What is CBT for insomnia (CBT-I)? Five methods, evidence, sleep hygiene
CareOps editorial team · · Updated · 6 min read
Mental wellness information and service guidance published by CareOps.
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Read our full editorial standards →You're tired, yet when you lie down sleep won't come, or you finally fall asleep only to wake before dawn and stay awake. If going to bed early, catching up on weekends, and cutting back on coffee haven't changed much, CBT for insomnia is worth knowing about.
At a glance
- CBT for insomnia (CBT-I) is a treatment that changes the habits and thoughts that get in the way of sleep, and the American College of Physicians recommends it as the first treatment for chronic insomnia in adults.
- It usually combines several of stimulus control, sleep restriction, working with thoughts about sleep, sleep hygiene, and relaxation.
- A meta-analysis of 20 randomized controlled trials found the time to fall asleep dropped by about 19 minutes and time awake during the night by 26 minutes on average.
What is CBT for insomnia (CBT-I)?
Cognitive behavioral therapy for insomnia, or CBT-I, works with sleep-related habits, worries and expectations. It aims to build skills that remain useful after treatment. It is not simply a list of bedtime tips, and medication decisions belong with the prescribing clinician.
In its 2016 clinical guideline, the American College of Physicians (ACP) recommended CBT-I as the initial treatment for chronic insomnia in all adults (a strong recommendation). For people in whom CBT-I alone isn't enough, it advised deciding with a clinician whether to add medication, weighing benefits, harms, and costs.
What are the five methods of CBT for insomnia?
| Method | What it involves |
|---|---|
| Stimulus control | Use the bed only for sleep; if you can't sleep, get up and come back when sleepy, so the bed means sleep again |
| Sleep restriction | Match time in bed to the time you actually sleep, then gradually extend it |
| Cognitive therapy | Look at and change worries and beliefs about sleep, like "if I don't get 8 hours, tomorrow is ruined" |
| Sleep hygiene | Adjust habits that affect sleep, such as caffeine, alcohol, screens, and the bedroom environment |
| Relaxation | Ease tension before sleep with breathing or muscle relaxation |
The American Academy of Sleep Medicine's 2021 guideline strongly recommends multicomponent CBT-I and found that stimulus control, sleep restriction, and relaxation can help on their own. By contrast, it did not recommend sleep hygiene as a stand-alone treatment; sleep hygiene does its part alongside the other methods.
Do sleep restriction with a professional
Sleep restriction changes time in bed and can temporarily increase daytime sleepiness. A trained clinician should assess suitability and monitor it, especially with bipolar disorder, seizures or work that requires sustained alertness. Do not cut sleep opportunity on your own from an online guide.
Does CBT for insomnia work?
Trauer and colleagues reviewed 20 trials involving 1,162 adults. Face-to-face CBT-I improved diary-reported time to fall asleep by about 19 minutes and nighttime wakefulness by 26 minutes compared with inactive controls. These are group averages, not a promised result. Trials with other co-occurring medical, sleep or psychiatric conditions were excluded, limiting how widely the figures apply; this was not a trial of Maeumi.
What are good sleep hygiene habits?
Sleep hygiene alone rarely resolves insomnia, but it lays the groundwork for the other methods to work. These are the habits the UK's National Health Service (NHS) suggests.
- Go to bed and get up at similar times, even on days off
- Give yourself time to wind down before bed (reading, breathing, calm music)
- Avoid caffeine, large meals, alcohol, and nicotine before bed
- Keep away from phones, tablets, and computers for an hour before bed
- Keep the bedroom quiet, dark, and cool
- If you worry a lot, write your worries down before bed, and try not to force sleep
Can I try it on my own?
You can begin by noting sleep patterns and making room for a quieter wind-down. If you are awake and becoming frustrated, try a calm activity elsewhere if getting up is safe, then return when sleepy. Avoid watching the clock to enforce an exact minute rule. A diary can record rough estimates the next morning. See When your mind races at bedtime. For how to keep one, see our sleep diary guide and free template. For why sleep starts to slip and keeps slipping, see causes of insomnia.
Try a self-assessment without signing inAIS · Sleep difficultiesIf falling asleep or feeling rested has been difficultStart the check →See a clinician first if
Talk with a clinician when poor sleep affects daily life; you do not need to wait three months. Mention loud snoring, pauses in breathing, marked daytime sleepiness, shift work and any relevant health conditions. Avoid driving or hazardous work when sleepy. The frequency and duration used to define chronic insomnia are not a waiting period for help.
Can you do CBT for insomnia with an app?
CareOps Maeumi is an AI counseling app. If sleep is a concern, you can add CBT for insomnia (CBT-I), and then you work through a sleep diary, a simple version of stimulus control, and thoughts about sleep together inside the conversation. Sleep restriction isn't done alone in the app, and if there are signs that clinical care should come first, Maeumi suggests seeing a clinician first. Cognitive behavioral therapy in general is covered in What is cognitive behavioral therapy?.
Frequently asked questions
- Where can you get CBT for insomnia?
- At psychiatry clinics, sleep clinics, and counseling centers that offer cognitive behavioral therapy. Format, number of sessions, and cost vary, so ask whether they offer CBT for insomnia before booking.
- Can I do CBT for insomnia while taking sleep medication?
- Whether to continue or reduce medication is something to decide with the doctor who prescribed it. The ACP guideline also recommends starting with CBT-I and deciding with a clinician whether to add medication if that isn't enough. You can keep up practices such as a sleep diary and sleep hygiene while taking medication.
- Is it bad to keep lying in bed when I can't sleep?
- If lying awake becomes frustrating, a quiet activity out of bed may help you return when sleepy. Adapt this with a clinician if getting up raises a fall or mobility risk. You do not need to watch the clock or force yourself to get up at an exact minute.
- Will sleep hygiene alone fix insomnia?
- It can help with mild sleep problems, but for chronic insomnia sleep hygiene alone isn't enough. The American Academy of Sleep Medicine also recommends combining it with other methods such as stimulus control and working with thoughts, rather than using it alone.
Sources
- Qaseem et al. (2016), Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians, Annals of Internal Medicine 165(2), 125–133
- Trauer et al. (2015), Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis, Annals of Internal Medicine 163(3), 191–204
- Edinger et al. (2021), Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline, Journal of Clinical Sleep Medicine 17(2), 255–262
- National Health Service (NHS), How to fall asleep faster and sleep better
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