Product Review

CBT-i Coach


 

References

Sleep. We love it, we need it, yet many of us don’t get enough of it. Nightmares, depression, posttraumatic stress disorder (PTSD), sleep apnea, medications, and a multitude of other factors can get in the way of falling asleep or staying asleep. So how can we get back in control of our own sleep patterns?

The VA National Center for PTSD, Stanford School of Medicine, and the DoD National Center for Telehealth and Technology collaborated to bring users the CBT-i (cognitive behavioral therapy for insomnia) Coach mobile app. Cognitive behavioral therapy is a nonmedication treatment that is based on scientific knowledge. The goals of CBT-i are “to help you fall asleep, stay asleep, and improve your daytime functioning as a result of better sleep at night.”

The CBT-i Coach is designed for patients engaged in CBT-i or who have experienced symptoms of insomnia and want to improve their sleep habits. Although the app is intended to augment face-to-face care with a health care professional, there are plenty of applications for users who are not enrolled in CBT-i and are not satisfied with the amount or quality of sleep they are getting.

SLEEP 101

Without knowing what or why sleep may need to be improved, it can be difficult to know what adjustments to make. To overcome a possible learning curve, users can navigate from the Learn option in the app menu to a section called “Sleep 101.” Here, the app lays out the fundamentals of sleep and why we need it, the stages of sleep and related brain-wave activity patterns, and what regulates our sleep and wakefulness.

The CBT-i approach is explained by its 2 parts: cognitive and behavioral aspects. The cognitive elements focus on “thoughts, feelings, and expectations about sleep and insomnia that may stand in the way of good sleep.” Behavioral aspects help people “adopt personal sleep habits that, based on the science of sleep, will help them sleep better.”

Important tips are provided in the “What is CBT-i,” section, including how dangerous it is to keep weapons within easy access of where an individual is sleeping and the important distinction between feeling sleepy and feeling tired. The app notes that sleepy refers to an actual need for sleep, whereas tired can mean that the person simply has low energy. Understanding this distinction, among many others, can aid us in determining when our bodies need sleep and how to enhance the process of falling asleep.

Also within the Learn menu is a section called “Habits and Sleep.” Here, users can scroll through a list of habits that may cause sleep issues and explore what they can do to make improvements. This list includes habits that might keep a person awake (exercise, worrying in bed, watching the clock, and napping), substances we might ingest that disrupt sleep (eating, caffeine, alcohol, and nicotine), and what can be done to improve sleep (winding down, limiting the bedroom to 2 activities, and getting comfortable).

TOOLS

“Create New Sleep Habits” is the first section within the Tools menu. Here, the app notes, “Incorporating new habits into your nighttime routine can help sleep come more easily.” Lists for middle of the night activities when you can’t sleep, setting up a proper sleep environment, and activities to keep you awake until your prescribed bedtime are all intended to lead to improved quality of sleep.

Within the second section, “Quiet Your Mind,” the app notes, “relaxation exercises are opportunities to help your body learn to relax.” The only list in this section is for winding down, making room in the menu for exercises and activities. Among these are perspective changes, which offer affirmations such as “I have been through many hard things in my life and survived” and “I will survive even if I don’t sleep at all tonight” in response to concerns over worrying about sleep and thinking about trauma; a breathing tool; a progressive muscle relaxation exercise; a 4-minute guided imagery exercise, available through forest, country road, or beach scenes; and 7 to 9 minute exercises for observing thoughts and sensations.

Another tool focuses on preventing insomnia, offering a self-administered quiz to determine personal areas that may need improvement. As the user grows more comfortable with the CBT-i Coach and uses it over a period of time, sleeping difficulties may still naturally return. The app reinforces “this is normal” and provides the quiz as a way for users to keep tabs on themselves and their habits to determine why their sleeping difficulties may have returned.

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