Overcoming insomnia: improving sleep hygiene and treating disordered sleep with cognitive behavioral therapy for insomnia | Ashley Mason, Ph.D.
Peter Attia
Mar 24, 2025
Episode description
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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.
We discuss:
Defining insomnia: diagnosis, prevalence, and misconceptions [3:00];
How insomnia develops, and breaking the cycle with cognitive behavioral therapy for insomnia (CBT-I) [7:45];
The different types of insomnia, and the impact of anxiety, hydration, temperature, and more on sleep [11:45];
The core principles of cognitive behavioral therapy (CBT) and how CBT-I is used to treat insomnia [20:00];
Implementing CBT-I: time in bed restriction, sleep scheduling, and the effect of napping [29:45];
Navigating family and partner sleep schedules, falling asleep on the couch, sleep chronotypes, and more [39:45];
Key aspects of sleep hygiene: temperature, light exposure, and circadian rhythm disruptions [44:45];
Blue light and mental stimulation before bed, and the utility of A-B testing sleep habits [52:45];
Other simple interventions that may improve sleep [57:30];
Ashley’s view on relaxation techniques and mindfulness-based practices [1:02:30];
The effectiveness of CBT-I, the role of sleep trackers, and best practices for managing nighttime awakenings [1:04:15];
Guidance on intake of food and alcohol for good sleep [1:16:30];
Reframing thoughts and nighttime anxiety to reduce sleep disruptions [1:18:45];
Ashley’s take on sleep supplements like melatonin [1:21:45];
How to safely taper off sleep medications like benzos and Ambien [
Mindsip insights from this episode:
Schedule worry time to enhance sleep quality
To prevent a racing mind at night, schedule a non-negotiable hour during the day specifically for worrying, which helps compartmentalize anxiety and prevent it from disrupting sleep.
Address behaviors that perpetuate insomnia for effective CBTI
In CBTI, the focus is not on the original cause of insomnia but on the current behaviors that perpetuate it, making the intervention the same regardless of the initial trigger.
Engage in non-productive activities to reset your brain at night
If you wake up in the middle of the night, get out of bed and do a mildly boring, non-productive activity you wouldn't want your boss to see you doing, to reset your brain without reinforcing wakefulness.
Taper sleep medications using a gem scale for precise reductions
To taper off sleep medications like Ambien, use a highly precise gem scale to make minuscule, psychologically manageable reductions in dosage over a long period.
Avoid cold plunges before bed for better sleep
While saunas can be helpful, cold plunges before bed are a bad idea because your body works to warm itself back up afterward, which is counterproductive for sleep.
Stop using sleep trackers to alleviate insomnia anxiety
For people with insomnia, it is often best to stop using sleep tracking wearables, as the data can create anxiety and distress that worsens the problem.
Wear wraparound orange glasses to combat sleep onset insomnia
For sleep onset insomnia, wearing wraparound, deep-orange colored glasses, not clear blue-light blockers, for two hours before bed can be highly effective.
Dictate consistent wake-up time based on sleep diary insights
Instead of letting patients choose any wake-up time, a more effective CBTI approach is to set a consistent wake-up time based on their sleep diary's evidence of when they naturally wake up.
Warm hands and feet to improve sleep onset
It's difficult to fall asleep with cold hands and feet because vasoconstriction in the extremities prevents your core from dumping heat, so warming them with a footbath or socks can aid sleep onset.
Replace down comforters with cotton blankets for better sleep
Replacing down comforters with cotton blankets can significantly improve sleep, especially for those with night sweats, by preventing the body from trapping too much heat.
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