OCD and Cognitive Behavioral Therapy for Insomnia (CBT-I)

by stuart miles freedigitalphotos.net

by stuart miles freedigitalphotos.net

Sleep is often a big issue for those with obsessive-compulsive disorder. In fact, in over five-and-a-half years of blogging, my most viewed post, by far, is OCD and Sleep.

OCD has the potential to complicate anything, and sleeping is no exception. While most of us, with and without OCD, can relate to bouts of insomnia, sometimes issues with sleep can be directly related to obsessive-compulsive disorder.

For example, someone with OCD might be terrified of sleeping because they are convinced they will die in their sleep. So they force themselves to stay awake. Or perhaps there is an obsession directly related to one’s bed or bedroom. When my son Dan’s OCD was severe and he was away at college, he was not able to touch his mattress and therefore couldn’t sleep on his bed. To this day, I don’t know where, how, or if, he slept at night.

If sleep issues are indeed directly related to OCD, then exposure and response prevention (ERP) therapy, the Cognitive Behavioral Therapy (CBT) used to treat OCD, can definitely help.

However, if someone with OCD has sleep problems that are not directly related to their disorder, then ERP is not the way to go; CBT-I is.

Cognitive Behavioral Therapy for Insomnia (CBT-I) , like other forms of CBT, addresses your thoughts and beliefs (which might be flawed), and helps you appropriately change your behavior. Some areas that CBT-I  specifically focuses on include what to do when you can’t sleep, what you do while you’re in bed, sleep restriction, and changing how you think about sleep. After learning about CBT-I many people are surprised that what they’ve done in the past to try to help themselves sleep might actually have made things worse. For example, “sleeping in” to try to catch up on sleep is not generally beneficial, but getting up at the same time every morning is.

Not surprisingly, when we sleep better, we feel better. Any of us who has experienced chronic insomnia knows how sleep deprivation can exacerbate other medical conditions we might be dealing with. OCD is no exception, and I have heard from so many people who state their OCD flares up when they are very tired.

According to Michael Perlis, Ph.D., an associate professor of psychiatry and director of the behavioral sleep medicine program at the University of Pennsylvania School of Medicine, “…treating insomnia concurrently with comorbid psychiatric disorders not only will improve sleep, but also may have a halo effect on those disorders.”

So a by-product of a good night’s sleep just might be milder OCD.

A discussion of sleep and OCD wouldn’t be complete without addressing the fact that some medications commonly used by those with OCD (such as SSRIs) might cause sleep problems. These might be remedied by simply changing the timing of when the medications are taken, or perhaps a change in medication is warranted. This issue,of course, should be discussed with your health-care providers.

For those who battle obsessive-compulsive disorder (indeed for all of us) a healthy lifestyle can result in many benefits. And an important component of a healthy lifestyle is a good night’s sleep. If you suffer from insomnia not directly related to OCD, I highly recommend looking into CBT-I.

Sweet Dreams!


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7 Responses to OCD and Cognitive Behavioral Therapy for Insomnia (CBT-I)

  1. sethgillihan says:

    Great post, Janet! I actually did some training and work with Dr. Perlis (I’m fortunate that he’s right here at Penn–actually on the same floor of the building where I used to work!) when I realized how many of the people I was treating for other things also struggled with insomnia. I now provide CBT-I and have been amazed at how quickly and effectively it can help with insomnia. I’ve even recommended it for family members who have found it really beneficial. It reminds me of ERP for OCD and the best CBT treatments for other issues–when we provide the right conditions, the mind and body are able to heal. Keep up the great work!

  2. I agree with Seth. Great post! I’ve noticed similar to him that a number of people I treat struggle with insomnia. Yup! Many of the things they do to deal with the insomnia make it worse. I’ve been reading a lot about CBT-I through professional organizations I’m involved with. Would love to get additional training in it! Thanks for your tireless work and contributions, Janet!

  3. Lenny Estrin says:

    Many a time when I do treatment of my patient they have similar problems. Sleep is very important for everyone, if sleep not taken problem then early in morning head pain, body pain like this symptoms can occurs.

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