Understanding Cognitive Behavioral Therapy for Insomnia (CBT-I)
Insomnia is when you have a hard time falling or staying asleep, or you wake up too early. It can happen for short periods of time and then go away. But for some people insomnia is an ongoing problem and becomes a disorder. Insomnia can make it hard to function during the day. It can cause problems at work or school, and with relationships. It can also cause concentration and mood problems.
Cognitive behavioral therapy for insomnia (CBT-I) is a way to treat someone who has ongoing trouble sleeping (insomnia disorder). Certain kinds of thoughts and habits can cause insomnia disorder. CBT-I works by changing these thoughts and habits with a series of tools. These tools can help you get to sleep, spend less time awake in bed, and feel better during the day.
How does CBT-I work?
CBT-I is most often done with a health care provider who talks with you about your sleep issues. Together you look at your sleep patterns. The provider will ask you to keep a sleep diary. This can help show what types of factors may be maintaining your insomnia. For example, staying in bed trying hard to relax or fall asleep may actually be making the problem worse. Sleeping late in the day on weekends can cause sleep trouble during the week.
Some people come to dread bedtime because the process of trying to fall asleep has become so frustrating. By helping you change problem thoughts and habits, CBT-I can help you fall asleep, stay asleep, and feel better during the day.
Does CBT-I really work?
Yes! CBT-I is the most effective treatment for insomnia disorder and is the gold standard of care. Research shows that it works as well as sleep medicine in the short term and works better than sleep medicine over time. Research also shows that CBT-I improves the quality of sleep.
Common CBT-I tools
CBT-I uses several tools to help a person change their thoughts and habits around sleep. The tools that are used vary from person to person. They can include:
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Using your bed only for sleep. This is also called stimulus control. It means you make sure your bed is only used for sleep (with sex as the only exception). This helps ensure that you mentally connect your bed with sleep. Bed becomes a place that is used for sleeping instead of a place where you are thinking about negative memories, your job, household tasks, life problems, or other concerns.
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Limiting your time in bed. This is also called sleep efficiency training or sleep restriction therapy. It helps ensure that you spend less time in bed awake. Sleep efficiency training can also improve the depth and quality of your sleep.
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Changing your thoughts about sleep. This is also called cognitive restructuring. When a person has insomnia disorder, going to bed can feel stressful. You may dread bedtime because you have trouble falling asleep. Or you may put a lot of pressure on yourself to sleep, for fear of having a very difficult next day. CBT-I uses methods to help you think differently about sleep. This helps reduce the pressure to sleep and can help you fall asleep faster.
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Relaxation methods. Methods to help you relax at bedtime can help lower stress hormones and slow the heart rate and breathing rate. These changes can make it easier for you to wind your mind and body down as you prepare for sleep.
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Sleep hygiene. This is a set of healthy habits that can help a person sleep better. Sleep hygiene includes keeping the bedroom dark and quiet, avoiding caffeine and alcohol, limiting naps, making diet and exercise changes, and other tasks.
Your active role in CBT-I
CBT-I is often completed in as few as 6 sessions with a health care provider. It can be done one-on-one or in a group setting. To make CBT-I work, you need to take an active role. You’ll get the most benefit if you:
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Tell your health care provider details about your sleep habits and problems
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Set sleep goals with your health care provider
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Attend all your sessions
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Keep a sleep diary
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Use your CBT-I tools on a regular basis
Think of CBT-I as a set of skills. Skills take practice to master. The more you practice your CBT-I skills, the more likely you are to have relief from insomnia.
Additional resources
Take a look at these VA virtual tools: