#341 - Overcoming insomnia: improving sleep hygiene and treating disordered sleep with cognitive behavioral therapy for insomnia | Ashley Mason, Ph.D.
Mar 24, 2025
auto_awesome
In this discussion, Dr. Ashley Mason, a clinical psychologist and UCSF associate professor, shares her expertise on cognitive behavioral therapy for insomnia. She breaks down effective techniques like time in bed restriction and managing racing thoughts. Listeners learn about the significance of sleep hygiene, optimal temperatures, and the influence of blue light on sleep. Dr. Mason also highlights how mindfulness can support sleep treatment and introduces innovative uses of AI in personalized sleep therapy. It's a treasure trove of insights for better sleep!
Cognitive Behavioral Therapy for Insomnia (CBT-I) utilizes structured techniques like time in bed restriction and cognitive restructuring to effectively manage disordered sleep.
Understanding insomnia as a clinical diagnosis rather than occasional sleeplessness is important for identifying effective treatment strategies.
Environmental factors, such as temperature regulation and appropriate bedding, play a crucial role in promoting better sleep and combating insomnia.
Key sleep hygiene practices, including avoiding blue light exposure and maintaining a consistent sleep schedule, significantly improve sleep quality and reduce insomnia symptoms.
Tracking sleep patterns through diaries and progress monitoring helps individuals identify effective strategies for improving their sleep and managing insomnia.
Deep dives
Translating Longevity Science
The podcast emphasizes the aim to make the science of longevity easily accessible for everyone. It stresses the importance of providing high-quality health and wellness content without reliance on paid advertisements, making membership support crucial for maintaining this business model. Exclusive content and benefits are offered to subscribers, ensuring that they receive value beyond the subscription fee. This approach helps foster a community that values informed knowledge in health management.
Overview of Cognitive Behavioral Therapy for Insomnia (CBTI)
Cognitive Behavioral Therapy for Insomnia (CBTI) is a non-pharmacological intervention that combines behavioral techniques like time in bed restriction and cognitive strategies such as cognitive restructuring. The podcast highlights CBTI’s structured methods for managing insomnia, including controlling sleep environments and stimulus control to improve sleep onset and maintenance. Managing racing thoughts through techniques like scheduled worry time is also discussed, showcasing CBTI's comprehensive approach to overcoming insomnia. This holistic treatment integrates both cognitive and behavioral elements to create a manageable sleep routine.
Understanding Insomnia Diagnosis
Insomnia is defined as a clinical diagnosis rather than an occasional sleepless night, requiring persistent issues that impact daily life and last longer than three months for it to be identified. This distinction is crucial because many individuals experience sleepless nights without meeting the diagnostic criteria, thus avoiding unnecessary alarm. The episode identifies a broad prevalence of insomnia, suggesting that a significant percentage of adults may encounter this issue at some point in their lives. Recognizing the difference between temporary sleeplessness and chronic insomnia is essential for effective treatment.
The Role of Temperature in Sleep
Temperature regulation is identified as a critical factor in achieving effective sleep onset, with discussions on body temperature's natural circadian rhythm. The podcast explains the significance of warming extremities, as well as creating optimal sleeping environments to promote better sleep. Specific strategies, such as ensuring warm hands and feet before sleep, are highlighted, alongside the negative effects of overheating due to improper bedding like down comforters. This insight emphasizes the importance of managing environmental factors to address insomnia effectively.
Sleep Hygiene Fundamentals
Key sleep hygiene practices are explored, including the impact of blue light exposure from screens, the importance of regular bedtime routines, and mindful consumption of substances such as food and alcohol before sleep. The podcast stresses that individuals should aim to avoid food and alcohol intake within three hours of bedtime to enhance sleep quality. Simple yet effective strategies like maintaining a regular sleep schedule and minimizing late-night screen time are highlighted as foundational steps to improve overall sleep health. These basic guidelines can lead to substantial improvements in sleep hygiene and reduce insomnia symptoms.
Tracking Sleep Progress
The episode provides practical advice on using sleep diaries and progress tracking tools to monitor nightly sleep patterns and identify effective interventions. By logging sleep quality and duration, individuals can better understand their unique circumstances and refine their approach to improving sleep. The utilization of A-B testing on different sleep strategies allows users to discover what works best for them. This systematic tracking is presented as an effective method to combat insomnia and achieve better sleep outcomes.
The Influence of Medications on Sleep
The podcast discusses the common usage of various medications for insomnia management, including the negative effects of benzodiazepines and prescribed sleep aids. It highlights the challenge of finding a balance between addressing acute insomnia symptoms through pharmacological means and the potential for long-term dependency or undesired side effects. Recommendations about tapering off medications while integrating CBTI principles to foster better sleep hygiene are shared. This allows for a more sustainable approach to sleep health, reducing reliance on drugs over time.
Importance of Consistent Wake Times
A crucial takeaway from the podcast is that maintaining consistent wake times is more effective than rigidly adhering to bedtime schedules. By waking at the same time daily, individuals can better align their sleep-wake cycles and promote deeper, more restorative sleep. The podcast suggests that social jet lag, caused by varying sleep schedules on weekends, should be minimized to optimize sleep health. Understanding the body’s natural rhythms can contribute significantly to improving sleep quality and mitigating insomnia.
Balancing Exercise and Sleep
The relationship between exercise and sleep is explored, with the understanding that while physical activity is important, its timing can impact sleep quality. For some, exercising close to bedtime may be stimulating and hinder sleep onset, while for others, it could serve as a helpful de-stressor. Specific exercises, like yoga or light stretching in the evening, may be less disruptive and still beneficial for sleep. Finding the right balance and timing of exercise in relation to sleep schedules is key to improving overall sleep quality.
Ashley Mason is a clinical psychologist and an associate professor at UCSF, where she leads the Sleep, Eating, and Affect (SEA) Laboratory. In this episode, Ashley provides a masterclass on cognitive behavioral therapy for insomnia (CBT-I), detailing techniques like time in bed restriction, stimulus control, and cognitive restructuring to improve sleep. She explains how to manage racing thoughts and anxiety, optimize sleep environments, and use practical tools like sleep diaries to track progress. She also offers detailed guidance on sleep hygiene; explores the impact of temperature regulation, blue light exposure, and bedtime routines; and offers guidance on finding a CBT-I therapist, along with sharing practical steps you can take on your own before seeking professional help.
We discuss:
Defining insomnia: diagnosis, prevalence, and misconceptions [3:00];
How insomnia develops, and breaking the cycle with cognitive behavioral therapy for insomnia (CBT-I) [7:45];
The different types of insomnia, and the impact of anxiety, hydration, temperature, and more on sleep [11:45];
The core principles of cognitive behavioral therapy (CBT) and how CBT-I is used to treat insomnia [20:00];
Implementing CBT-I: time in bed restriction, sleep scheduling, and the effect of napping [29:45];
Navigating family and partner sleep schedules, falling asleep on the couch, sleep chronotypes, and more [39:45];
Key aspects of sleep hygiene: temperature, light exposure, and circadian rhythm disruptions [44:45];
Blue light and mental stimulation before bed, and the utility of A-B testing sleep habits [52:45];
Other simple interventions that may improve sleep [57:30];
Ashley’s view on relaxation techniques and mindfulness-based practices [1:02:30];
The effectiveness of CBT-I, the role of sleep trackers, and best practices for managing nighttime awakenings [1:04:15];
Guidance on intake of food and alcohol for good sleep [1:16:30];
Reframing thoughts and nighttime anxiety to reduce sleep disruptions [1:18:45];
Ashley’s take on sleep supplements like melatonin [1:21:45];
How to safely taper off sleep medications like benzos and Ambien [1:26:00];
Sleep problems that need to be addressed before CBT-I can be implemented [1:38:30];
The importance of prioritizing a consistent wake-up time over a fixed bedtime for better sleep regulation [1:40:15];
Process S and Process C: the science of sleep pressure and circadian rhythms [1:45:15];
How exercise too close to bedtime may impact sleep [1:47:45];
The structure and variability of CBT-I, Ashley’s approach, and tips for finding a therapist [1:50:30];
The effect of sauna and cold plunge before bed on sleep quality [1:56:00];
Key takeaways on CBT-I, and why no one should have to suffer from insomnia [1:58:15]; and
