The premise for cognitive therapy is that a patient’s negative thoughts and emotions about their sleep disorder are incompatible with sleep, and therefore addressing these dysfunctional cognitive processes may help to promote sleep. Cognitive therapy first identifies the dysfunctional thoughts, attitudes or expectations. For example, a patient may have unrealistic expectations that they must sleep 8 hours a night, or worry that they will fail in their day’s activities if they have had a bad night’s sleep. During cognitive therapy, the physician will correct any misconceptions, and help the patient to adapt any counterproductive thoughts and attitudes into less harmful substitutes.1
One specific form of cognitive therapy is paradoxical intention, in which the physician convinces the patient to face their anxiety, e.g., by telling them to stay awake and not sleep. The aim of this technique is to reduce performance anxiety (i.e., worrying about trying to sleep), and promote relaxation and sleep.2
References:
1. Szuba MP, Kloss JD, Dinges DF (Eds). Insomnia. Principles and management. © Cambridge University Press, 2003.
2. Nau SD, Lichstein KL. Insomnia: causes and treatments. In: Carney PR, Berry RB, Geyer JD, eds. Clinical Sleep Disorders. © Lippincott Williams & Wilkins, Philadelphia, USA, 2005: 157–190.