Eli Hendel M.D.
A Medical Corporation


Cognitive Behavioral Therapy for Sleep Enhancement (CBTse)


Struggling with falling asleep or staying asleep? Insomnia is one of the most frustrating and debilitating health conditions. Why? Because lack of sleep affects pretty much every life process. It can raise your risk of developing obesity, heart disease, and other serious chronic conditions, and it directly impacts physical and mental energy levels. CBTse can help to limit and resolve insomnia.


Some common questions you may have:

What is CBTse?

It’s a six session program designed to train the individual who has problems with initiating or maintaining sleep.


What are some of the components of the program?

One component is cognitive restructuring to eliminate negative thoughts associated with sleep. Sleep restriction helps one to determine the optimum time to go to bed in order to maximize sleep efficiency. Stimulus control helps to eliminate the barriers that prevent you from initiating sleep. Relaxation techniques help to allow one to develop the skills needed to eliminate all the mental barriers to initiating sleep.


Does CBTse involve medications?

Sleep aides are avoided if possible. If they are necessary, they are used for a short period. This program is primarily an educative and training program to enable the individual to take control of sleep ability.


Why do you need so many sessions?

Sleep is complicated and so it takes time to identify what is the source of the difficulty and then to train the individual to fix the problem.


Why do I have to pay for the whole program in advance? Why can’t I try one session to decide if it’s worth committing to the whole program?

The whole program is prescribed in order to treat a chronic, persistent problem. There are different phases and learning to master each, will allow one to benefit from the others. The only way to get the full benefit from the program is to commit to and complete the whole program. If you don’t believe that you are ready to fully commit, then you shouldn’t start.  It will be a waste of time.


Why doesn’t insurance cover the program?

The insurance policies that require pre-authorizations usually approve a one-time consultation with the expectation that the problem will be solved in that one session. CBTse involves significant education, use of diary entries to track and provide important habit information that will then be modified, and it requires practice time. It cannot be accomplished in a one-time consultation.


What about other medical problems that affect sleep - do they get addressed?

The first session consists of a comprehensive history and physical examination and will also include laboratory testing. If any other problems are identified, they will be addressed and stabilized before you start the CBTse program. This program is designed to treat chronic idiopathic insomnia.


Is a sleep study part of this program?

A sleep study is not recommended for the diagnosis or treatment of insomnia. If during the initial history there is reason to suspect a diagnosis of sleep apnea then a sleep study will be requested outside of this program. If sleep apnea is diagnosed, he treatment protocol for that condition will be recommended before starting CBTse.


What is the formal structure of the CBTse program?

Session 1: Introduction basic principles and initial medical evaluation

Session 2: Understanding sleep medications and sleep scheduling

Session 3: Cognitive restructuring

Session 4: The basic principles of sleep hygiene

Session 5: Stimulus control and reinforcing healthy sleep structure

Session 6A: Progressive muscle relaxation

Session 6B: Mental relaxation techniques

Session 6C: Relaxation techniques Part 2 with audio version