Cognitive Behavioral Therapy for Insomnia (CBT-I)

Cognitive behavioral therapy for insomnia (CBT-I) is a type of short-term structured therapy that’s the go-to treatment for insomnia. You work with a licensed therapist to adjust your sleeping routine. You also work on sleep-related behaviors and thinking patterns. The treatment is structured and goal-oriented.

CBT-I is effective for improving nighttime and daytime symptoms of chronic insomnia, like waking up overnight and daytime sleepiness. It’s also effective for people with insomnia and comorbid conditions, like depression, PTSD and obstructive sleep apnea.

If you’re struggling to get restful sleep, talk to your healthcare provider to see if CBT-I could help.

What happens during this treatment?

Cognitive behavioral therapy for insomnia (CBT-I) is a structured sleep program that helps your brain and body relearn how to sleep.

You’ll keep a simple sleep diary and follow a personalized sleep schedule based on your actual sleep patterns. The goal is to strengthen your natural sleep drive. You’ll also retrain your brain to associate your bed with sleeping instead of frustration or worry.

During CBT-I, you’ll learn clear, practical rules for sleep. These include when to go to bed, when to get up and what to do if you can’t fall asleep. You’ll also learn how sleep works and why “trying harder” can backfire. Each week, your sleep plan is adjusted as your sleep improves.

The goal is to help you sleep more consistently and feel better during the day — without using medication.

CBT-I involves several components that work together to improve sleep.

Stimulus control

Stimulus control therapy means pairing sleep-related things — like your bed and darkness — with sleep. You avoid things associated with being awake — like screen time or reading — in your bedroom.

Stimulus control recommendations include:

• Lying down to sleep only when you’re sleepy
• Avoiding using your bed for activities other than sleep or sex
• Getting out of bed if you can’t fall asleep within 15 to 20 minutes
• Getting up at the same time every day
• Avoiding napping throughout the day

Sleep restriction (consolidation)

Sleep restriction therapy (SRT) addresses the tendency for people with insomnia to make up for “lost” sleep by increasing their time in bed. For example, you may go to bed earlier, sleep in later or nap.

SRT tackles the mismatch between your sleep ability (how much you actually sleep) and your sleep opportunity (how much time you spend in bed).

You’ll temporarily limit the time you spend in bed to build a stronger sleep drive. Then, you’ll gradually increase your time in bed as sleep becomes more consistent. This improves sleep depth and efficiency.

Sleep education

Your therapist will review common beliefs about sleep that aren’t necessarily true and lead to further issues. You’ll learn:

• How sleep pressure and your body’s internal clock work together
• Why certain habits and behaviors interfere with sleep
• The purpose behind treatment recommendations

You’ll also learn relaxation and wind-down strategies. They help prepare your body for sleep and lower your physical and mental arousal.

Cognitive therapy

Your therapist will help you change unhelpful thoughts and worries about sleep. For example, you may get anxious and anticipate not being able to fall asleep. Or you might believe that your new sleep routine won’t work. They’ll help you focus on changing your responses to thoughts rather than forcing sleep.

How long does CBT-I last?

Typically, CBT-I is a brief, short-term therapy that most people complete within four to eight sessions. Each session lasts 30 to 60 minutes. The typical frequency of sessions is weekly or every other week. But this may vary depending on the program and your therapist.

What are the potential benefits and risks of this treatment?

One of the main benefits of CBT-I is its long-term effectiveness. This is generally more helpful than medications for insomnia, which are typically only meant for short-term use.

In addition to helping with insomnia symptoms, CBT-I can help reduce symptoms of depression and anxiety. It may have benefits for other medical and psychiatric issues. People who do this therapy tend to have improvement in daytime functioning and quality of life, as well.

CBT-I takes work. You’ll likely have to make several changes to your routines and habits. This can be difficult. You may feel slightly more upset during therapy or get frustrated by the process. Your therapist can help you work through these feelings. You may also be more tired at first due to sleep restriction therapy. But this should be temporary.

How long will it take for me to feel better?

Most people see an improvement in their insomnia symptoms within six to eight weeks of starting CBT-I. But each person is different. It can take a while to restore your sleep-wake cycle to a consistent rhythm.

What is the success rate for CBT-I?

CBT-I is a highly effective first-line treatment for chronic insomnia. Research has found that 7 to 8 out of 10 people show significant improvement in their sleep when engaging in this therapy. The effects of it are long-lasting, too.

Is there anything I can do to make this treatment easier on me?

It’s important to commit to your treatment plan. Try to avoid exceptions to your schedule. Things you can do to help maintain consistency include:

• Setting an alarm for wakeup
• Telling your bed partner about your required bed and wake times so they can support you
• Scheduling morning activities with other people to help motivate you to get out of bed, especially on weekends
• Staying active in the hours leading up to your prescribed bedtime so you don’t fall asleep too early
• Planning what you’ll do after you get out of bed for the “15- to 20-minute rule”