxation and stress-lowering technique in which you practice relaxation and focus on pleasant or neutral mental images.

The process of focusing on pleasant images can make you feel happier. It is often done by following an audio or video program that leads you through the steps.

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Body Scan Meditation

This involves paying attention to parts of the body and bodily sensations or discomfort in a gradual sequence starting from your feet and eventually getting to your head.

The goal is not to relieve discomfort, but to get to know it and learn from it, so you can better manage it. When performed daily, it is associated with stress reduction and many other mental and physical health benefits. 

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Which relaxation technique will you try before bed today?

__ Breathing exercises

__ Progressive muscle relaxation (PMR)

__ Guided imagery meditation

__ Body scan meditation

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What did you notice as you practiced the relaxation technique?

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Relaxation Tips

It’s not uncommon to find it difficult to relax at the start. Below are some helpful tips.

  • Recognizing tension is the first step in the relaxation process.

  • Relaxation does not eliminate tension, it reduces it.

  • Be aware of your critical thoughts while engaging in relaxation.

  • Losing focus is normal. Just bring your focus back to your relaxation practice.