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.
View show notes here: https://bit.ly/4bTivQs
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We discuss:
0:00:00 - Intro
0:01:35 - Defining insomnia: diagnosis, prevalence, and misconceptions
0:07:15 - How insomnia develops, and breaking the cycle with cognitive behavioral therapy for insomnia (CBT-I)
0:11:39 - The different types of insomnia, and the impact of anxiety, hydration, temperature, and more on sleep
0:21:16 - The core principles of cognitive behavioral therapy (CBT) and how CBT-I is used to treat insomnia
0:32:37 - Implementing CBT-I: time in bed restriction, sleep scheduling, and the effect of napping
0:43:52 - Navigating family and partner sleep schedules, falling asleep on the couch, sleep chronotypes, and more [39:45];
0:49:49 - Key aspects of sleep hygiene: temperature, light exposure, and circadian rhythm disruptions
0:58:55 - Blue light and mental stimulation before bed, and the utility of A-B testing sleep habits
1:04:30 - Other simple interventions that may improve sleep
1:10:20 - Ashley’s view on relaxation techniques and mindfulness-based practices
1:12:57 - The effectiveness of CBT-I, the role of sleep trackers, and best practices for managing nighttime awakenings
1:26:27 - Guidance on intake of food and alcohol for good sleep
1:32:29 - Reframing thoughts and nighttime anxiety to reduce sleep disruptions
1:37:37 - Ashley’s take on sleep supplements like melatonin
1:51:45 - How to safely taper off sleep medications like benzos and Ambien
1:51:46 - Sleep problems that need to be addressed before CBT-I can be implemented
1:53:45 - The importance of prioritizing a consistent wake-up time over a fixed bedtime for better sleep regulation
1:59:23 - Process S and Process C: the science of sleep pressure and circadian rhythms
2:02:07 - How exercise too close to bedtime may impact sleep
2:05:21 - The structure and variability of CBT-I, Ashley’s approach, and tips for finding a therapist
2:11:58 - The effect of sauna and cold plunge before bed on sleep quality
2:14:32 - Key takeaways on CBT-I, and why no one should have to suffer from insomnia
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About:
The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, and all that goes into that from physical to cognitive to emotional health. With over 90 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, and much more.
Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan.
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