Cognitive Behavioral Therapy for Insomnia (CBT-I)

It’s normal to have difficulty falling asleep from time to time, and most cases of occasional insomnia (also called acute insomnia) do not require treatment. However, chronic insomnia—defined as difficulty falling or staying asleep at least three nights a week for three months or more—is a serious condition that can adversely affect physical health, mental health, and general quality of life. Many cases of chronic insomnia can be treated effectively with CBT-I.

Insomnia is often categorized as primary or secondary. In primary insomnia, sleep problems do not appear to be caused by another condition or their cause is unknown; in secondary insomnia, sleep problems appear to have arisen as the result of another physical or mental health condition, such as cancer, depression, anxiety, or chronic pain.

In cases of secondary insomnia, treating the primary condition may resolve or dramatically improve sleep-related symptoms, but doesn’t always. CBT-I can be an effective treatment for either primary or secondary insomnia, and treating insomnia in any form is likely to lead to improvements in other domains of physical or mental health—for example, many people treated with CBT-I report fewer symptoms of depression and anxiety, improved focus and reaction time, and better emotional regulation.

CBT-I is a short-term approach that generally takes six to eight weeks. Sessions, which last 30 to 60 minutes, can be conducted in person or online. Some organizations have also released apps that guide users through the stages of CBT-I. Research has generally found that online CBT-I is just as effective as in-person CBT-I.

CBT-I practitioners typically begin treatment by collecting information on the client’s health history, primary sleep concerns (for example, whether the client has trouble falling asleep, staying asleep, or feeling rested after sleep), sleep habits, and nightly routine. Clients will be instructed to keep a sleep diary tracking when they go to bed and wake up, how long they stay in bed, how much sleep they get, and how rested they feel each day.

In subsequent sessions, clients will learn several CBT-I techniques, such as sleep restriction (limiting the amount of time they spend in bed awake by getting out of bed whenever they are unable to fall asleep), stimulus control (restricting the activities they do in bed to sleeping and sex), and relaxation exercises that can help them soothe their body and mind before bed. Clients will also be instructed on sleep hygiene best practices—such as going to bed and waking up at the same time every night, avoiding caffeine or alcohol close to bedtime, and practicing a regular bedtime routine.

Because CBT-I is a form of CBT, it also involves a significant cognitive element, in which clients identify their negative thoughts surrounding sleep (for example, “I’ll never get to sleep” or “I’m going to be so tired tomorrow unless I fall asleep right now”). Such thoughts, while automatic and understandable, are often counterproductive because they can increase anxiety around sleep; they may also encourage maladaptive behaviors, like relying on alcohol or drugs to go to sleep. CBT-I helps clients become more aware of these thoughts and learn to replace them with more adaptive ones (such as “I trust my body to go to sleep when it’s ready” or “even if I don’t get much sleep tonight, I’ll still be OK tomorrow”).

Insomnia can have physical causes that require separate treatment—for example, chronic pain or sleep apnea. But often, insomnia persists because people who struggle to fall asleep engage in counterproductive behaviors—like sleeping in on the weekends, taking naps during the day, or staying up later and later each night due to sleep-related anxiety—that make falling asleep harder and keep them trapped in a vicious cycle.

CBT-I encourages clients to look critically at their sleep habits, develop a healthier bedtime routine, and challenge the unhelpful thoughts that may be, unbeknownst to them, keeping them agitated and awake late into the night. Not only does CBT-I effectively treat insomnia in the majority of cases, but it also helps clients accept that occasional sleepless nights are normal and gives them the tools to manage acute insomnia when it arises in the future.

Clients should look for a mental health professional who has been trained or certified in CBT-I specifically; such therapists may be located on the Psychology Today Therapy Directory or by reaching out to sleep-focused medical organizations, such as the American Board of Sleep Medicine. If you are unable to locate a CBT-I therapist in your area, this therapy can also be effective when delivered via telehealth or via app.