Most people with long-running insomnia have tried sleep hygiene, found it did very little, and concluded that nothing works. Sleep hygiene is one component of the actual treatment, and on its own it is the weakest one.
What CBT-I is
Cognitive behavioural therapy for insomnia is the first-line treatment for chronic insomnia internationally, ahead of medication. SingHealth describes it as five components:
- Cognitive therapy, which targets the beliefs about sleep that generate the arousal that prevents it. The fear of not sleeping is a substantial part of not sleeping.
- Sleep hygiene, the familiar part: light, caffeine, screens, routine.
- Relaxation techniques.
- Sleep restriction, which deliberately compresses time in bed to rebuild sleep pressure. It is counterintuitive, it is uncomfortable for the first week or two, and it is usually the component doing the work.
- Stimulus control, which re-associates the bed with sleeping rather than with lying awake, chiefly by getting you out of it when you are not asleep.
It is typically delivered over a handful of sessions with a sleep diary between them. It is structured and time-limited, not open-ended.
Where it is available
Five public hospitals run dedicated sleep services: Singapore General Hospital, National University Hospital, Ng Teng Fong General Hospital, Changi General Hospital and Sengkang General Hospital. SGH describes its Sleep Centre as the largest in Singapore.
SingHealth lists CBT-I as available at Singapore General Hospital, Changi General Hospital and Sengkang General Hospital, and National University Hospital states insomnia is best treated with cognitive behavioural therapy, medication, or both.
When it is worth pursuing
The usual threshold for chronic insomnia is difficulty falling or staying asleep on three or more nights a week, for three months or more, with daytime consequences. That is a reasonable point to raise it with a GP.
A different problem, and one to have assessed rather than managed at home: loud snoring with pauses in breathing, or falling asleep during the day despite adequate time in bed. That points at obstructive sleep apnoea, which the same sleep services investigate.
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