Hi, thanks for this. I am personally very enthusiastic about CBT-i as it worked for me and has done for a couple of friends and the evidence seems to be reasonably good. One of the attractions of CBT-i for me was that you I don’t really think you need a trained therapist or an app, you can just follow instructions in a book about sleep hygiene and sleep restriction. I did use an online course, but I don’t think it was really necessary. The instructions are quite straightforward -
have a set waking up time. Spend the time in bed that you wish to spend sleeping (e.g. 7 hours) and then taper down time in bed by a half an hour each week until you reach the time you actually spend sleeping (e.g. 4 hours) and then ramp back up half an hour a week once the association between bed and stress is broken. If you can’t sleep for an hour get out of bed.
Sleep hygiene also seems quite straightforward—cut out caffeine, booze and nicotine, dim the lights, don’t look at your phone for tv two hours before bed, exercise. Just use bed for sex and sleep—don’t read in bed.
I think you could just get this by reading the second half of Colin Espie’s short book Overcoming Insomnia. Given this, what value do you think an app adds?
My favoured EA insomnia solution would be to publicise the Espie book far and wide and to get doctors to do what is required by their guidelines and recommend CBT-i, rather than just prescribing sleeping pills.
This feels more like something that could be conveyed on 1 side of A4. Could someone create a webpage with the evidence on CBT-i and instructions on how to do it?
Thanks for your reply! I agree, CBT-i is super promising and I’m all about finding effective ways to spread it.
Almost got confused as to which Overcoming Insomnia book before I added the author title—first result is a $50 therapist manual lol.
I think it’s possible to treat yourself this way if you’re decently analytical (as I suspect most visitors in this forum to be), but quite difficult to stick to otherwise. E.g. I can’t really imagine telling my aunt with insomnia to read the book and apply the techniques to herself, both from a comprehension perspective and a habit maintenance perspective. It’s kinda similar to how there’s a lot of high-quality books out there on fitness, but classes or personal trainers provide more value to most people.
Regarding the CBT-i guidelines, different techniques are more or less useful in different circumstances. For instance, what you describe in the first bullet point is known as Sleep Compression Therapy—a useful technique, but it takes longer and has less empirical support than Sleep Restriction Therapy (SRT, where you immediately restrict time in bed based on a baseline of time sleeping). The slower Compression edition is helpful in cases where patients have trouble with the sudden schedule shift, so it’s quite useful, but not always ideal.
Similarly, sleep hygiene education is actually significantly less impactful than other core CBT-i techniques such as Stimulus Control Therapy (SCT), which is all about turning the bedroom into a strong environmental trigger for sleep. And sometimes the above doesn’t click without additional help from relaxation training (usually Progressive Muscle Relaxation) or some cognitive interventions (such as Paradoxical Intention Therapy).
It looks like Espie addresses much of these in his book, which is great, but it’s harder to distill into core techniques. If one did distill into core techniques, sleep hygiene probably wouldn’t be mentioned due to that being the first advice anyone with insomnia gets. The sleep therapists I’ve talked to usually emphasize SRT, SCT, and relaxation training where necessary (covering other bases like hygiene over time).
tl;dr: There are many potentially helpful techniques and a lot of information to consider, but it’s cognitively demanding to do so and manage your own treatment. The app will take away that cognitive strain by customizing treatment and offering behavioral support along the way, so the user only sees the information they need and can reach out for support when necessary. We’ve all seen research on how much convenience affects behavior—I want to take this therapy and make it extremely convenient, thus improving treatment outcomes and reaching a larger audience.
Does that make sense / illustrate the value I think the app provides?
(am definitely on board with convincing more doctors to push CBT-i instead of sleeping pills—the book would be a far better option than the pills (though with more cognitive effort required)).
Hi, thanks for this. I am personally very enthusiastic about CBT-i as it worked for me and has done for a couple of friends and the evidence seems to be reasonably good. One of the attractions of CBT-i for me was that you I don’t really think you need a trained therapist or an app, you can just follow instructions in a book about sleep hygiene and sleep restriction. I did use an online course, but I don’t think it was really necessary. The instructions are quite straightforward -
have a set waking up time. Spend the time in bed that you wish to spend sleeping (e.g. 7 hours) and then taper down time in bed by a half an hour each week until you reach the time you actually spend sleeping (e.g. 4 hours) and then ramp back up half an hour a week once the association between bed and stress is broken. If you can’t sleep for an hour get out of bed.
Sleep hygiene also seems quite straightforward—cut out caffeine, booze and nicotine, dim the lights, don’t look at your phone for tv two hours before bed, exercise. Just use bed for sex and sleep—don’t read in bed.
I think you could just get this by reading the second half of Colin Espie’s short book Overcoming Insomnia. Given this, what value do you think an app adds?
My favoured EA insomnia solution would be to publicise the Espie book far and wide and to get doctors to do what is required by their guidelines and recommend CBT-i, rather than just prescribing sleeping pills.
Perhaps an app is an efficient way to popularize the ideas from the book? Many people don’t commonly read non-fiction.
This feels more like something that could be conveyed on 1 side of A4. Could someone create a webpage with the evidence on CBT-i and instructions on how to do it?
I think this is a good start! https://effectivealtruismcoaching.com/blog/2019/10/24/lu1xjfsg8i9rzkatmnqgh2r9ykb0r1
Interesting, makes sense! I like that suggestion.
Thanks for your reply! I agree, CBT-i is super promising and I’m all about finding effective ways to spread it.
Almost got confused as to which Overcoming Insomnia book before I added the author title—first result is a $50 therapist manual lol.
I think it’s possible to treat yourself this way if you’re decently analytical (as I suspect most visitors in this forum to be), but quite difficult to stick to otherwise. E.g. I can’t really imagine telling my aunt with insomnia to read the book and apply the techniques to herself, both from a comprehension perspective and a habit maintenance perspective. It’s kinda similar to how there’s a lot of high-quality books out there on fitness, but classes or personal trainers provide more value to most people.
Regarding the CBT-i guidelines, different techniques are more or less useful in different circumstances. For instance, what you describe in the first bullet point is known as Sleep Compression Therapy—a useful technique, but it takes longer and has less empirical support than Sleep Restriction Therapy (SRT, where you immediately restrict time in bed based on a baseline of time sleeping). The slower Compression edition is helpful in cases where patients have trouble with the sudden schedule shift, so it’s quite useful, but not always ideal.
Similarly, sleep hygiene education is actually significantly less impactful than other core CBT-i techniques such as Stimulus Control Therapy (SCT), which is all about turning the bedroom into a strong environmental trigger for sleep. And sometimes the above doesn’t click without additional help from relaxation training (usually Progressive Muscle Relaxation) or some cognitive interventions (such as Paradoxical Intention Therapy).
It looks like Espie addresses much of these in his book, which is great, but it’s harder to distill into core techniques. If one did distill into core techniques, sleep hygiene probably wouldn’t be mentioned due to that being the first advice anyone with insomnia gets. The sleep therapists I’ve talked to usually emphasize SRT, SCT, and relaxation training where necessary (covering other bases like hygiene over time).
tl;dr: There are many potentially helpful techniques and a lot of information to consider, but it’s cognitively demanding to do so and manage your own treatment. The app will take away that cognitive strain by customizing treatment and offering behavioral support along the way, so the user only sees the information they need and can reach out for support when necessary. We’ve all seen research on how much convenience affects behavior—I want to take this therapy and make it extremely convenient, thus improving treatment outcomes and reaching a larger audience.
Does that make sense / illustrate the value I think the app provides?
(am definitely on board with convincing more doctors to push CBT-i instead of sleeping pills—the book would be a far better option than the pills (though with more cognitive effort required)).