Use Cognitive Behavioral Therapy To Get Over Insomnia Caused By Back Pain 

You can put an end to sleepless nights caused by your back pain by changing how you think about sleep and pain. 

cognitive behavioral therapy for insomnia

​Do you regularly find yourself staring at the ceiling in the middle of the night when all you want to do is be able to sleep? 

If you do then this is bad news. ​

Because getting a good night's sleep is crucial for both your physical and mental health and well-being. 

However it can remain elusive for people with chronic pain.​ 

For instance one study of people with chronic lower back pain found that a whopping 78% of them said they were suffering from some kind of sleep disorder. 

So there's a good chance you'll understand what I'm talking about here! 

However it doesn't have to be this way. ​

Because there are many ways you can get over your sleep disorder such as:

  • Working to reduce your pain levels during the day.
  • Improving your sleep hygiene.
  • Changing your behaviours in the lead up to going to bed.

And I've written about how you can do this in detail here.

However problems with sleep are not only caused by these factors. 

They can also be caused by how you think about sleep and the effect your pain will have on it.

Because people with insomnia may hold negative thoughts, attitudes and beliefs about being unable to sleep.

And that’s only logical right?

As it’s hard to be positive about something you have a problem doing.

However these thoughts only make it even harder to sleep.

For example recent research by the University of Warwick has found that chronic conditions such as back pain are directly linked with people having these negative thoughts.

And people who believed they wouldn't be able to sleep because of their pain were more likely to suffer from insomnia.​

So when trying to treat your insomnia you also need to examine what is going on in your mind.

Why Does How You Think About Sleep Cause Insomnia?

​So why do negative thoughts about sleep make it harder for you to drift off?

It comes down to 3 main factors:

  • They heighten your emotional responses to sleep disturbances making you feel anxious, angry and frustrated.
  • You become more aroused in both your mind and body before sleep. And when your mind is whirling and your body is alert sleep is going to be a problem.
  • They lead to people adopting poor sleeping practices and not using the right strategies to cope with their pain.

​And all three of these factors will have a major effect on your ability to sleep well.


But the problem is that these negative thoughts can become so ingrained in your mind that they become automatic.

So you may not even realise that you are having them!

However when you do become aware of them and look at them closely they rarely turn out to be accurate.

And in most cases by applying some logic to them they can be challenged and disproved.

To do this you need to put on your reconstruction hard hat​.

Putting On Your Reconstruction Hard Hat

positive thinking

'Putting on your reconstruction hard hat' is a term I use to describe the process of changing your negative thought processes by using Cognitive Behavioural Therapy techniques.

But don't worry as it's not as scary as it sounds!​

The aim is to identify negative thoughts that make it hard to sleep, challenge them and reframe them in a way that more positively and accurately describes reality.

By doing this you will lower your stress levels making it easier to relax.

Which in turn will make it much easier to get to sleep.

And these techniques have been shown to work really well for people with sleep disorders.​

For instance, Cognitive Behavioral Therapy for Insomnia (or CBTi for short) has been found to be a very effective treatment method for between 70-80% of insomnia patients.

Also in a review of five studies into treatments for insomnia it was found that treating patients using CBTi methods was more effective and longer lasting than treating patients using medication.

So it can work even better than taking sleeping pills!

And unlike taking pills, by changing your attitudes and thoughts about sleep you can find a long-term solution to insomnia that will help you to cope better with your chronic pain.

So how does it work?​

There are three stages in the CBTi process:

  • Identify your negative thoughts and beliefs about your ability to sleep and the effect your pain will have on it.
  • Challenge these thoughts using evidence, knowledge and past experience to see if they're true or not.
  • And use that to reconstruct (reframe) these thoughts in a more positive, accurate and healthy way.

And I'll take you through how you can do this now.

How To Identify Negative Thoughts: Keep A Sleep Diary

​If you are going to change your negative thoughts and beliefs you firstly need to become aware of them.

And this isn't easy.

As these negative thoughts can become so automatic that you may not even realise they are there.

But in order to be able to challenge them and reframe them in a more positive way you need to make sure you become aware of them as they happen.

And this is where keeping a sleep diary can be a helpful tool.

Sleep diary

As by consciously writing down your thoughts and experiences each night you can identify these deep-lying negative thoughts and attitudes that would remain undetected otherwise.​

So over the next couple of weeks ask yourself the following every day and write down the answers in a sleep diary:

  • ​What time did you go to bed?
  • How many hours of sleep did you get?
  • What time did you wake up?
  • How many caffeinated drinks did you have during the day and at which times?
  • What were you doing in the hours leading up to going to bed?
  • How did you feel when you woke up?
  • How did you feel during the day?
  • What thoughts were going through your head as you tried to get to sleep?
  • What are your main worries about not being able to sleep?
  • How do you think this lack of sleep is going to affect you the following day?
  • Which emotions are these thoughts creating in you? Are you feeling angry? Anxious? Frustrated? 

By doing this for a couple of weeks the benefits are twofold.

Firstly you will be able to see if there is a link between your behaviours during the day and your sleeping problems at night.

Which will gives you the chance to correct these behaviours and replace them with behaviours that will encourage you to sleep easier instead.

It will also make you aware of which thoughts and emotions are occurring in your mind as you struggle to get to sleep.

And it's these thoughts that you need to change if you are going to get a better night's sleep.​

So make a list of all the negative thoughts you can identify in your sleep diary.

And then you're ready ​for the next step which is to challenge them.

Challenge Your Negative Thoughts Towards Sleep And Pain

Now unfortunately you can't stop negative thoughts from occurring.

However you can learn to disrupt them, challenge them and replace them with a more positive (and accurate!) way of looking at your pain instead.​

So once you are aware of your negative thoughts and attitudes towards sleep they can be challenged.

And you do this by looking at them in detail and seeing just how accurately they represent your sleep problem.

challenge negative thoughts

Because you'd be surprised at how often your brain can trick you into thinking things that​ are simply not true.

And this makes it too easy to get stuck in ways of thinking that are exaggerated and unhealthy. 

But by gradually changing how you think about the relationship between your pain and sleep you can get a more balanced view of reality.

Which will leave you feeling more relaxed, hopeful and in control rather than stressed and frustrated.​

So you need to challenge negative thoughts by using evidence and knowledge that can disprove them.​

Therefore the more knowledge you have about your experience of insomnia and chronic pain the easier it is going to be to challenge them.​

​And the good news is you've already made a start without realising it!

Because by reading through articles online like this one you can gain an understanding of why insomnia occurs and what kind of things you can do to prevent it.

​And this greater understanding will give you the knowledge you need to show just how irrational and false most of your negative thinking is.

So once you are armed with this knowledge it is time to put on the reconstruction hard hat and get ready for action!

Reconstruct Your Thoughts: Turn The Negative Into The Positive

Now you have a list of negative thoughts from your sleep diary and have armed yourself with a wealth of knowledge on insomnia and chronis pain how do you go about reconstructing them?

One way to do this is to go through them one by one and replace them with a positive coping statement.

positive thinking

A coping statement is a more positive, rational and healthy way of thinking about sleep and pain than the negative thoughts you are having.​

And this can relax you and put you in a healthier frame of mind.

Which makes it easier both to fall asleep and to cope with your pain.​

False Beliefs & Catastrophic Thinking

​Many negative thoughts fall into the categories of false beliefs or catastrophic thinking.

And both of these are unhealthy when it comes to getting to sleep or dealing with your pain.​

So for example you might notice when struggling to fall asleep that you are having the thought:

‘If I can’t fall asleep now then I won’t be able to function tomorrow’

Now having this thought whirling around in your mind is only going to make you worry.

Which will arouse your nervous system and make it even harder to sleep.

But look closely at it.

Is it really true?

Think back to all the times when you’ve had trouble sleeping in the past and still managed to make it through the following day.

​For instance when you've had to wake up earlier than normal to go to work and have been fine.

When examined through this lense the thought doesn't stand up to scrutiny.

So use this evidence to replace the negative thought with a more positive one:

‘Even if I don’t get enough sleep I will still make it through the day tomorrow and do what I need to do, just as I have done in the past’

​With this thought in your mind instead you'll be much more likely to relax enough to drift off.

Or maybe you find yourself lying there thinking:

"I'll never be able to fall asleep"

This will only make you feel helpless and frustrated.

However it's a ridiculous statement when you really look at it closely isn't it?

I mean you may be struggling but you're not going to be up all night are you?

So change this to:

"I always fall asleep eventually"

Just this simple shift in thinking can ​quieten your mind and relax you enough to have a far better chance of falling asleep.

Thinking You Won't Be Able To Fall Asleep Because Of Your Pain​

Unfortunately those of us with chronic pain can have an additional problem.

As we can become preoccupied with the effect our pain will have on our ability to sleep.

Now pain does affect your ability to sleep. 

​But it can also lead to catastrophic negative thinking that will only make your sleep problems worse.

For instance you might find yourself thinking:

"I have insomnia because of my pain and there is nothing I can do about it"​

​How is this going to make you feel? 

​Hopeless? Despondent? Helpless? 

​It's certainly not going to help you sleep is it!

But again examine it closely.

Is it really true?

​Because while pain does impact on your ability to sleep there are loads of things you can every day to try and reduce your pain.

So use this information to give you the ammo to change that thought to:

"Ok I know pain can affect my sleep but I'm doing everything right to minimise it's impact"​

​By thinking this way you'll have a far more positive outlook towards your ability to sleep.

And you'll be back in control and more likely to use good sleeping practices and pain-coping strategies.

Which will greatly improve your chances of sleeping well.

​Here's another example to give you an idea of how to reframe your negative thoughts:

"I won't be able to cope with my pain if I don't sleep well"

Can be changed to

"Even if I don't sleep well I have pain-coping strategies I can use to deal with my pain tomorrow"

Can you see the idea here?​

The first thought in each example would create frustration and helplessness at your inability to sleep leaving you feeling angry and stressed.

While the positive coping statement you replace it with would put you in a more hopeful frame of mind.

Giving you a greater sense of control which will help to relax your mind and body and make it easier to sleep.​

And this is the change we are looking for with CBTi techniques.​

So go through all the negative statements in your sleep diary and challenge and reconstruct them in this way so they more accurately reflect reality.

And then internalise them so they become second nature.​

Use The Flashcard Method​ To Make Positive Thoughts Stick

While challenging your negative thoughts is a great thing to do changing your ingrained habits is a difficult process.

And this is especially the case with thought processes that may have become automatic.

So for this change in thinking to occur you need to keep at it.​

As positive coping statements need to be repeated over and over to become automatic in your mind and override the negative thoughts.​

And in time your brain will use these positive beliefs instead of the negative thoughts that can worsen your insomnia.

The result of this is you will worry less, have lower stress levels, be less angry and frustrated and have a far greater chance of getting a good night’s sleep.

​And my favourite technique for doing this is to use flashcards.

​These are a great way of memorising things for exam revision and they can work just as well for getting those positive coping statements into your brain.

So write down a negative thought on one side of a flashcard.

And on the other side write down the positive coping statement that replaces it.

Now do this for each and every negative thought about sleep that you have in your sleep diary.​

Then keep these flashcards handy and when you are struggling to sleep have a quick read through them.

As through repetition your brain will learn to associate the positive coping statement as the counter for the negative thought.

And hopefully over time this will not only lessen the frequency of these negative thoughts, it may even replace them completely.

Rounding Up​

mattress for back pain

Sleeping well is so important when you suffer from chronic back pain.

Because it is when you get the chance to heal, repair and regenerate your mind, body and soul.

So when it's disrupted it can cause a multitude of health problems including an increase in the amount of pain you feel.

Unfortunately sleep disorders are increasingly common amongst people who suffer from chronic lower back pain.

​However you can learn how to give yourself the best chance of getting a good night's sleep by:

  • Managing your pain.
  • Getting into good sleeping practices.
  • Changing your behaviours in the lead up to sleep.
  • Challenging and reframing negative thoughts about sleep in a more positive way.

In this article I've focused on the latter.

And doing this will be a massive help in overcoming insomnia.​

Now I've given you some basic Cognitive Behavioral Therapy techniques for insomnia to try here.

But if you want to go further a book I'd recommend getting is 'Overcoming Insomnia And Sleep Problems: A Self-Help Guide Using Cognitive Behavioral Techniques' by Colin Espie.

This book is by a well respected expert in the field of overcoming insomnia using CBTi techniques.

And it contains a detailed 6-week self-help course that you can follow.

Which judging by the reviews has worked well for lots of people already.

But whatever way you do it, working on the mental side of insomnia alongside changing your behaviours during the day will give you the best chance of beating it for good.

Let me know how you get on!​

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I'm a Painter and Decorator, psychology graduate, and veteran of 5 spinal surgeries. I want to help my fellow construction workers to fight back against persistent back pain like I have.

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