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Doctors David Reed and William Sacco

SomniSkills Workbook: A Do-It-Yourself Guide to Cognitive Behavioral Therapy for Insomnia (CBT-I)

"If you can’t sleep, then get up and do something instead of lying there worrying. It’s the worry that gets you, not the lack of sleep."
– Dale Carnegie

Carnegie’s quote taps into the heart of the matter – worry about sleep. The worry so many people know all too well. Lying in bed hoping and struggling to fall asleep. Sometimes it is more than worry. Sometimes it is panic. Panic due to feeling out of control. Panic about the dire consequences if you keep missing out on sleep.

This worry can pervade your waking hours. Even during the day, you can find yourself apprehensive about the possibility of another difficult night of sleep.

Unfortunately, telling yourself to stop worrying rarely works. Just reading Carnegie’s good advice will not magically turn a person into someone who no longer “worries” about sleep. If it were only that simple.

So, what to do? You could continue doing what you are doing. If so, you can probably expect about the same results. Or you can try something different. But what should you try?

We believe your best bet is to choose a treatment that is supported by high quality research. That research strongly points to Cognitive Behavioral Therapy for Insomnia (CBT-I). As you can read below, prestigious scientific and medical organizations judge CBT-I to be the treatment of choice for insomnia. Our recommendation is, therefore, that you should try CBT-I for sleep problems that cause distress or interfere with your life.

To give CBT-I a fair chance, it should be done properly. Optimally, you would be assisted by a licensed practitioner who is trained to administer CBT-I. Unfortunately, that may not be possible, which is the primary reason we wrote this book. The SomniSkills Workbook was written to mimic the treatment program that would be provided by a trained CBTI practitioner.

For the best outcome, it is best to follow the step-by-step instructions in the Workbook. We have worked hard to make those instructions easy to follow. But if you are not ready to commit to following all the instructions, you can benefit from simply reading the SomniSkills Workbook. It will give you an excellent idea of what CBT-I is all about. You will learn exactly what the experts are recommending. You are also bound to learn some useful information about sleep and how to cope with sleep problems.

  1. This book was written for anyone who wants to improve their sleep.  Don’t concern yourself with whether you meet the diagnostic criteria for “insomnia.”  For our purposes, the term “insomnia” refers to sleep problems that are upsetting or interfere with a person’s life.  If that describes your problem with sleep, then you are likely to benefit from the SomniSkills Workbook.
  2. We do not believe in a one-size-fits-all approach.  Everyone is different.  A variety of factors can contribute to sleep problems.  The causes of your sleep problems may not be the same as the causes of another person’s. The SomniSkills Workbook offers a tool called the “Formulator.”  The Formulator enables you to identify the factors contributing to your sleep problems.  Then you will be guided to create a personalized treatment plan to address those factors.
  3. You do not have to give up sleep medication to benefit from CBT-I.  Many people rely on sleep medication.  Many do not want to give up sleep medication until there is a better alternative.  You DO NOT have to give up sleep medication to benefit from learning the SomniSkills taught in this Workbook.  We devote an entire chapter to the use of sleep medication.
  4. The guiding principle of CBT-I is that you can control how well you sleep. Getting a good night’s sleep is not a mysterious, uncontrollable event.  You can do something about it!  It basically comes down to changing habits. The goal is to rid yourself of habits that interfere with a good night’s sleep, while developing habits that improve sleep.  We call the beneficial habits, SomniSkills. The steps to learning the SomniSkills are not difficult.  Anyone can do them.  It requires more than just reading an inspirational quote like Dale Carnegie’s.  But the benefits are available to those who persist.

“The American College of Physicians recommends that all adult patients receive cognitive behavioral therapy for insomnia (CBT-I) as the initial treatment for chronic insomnia disorder.”
Clinical Guideline for the Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline from the American College of Physicians. Annals of Internal Medicine, July 2016.

“Use of cognitive behavioral therapy for insomnia is recommended as the first-line treatment.”
Clinical Management of Insomnia Disorder. Journal of the American Medical Association, November 2017.

“Psychological and behavioral interventions are effective in the treatment of both chronic primary insomnia and secondary insomnia.”
Standards of Practice Committee of the American Academy of Sleep Medicine. Practice Parameters for the Psychological and Behavioral Treatment of Insomnia: An Update. An American Academy of Sleep Medicine Report, SLEEP, 2006.

“When these cognitive methods have been added to the behavioral methods to compose a cognitive-behavioral treatment package, it has been found to be as effective as prescription medications are for brief treatment of chronic insomnia. Moreover, there are indications that the beneficial effects of CBT, in contrast to those produced by medications, may last well beyond the termination of treatment.”
Manifestations and Management of Chronic Insomnia in Adults. National Institutes of Health, State of the Science Conference Statement June 13–15, 2005.

  • Step-by-step Approach: Throughout the book, the reader is given step-by-step instructions to accomplish each diagnostic and treatment goal.
  • User friendly: Each component of CBT-I is described using language that is simple, direct, and straightforward. The goal of this book is to “walk the reader through” all the steps necessary to learn each CBT-I skill.
  • The Formulator (Your Personal Guide): The Formulator is a 47-item checklist created by the authors. It is a unique part of the SomniSkills Program. No other insomnia treatment program offers anything like it. The Formulator accomplishes three objectives: It helps the reader identify the factors that may be contributing to their insomnia. It briefly explains how these factors could be maintaining their insomnia. It then directs the reader to specific instructions on how to correct each problem.
  • Personal SomniPlan: Based on Formulator responses, the reader develops a personalized treatment plan that is based on their unique sleep problems.
  • Sleep Medication Usage: An entire chapter is devoted to the use of sleep medicine while learning CBT-I.  Our approach, backed by research, is one of acceptance. People can continue to use sleep medication and still benefit from the SomniSkills Program.  For those interested, we present two approaches to reducing or stopping sleep meds.
  • Duration of the Sleep Episode: Duration of Sleep Episode is a term that we originated (Reed & Sacco, 2016). Sleep experts often use the term “Time in Bed” (TIB) to refer to the block of time during which a person is trying to sleep.  But many people spend “time in bed” doing things other than trying to sleep. They read, watch television, talk to their partners, etc. The concept of DSE is therefore a more precise description of amount of time people “try to sleep.”
  • Sleep Episode Rationing: Sleep Episode Rationing is our preferred term for what others have called Sleep Scheduling, Sleep Restriction Therapy, or Sleep Compression. Sleep Episode Rationing makes systematic adjustments to the sleep schedule. These adjustments are designed to strengthen the sleep drive and re-establish a healthy balance between sleep and wakefulness.
  • Levels of Sleep Restriction: This Workbook is the only one that incorporates three levels of Sleep Restriction Therapy (referred to in this book as Sleep Episode Rationing). Sleep Restriction Therapy is one of the most powerful components of CBT-I. However, a one-size-fits-all approach can be intimidating. Our approach includes a “very gradual” initiation of sleep restriction. The goal is to help readers become more comfortable using this powerful technique, rather than avoid it due to anxiety about loss of sleep. Step-by-step instructions walk the reader through this critical treatment component.
  • Concept of Sleep/Wake Balance: The concept of Sleep/Wake balance is incorporated throughout the book.  This helps the reader better understand the rationale for many of the techniques used with CBT-I.
  • Pep Talks: Throughout the book, we offer “pep talks” to help readers overcome various psychological obstacles to using CBT-I effectively.
  • Maintaining Gains and Staying Motivated: An entire chapter is devoted to addressing doubts, uneven progress, and loss of motivation.  Options for troubleshooting and making minor alterations to the SomniPlan are provided.
  • Text Boxes: Text Boxes appear throughout the book to provide additional insights and important notes that complement the chapter’s main material.
  • Readers have access to the website. This site has all SomniSkills forms and worksheets in a printable format.
  • People Wanting to Know More About CBT-I. CBT-I is mentioned in the popular press more and more these days. People with insomnia and their family members are curious. They want to learn more about it. The SomniSkills Workbook provides an easy-to-read, complete description of all aspects of CBT-I. With this knowledge, readers can decide whether CBT-I is what they want.  If so, they can use the SomniSkills Workbook to learn CBT-I on their own. Or they may decide to seek the help of a healthcare professional.
  • Anyone with Sleep Problems. Readers do not have to meet the formal diagnostic criteria for insomnia to benefit from the SomniSkills Workbook. Anyone who is troubled by sleep problems can benefit.
  • People Who Want to Work on Their Own. This book is designed to be a self-help manual.  People who want to work on their own or have no other treatment options can use the SomniSkills Workbook to learn the sleep skills taught by CBT-I. The SomniSkills Workbook provides step-by-step instructions.  It was written to “walk the reader” through the entire process of CBT-I.
  • General Mental Health Providers. Mental health providers are in excellent positions to deliver CBT-I to patients with insomnia. But all too often their patients suffer from a variety of psychological problems along with insomnia. Those other problems are often more severe and urgent. The provider is forced to delay or ignore sleep complaints to focus on more pressing issues. A viable alternative is to have clients use the SomniSkills Workbook in a self-help fashion.  The therapist can devote a short amount of time during each session to review progress and provide additional, but minimal, guidance as the patient proceeds with the SomniSkills Workbook. This treatment approach allows the therapist to tackle other psychological problems, but still address insomnia.
  • Providers of Group Administration of CBT-I. The SomniSkills Workbook provides an excellent resource for delivering CBT-I in a group format. The detailed, step-by-step approach allows providers to meet with participants in a group setting on a weekly or bi-weekly basis. During those meetings, providers can review one or two chapters of the SomniSkills Workbook, answer questions, and review progress as participants work primarily on their own. Research has demonstrated that group-administered CBT-I is quite effective. One variation on this treatment delivery model that has been used successfully involves interacting with participants electronically (by email) rather than face-to-face.
  • Students and Trainees Interested in Insomnia. Students in various health-related programs will find that reading the SomniSkills Workbook is an excellent way to learn exactly what CBT-I entails. Knowing the ins and outs of this highly effective intervention will provide an invaluable complement to academic articles on CBT-I.
  • Medical Providers Who See Patients with Insomnia. Most medical professionals know that CBT-I is the treatment of choice for insomnia. Few have time to administer CBT-I in a formal manner.  However, a full understanding of CBT-I and how it works is invaluable. The SomniSkills Workbook provides a technically accurate and comprehensive description of all aspects of CBT-I. Enhanced knowledge of CBT-I will enable medical providers to make more effective recommendations to their patients. They can also confidently recommend the SomniSkills Workbook to their patients.  Research supports the efficacy of manual-delivered CBT-I in primary care.
  • Sleep Centers. Sleep Centers can use the SomniSkills Workbook in the same ways described above for Medical Providers, General Mental Health Providers, and delivery of CBT-I in a group format. The SomniSkills Workbook can also be used as a tool to help train new employees who must learn how CBT-I is delivered.

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