Improving Sleep during Perimenopause with Tools from Cognitive Behavioral Therapy
During perimenopause, fluctuations in estrogen and progesterone can cause multiple symptoms that can disrupt sleep such as hot flashes, night sweats, and insomnia. Cognitive behavioral therapy or CBT is a promising tool that can help to address these symptoms
What is Cognitive behavioral therapy or CBT?
CBT is a form of psychological treatment that is based on taking steps to change thinking patterns (American Psychological Association, 2017). CBT is based on the principle that psychological problems are based, at least in part, on unhelpful ways of thinking that inform unhelpful ways of living or behaviors (APA, 2017). Therefore, those with psychological problems can learn to cope better which will help to relieve their symptoms and help them to live better lives (APA, 2017). CBT has been shown to be as effective as or more effective than traditional therapy and even psychiatric medications for a variety of problems such as depression, anxiety disorders, and sleep disorders (APA, 2017).
CBT-I is cognitive behavioral therapy specifically for insomnia, a symptom that some women experience during perimenopause (Newsom & Dimitriu, 2024). CBT-I is recommended by the American College of Physicians as the first line of treatment for insomnia (Qaseem et al., 2016).
CBT-I is provided by doctors, therapists, counselors, and psychiatrists that are trained in this specific type of CBT. You can find practitioners with experience in CBT-I through the Society of Behavioral Sleep Medicine or the American Board of Sleep Medicine (Newsom & Dimitriu, 2024). However, there may not be a certified practitioner in your area. Taking techniques from CBT-I can help you to confront your thoughts and unhelpful habits related to sleep.
Applying CBT-I Techniques
Cognitive Restructuring: This technique involves challenging negative thoughts relating to sleep and replacing them with more realistic statements (Newsom & Dimitriu, 2024). An example of a negative and unrealistic thought is: “I’ll never be able to fall asleep”. This thought could be changed to: “It might take a while to fall asleep tonight, but I have tools in my toolbox to help me fall asleep eventually”. Writing down your negative thoughts and reframed realistic thoughts in a journal or sleep diary can help you to keep track of what is working.
Stimulus Control: This technique involves limiting the time spent in bed for sleep and sex. In some people with insomnia, they can begin to dread going to bed and begin to associate the bed with feelings of frustration (Newsom & Dimitriu, 2024). Those using stimulus control therapy should get out of bed if they are having difficulty falling asleep and should limit the amount of time they spend in bed before falling asleep doing activities like reading, watching TV, or scrolling on their phones (Newsom & Dimitriu, 2024). By limiting the time spent in bed for activities other than sleep and sex, you can begin to associate your bed and bedtime with positive thoughts (Newsom & Dimitriu, 2024).
Relaxation techniques: Implementing techniques such as breathing exercises, progressive muscle relaxation (PMR) and meditation can help to calm and relax you before bed, helping to create positive behaviors prior to bedtime (Newsom & Dimitriu, 2024). A CBT-I practitioner can lead you through these activities, but there are also many online resources and guides to practicing relaxation.
If you are experiencing sleep disturbances in perimenopause that are impacting your quality of life, consider speaking with your healthcare provider or a sleep specialist to determine if CBT-I is right for you or if there might be another underlying condition disrupting your sleep.
Disclaimer: At It’sFetch.co we strive to provide valuable and reliable health information through our blog. We believe in empowering individuals to make informed decisions about their health and well-being. However, it is important to understand that the content on our blog is not intended to replace the advice, diagnosis, or treatment provided by a qualified medical professional.
References
American Psychological Association. (2017). What is cognitive behavioral therapy?. American Psychological Association. https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral
Newsom, R., & Dimitriu , A. (2024, January 16). Cognitive behavioral therapy for insomnia (CBT-I): An overview. Sleep Foundation. https://www.sleepfoundation.org/insomnia/treatment/cognitive-behavioral-therapy-insomnia#references-79690
Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., Denberg, T. D., & Clinical Guidelines Committee of the American College of Physicians*. (2016). Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Annals of internal medicine, 165(2), 125-133.