Finding it hard to get to sleep? Tossing and turning all night? Waking up at 4 a.m.,  held captive by your busy mind? We all have trouble sleeping now and then, but if insomnia is your default position, help may be available. 

No, this is not an ad for sleep medication. 

“Medications are helpful but, over time, they stop working, and they don’t treat the underlying causes of insomnia,” says Linda Pevnick, a licensed clinical social worker. 

In addition to her other clients, Pevnick treats people who can’t sleep. She is one of the few therapists in the area who is trained in cognitive behavioral therapy (CBT) for insomnia.

A native St. Louisan and a member of Congregation Neve Shalom, Pevnick says half of adults complain of difficulty sleeping — half of them chronically. Research shows that after six or seven sessions of CBT, about 75 percent of patients experience significantly improved sleep.

Pevnick, 66, made time recently to talk about CBT for insomnia.

How did you get interested in this treatment?

I met a pulmonologist, a doctor treating people for sleep apnea, and he said he also was seeing people with insomnia. He told me about CBT and asked if I would be interested in offering it to patients. I said I would be very interested. 

What happened next?

I learned that the National Institutes of Health and the National Sleep Institute both endorse CBT for insomnia, and I took the advanced training for it. I’ve been using CBT now for about five years. 

Have you had good results? 

Yes. The majority of patients have become normal sleepers, and 85 to 90 percent of those on medications are able to reduce or eliminate sleeping pills.

What is the secret?

You must address the underlying causes of insomnia and unlearn the thoughts and behaviors that lead to insomnia. 

What sorts of thoughts and behaviors?

When we toss and turn, negative thoughts take over. “If I don’t sleep, I won’t be able to function tomorrow,” or “I won’t feel OK,” or “I may not be able to sleep again tomorrow night.” These negative feelings keep us awake. These negative thoughts can enforce a pattern that can last for years.

How does CBT stop that?

First, it helps to change your thinking about sleep, which is letting go of consciousness. If you can’t sleep, you want to get control over that, and when you try to take control, you can’t let go and go to sleep. 

What are some helpful patterns that CBT can teach?

CBT has several components, including changing thoughts and behaviors, practicing relaxation techniques, keeping a sleep diary and developing habits that improve sleep. 

What sort of habits?

Light is the enemy of sleep, because light signals your brain that it’s time to wake up. So if you can’t sleep, you should avoid watching TV, working on a computer or looking at any device that is backlit. It’s best to keep the bedroom cool and dark, and keep clocks out of sight — and don’t read books like “Jurassic Park” just before time for bed. 

Are there behaviors people can practice during the day to ensure better sleep?

Yes. Exercise is good, as is getting some sunshine. Don’t drink caffeinated beverages after noon. And remember that though alcohol may make you sleepy, it is a stimulant. Every hour you are awake, chemicals build up in your body to help promote sleep, especially if you get into a regulated wake and sleep cycle.

Is there any upside to insomnia?

Most people underestimate the amount of time they actually sleep, even when they think they have tossed and turned all night. There is an amnesiac quality to light sleep, when you may be sleeping but not remember it when you wake. 

Anything else? 

Most insurance plans cover CBT for insomnia.