Millions struggle with chronic insomnia—waking up multiple times a night, rising too early, or lying awake with racing thoughts. When these symptoms occur more than three times a week for over three months, it’s considered chronic insomnia. Taiwan sleep specialist Dr. Hsu Shang-Fu noted that the most effective treatment isn’t necessarily medication—but cognitive behavioral therapy (CBT), a structured approach that tackles the underlying thoughts and behaviors interfering with sleep.
Hsu, who appeared on NTDTV’s “Health 1+1” program, emphasized that CBT empowers people to replace negative sleep patterns with healthy habits. In his clinic, he customizes treatment plans combining cognitive restructuring, relaxation techniques, and behavioral adjustments to help patients sleep better—naturally.
How CBT Helps Overcome Insomnia
CBT works by helping people break the cycle of worry, poor sleep habits, and negative thinking that keeps insomnia going. Through simple, structured techniques, it’s possible to retrain both the mind and body for better sleep.
Adjust Sleep Cognition
Some patients worry that if they have insomnia, it will affect their work or something important the following day, leading to even higher stress, making it more difficult to fall asleep. In this situation, Hsu will encourage patients to understand that occasional poor sleep will not cause catastrophic effects, thereby reducing the psychological burden.
Use a Sleep Log
Patients are asked to record their sleep quality from the night before and their mental state the following day. This practice helps them objectively analyze the connection between sleep and daily performance, dispelling the common misconception that “a bad night’s sleep will definitely ruin the next day.”
Relaxation Skills Training
Through techniques like mindful abdominal breathing, patients can learn how to relax before going to bed, reduce mental distractions, and ultimately improve sleep. This cultivates a calmer state conducive to sleep.
Case study:
Su, a career woman, suffered from chronic insomnia due to long-term work and childcare pressures, which led to significant worry and anxiety. Preliminary consultation found that she took sleep too seriously. If she could not fall asleep in the first half hour, she would become more anxious afterwards and then could hardly fall asleep at all.
By changing her concept of sleep, she experienced significant improvement after one month. She could now easily fall asleep five or six days a week. Even on occasional nights when she might take an hour or so to fall asleep, she no longer felt overly anxious.
Special Cases: Menopause and Underlying Illness
Hsu highlighted that sleep issues may also signal physiological changes or medical conditions.
Menopause
Menopause can cause a sharp drop in hormones, affecting emotional stability and the ability to fall asleep, said Hsu. It may also be accompanied by hot flashes and cold sweats at night, making sleep difficult. For such cases, sleep specialists work closely with obstetrics and gynecology units to evaluate whether hormone replacement therapy is suitable to improve the patient’s physiological symptoms so that she can sleep more comfortably.
Case study:
A daughter expressed concern about her mother, who had never snored before but recently began doing so during menopause. After a sleep review, it was found that the mother suffered from moderate sleep apnea, which was related to hormonal changes caused by menopause. After receiving appropriate treatment, both her snoring and insomnia improved significantly.
Medical Conditions
Some insomnia problems are not merely standalone sleep disorders but are actually caused by underlying physical diseases. Recognizing these connections is crucial for proper diagnosis and treatment.
Case study:
Hsu has a family member who, in addition to having difficulty falling asleep, also had hand tremors and constipation, which are typical early symptoms of Parkinson’s disease. Following a diagnosis by the Department of Neurology, early Parkinson’s disease was confirmed, and medication was initiated. The treatment significantly improved the patient’s insomnia.
Everyday Habits That Harm Sleep
Hsu said that many daily habits could affect the quality of sleep. Once these habits are properly adjusted, sleep can improve.
- Using electronic devices before bed: Mobile phones and tablets release blue light, which inhibits the secretion of melatonin and makes it more difficult to fall asleep. These devices are also used close to the eyes, increasing stimulation.
- Drinking coffee, tea, or wine: Caffeine and theophylline in coffee and tea can have effects that last for several hours, reducing the ability to fall asleep. Alcohol interferes with deep sleep and causes frequent awakenings at night.
- Eating late-night snacks: Late-night meals activate the stomach at the wrong time, leading to gastroesophageal reflux and disrupting sleep stability.
Mindful Abdominal Breathing Practice
Hsu highlighted the importance of relaxing and calming yourself before bed to make it easier to fall asleep. Mindful abdominal breathing is a simple relaxation technique that can be tried at home. It is especially suitable for people with insomnia, racing thoughts, and high stress levels.
- Sit in a quiet and comfortable place and relax your body.
- Place one hand on your chest and one hand on your abdomen.
- Inhale through your nose, count slowly to three, and feel your abdomen bulge slightly.
- Exhale slowly through your nose or mouth, counting to four, and feel your abdomen retract.
Focus on the breathing process. If your thoughts drift away, do not blame yourself—gently bring your attention back to your breathing. Continue practicing for 5 to 10 minutes and make it a habit. Over time, you will be able to enter a relaxed state sooner, making it easier to fall asleep.
Other Methods to Help Sleep
Hsu believes that if a sleep aid is harmless to the body and does not cause a financial burden, people can try it to see what works for them. The following are some popular practices:
- Soak your feet before going to bed: Soaking your feet improves blood circulation, relieves fatigue in the leg muscles, and promotes relaxation, which helps you fall asleep.
- Drink some hot milk: Drinking milk provides tryptophan, which can promote the production of melatonin, though the amount is small. The main benefit may come from the “sense of ritual before going to bed,” which helps people relax. This method is not suitable for people with lactose intolerance, as it can cause bloating or gastroesophageal reflux, affecting sleep.
- Use essential oils: Using essential oils, such as lavender, helps promote relaxation and may shorten the time it takes to fall asleep. However, their effectiveness diminishes if you dislike strong scents.
- Listen to white noise or alpha wave music: Listening to soothing sounds provides a stable audio environment, reduces external noise disturbances, and helps the brain enter a relaxed state.
If these strategies are not effective or interfere with sleep, stop them and seek help from a qualified physician.
Insomnia is more than just a sleep issue—it’s often a reflection of stress, physiological changes, or deeper health concerns. With the right support and behavioral tools like CBT, many people can reclaim restful nights without relying on medication.
