#341 - Overcoming insomnia: improving sleep hygiene and treating disordered sleep with cognitive behavioral therapy for insomnia | Ashley Mason, Ph.D.

The Peter Attia Drive

Peter Attia, MD

Health & Fitness, Medicine, Fitness

4.7 • 7.3K Ratings

🗓️ 24 March 2025

⏱️ 125 minutes

🔗️ Recording | iTunes | RSS

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Summary

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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 [1:26:00];
Sleep problems that need to be addressed before CBT-I can be implemented [1:38:30];
The importance of prioritizing a consistent wake-up time over a fixed bedtime for better sleep regulation [1:40:15];
Process S and Process C: the science of sleep pressure and circadian rhythms [1:45:15];
How exercise too close to bedtime may impact sleep [1:47:45];
The structure and variability of CBT-I, Ashley’s approach, and tips for finding a therapist [1:50:30];
The effect of sauna and cold plunge before bed on sleep quality [1:56:00];
Key takeaways on CBT-I, and why no one should have to suffer from insomnia [1:58:15]; and
More.

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Transcript

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0:00.0	Hey everyone. Welcome to the Drive podcast. I'm your host, Peter Attia. This podcast, my website, and my weekly newsletter all focus on the goal of translating the science of longevity
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0:58.5	If you want to learn more about the benefits of our premium membership, head over to peteratiamd.com forward slash subscribe.
1:04.1	My guest this week is Ashley Mason.
1:06.2	Ashley is an associate professor at UCSF, where she leads the sleep, eating, and affect laboratory.
1:12.8	Her research focuses on non-pharmacologic interventions for mental health, particularly
1:17.2	exploring how treatments like whole body, hyperthermia, mindfulness-based approaches can improve
1:22.0	mood disorders, sleep, and eating behaviors. She's also the director of UCSF's Center for Obesity, Assessment, Study,
1:29.2	and Treatment, known as Coast. Her work integrates clinical psychology with integrative medicine,
1:35.6	aiming to develop accessible treatments that address the biological and behavioral aspects of
1:40.6	health. In this episode, we focus almost entirely around one area of her expertise,
1:46.5	which is cognitive behavioral therapy for insomnia or CBTI. Ashley gives us a masterclass
1:52.8	exploration of CBTI, including various methods, including time and bed restriction, stimulus
1:58.5	control, and cognitive restructuring to combat insomnia.
2:01.7	We speak about how to manage racing thoughts and anxiety, and Ashley shares techniques like scheduled
2:07.3	worry time to address stress during the day and prevent sleep disruption at night. We talk about the
	...

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