Cognitive Behavior Therapy for Insomnia (CBT-I)

CBT-I is a structured program to help you identify and change the thoughts, feelings, and behaviors that cause insomnia to persist over time. You will be meeting individually with a CBT-I therapist to set goals and work towards those goals. With CBT-I, the goals are sleep focused: falling asleep more quickly, reducing wakefulness during the night, improving sleep quality, worrying less about sleep, and coping better with the effects of poor sleep when insomnia nights happen. We will be asking you to track your sleep every morning, using a simple sleep diary, and your CBT-I therapist will help you use your diary to keep track of your progress.

CBT-I is what’s called a multi-component treatment, meaning that your CBT-I therapist will be drawing from a toolbox of strategies that have proven to be effective for sleep problems like yours. We’ll customize your treatment plan to target your individual sleep goals, but some of the most common CBT-I tools are:

Sleep 101: Learn more about the science of sleep so that you can leverage your body’s natural sleep systems.

Time in Bed Restriction, or Sleep Compression: Reduce the time you spend trying to sleep at night, to increase your body’s capacity for deep sleep.

Stimulus Control: Retrain your brain to maximize the Bed-Sleep connection.

Cognitive Therapy: Learn to change the unhelpful messages you may be telling yourself about sleep.

Counter-Arousal Strategies: Quiet an active mind to get to sleep faster.

The most effective “dose” of CBT-I is four individual sessions with a CBT-I therapist. Most patients meet with us for a total of four to six bi-weekly treatment visits.

In our experience, most people with chronic insomnia already have impeccable sleep hygiene! Sleep hygiene is not considered an effective treatment for chronic insomnia. In fact, sleep hygiene education is the literal sugar pill of insomnia treatments: when we do research studies of CBT-I, we use sleep hygiene as the placebo control. If you have chronic insomnia, you’ve probably learned the hard way that buying a new mattress, using white noise or room-darkening blinds, and cutting back on alcohol and caffeine are not enough to solve your sleep problem for good. Unlike sleep hygiene, CBT-I helps you to fix the underlying causes of your sleep problem.

70-80% of CBT-I patients experience improvements in sleep: less time to fall asleep, less wakefulness during the night, and better sleep quality. They also report that they feel and function better during the day. And these benefits persist long after treatment has ended.

In general, CBT-I works just as well in patients who have insomnia alongside other medical or mental health conditions such as depression, anxiety, trauma, or chronic pain. And the health benefits of improved sleep can relieve stress and anxiety, improve mood, and even lessen pain and inflammation. 

There are a few medical conditions that require special consideration when participating in CBT-I. These include bipolar mood disorders, seizure disorders, and obstructive sleep apnea. Your CBT -I therapist will assess for these and other medical factors that might be contributing to poor sleep and will help you develop a treatment plan that takes into account these conditions.

Good news: CBT-I works well even in patients who take a nightly sleeping aid. You do not have to come off of your sleep medication in order to do CBT-I. If one of your goals is to reduce your dependence on sleeping pills, your CBT-I therapist can work with you and your prescriber on a guided taper as part of your treatment plan.