Cognitive Behavioral Therapy for Pain-Related Sleep Problems

Poor sleep and chronic pain often go hand-in-hand.  Millions of patients who live with fibromyalgia, arthritis, migraines, and other painful conditions have trouble falling or staying asleep because of their symptoms. The more sleep they lose, the more stressed and exhausted they feel and the more pain they experience.  Some patients count sheep and hope sleep will eventually come. Others use over-the-counter or prescription medication to battle their insomnia. But could cognitive behavioral therapy (CBT) be a better option? Could CBT solve your really pain-related sleep problems?

Why is Quality Sleep So Important for Pain Patients?

Sleep is particularly important for patients with challenging health conditions like chronic pain. Deep tissue repair and cell recovery only occur with good quality, deep sleep.  Many patients struggle to find the best sleep solution.  They worry about using too much medication and side effects and then drag through their days feeling painful, groggy, and anxious.  A study presented in the Journal of Clinical Sleep Medicine says that cognitive behavioral therapy techniques specifically targeting sleep can improve sleep and lead to improvement in co-existing medical illnesses.  It's a win-win situation since improving sleep also improves their overall health.

What is Cognitive Behavioral Therapy

The National Association of Cognitive Behavioral Therapists defines CBT as a form of psychotherapy that emphasizes the important role of thinking in how we feel and what we do.  CBT isn't one specific technique.  It's a general term for a classification of therapies based on the idea that our thoughts cause our feelings and behaviors, not external things, like people, situations, and events.  If we change the way we think, we'll feel and act better even if the situation does not change. 

How Does Cognitive Behavioral Therapy Work?

The cognitive part of CBT teaches you to recognize and change beliefs that affect your ability to sleep. The behavioral aspect helps you develop good sleep habits and avoid behaviors that keep you from sleeping well.

CBT for insomnia may include one or more of the following techniques:

  • Sleep education to understand sleep cycles, beliefs and behaviors affecting sleep. 
  • Cognitive control and psychotherapy to control negative thoughts.
  • Sleep restriction to limit non-sleep activities in bed and the amount of time spent awake in bed. 
  • Remaining passively awake means avoiding any effort to fall asleep. Worrying about sleep keeps you awake and eliminating worry helps you sleep.
  • Stimulus control therapy to remove factors that condition the mind to resist sleep, for example leaving the bedroom if you can't sleep.
  • Sleep hygiene involves changing basic habits that influence sleep, such as eliminating napping, smoking, alcohol and caffeine consumption, getting regular exercise, maintaining regular sleep and wake schedules, and using the bed only for sleep and sex.
  • Relaxation training techniques like meditation, hypnosis and muscle relaxation to calm the mind and body.
  • Biofeedback to observe biological signs such as heart rate and muscle tension.
  • Sleep diary to journal when you go to bed and wake up, how much time you spend unable to sleep, total sleep time and other details about your sleep patterns.

Multiple studies indicate that CBT not only works for many patients, but its effects are long lasting.  Once a patient learns CBT techniques, they're able to replicate them if sleep problems arise again.  Studies show that better quality sleep is associated with decreased pain levels.  Ask your physician to refer you to a sleep medicine specialist or search online for cognitive behavioral therapists in your area.


Journal of Clinical Sleep Medicine

Cognitive Behavioral Therapy for Insomnia Improves Sleep and Decreases Pain in Older Adults with Co-Morbid Insomnia and Osteoarthritis

Michael V. Vitiello, Ph.D.1; Bruce Rybarczyk, Ph.D.2; Michael Von Korff, Ph.D.3; Edward J. Stepanski, Ph.D.4

National Association for Cognitive Behavioral Therapy

Journal of Behavioral Medicine

Volume 25, Number 2, 135-153, DOI: 10.1023/A:1014832720903

April 2002

Clinical Significance and Predictors of Treatment Response to Cognitive-Behavior Therapy for Insomnia Secondary to Chronic Pain

Shawn R. Currie, Keith G. Wilson and Dorothyann Curran