How Cognitive Behavioral Therapy for Insomnia (CBTI) Works

Cognitive behavioral therapy for insomnia (CBTI) is sometimes recommended to treat difficulty falling or staying asleep, the defining characteristics of insomnia. In fact, it is now recommended as the first-line treatment for chronic insomnia, even before the use of sleeping pills. What is CBTI? Learn about this behavioral treatment and why it may be just the thing to help you get the rest that you need and help you to avoid the use of sleeping pills.

Overview

Cognitive behavioral therapy for insomnia (CBTI) is a 4- to a 6-session treatment program that can help people who have difficulty falling asleep, staying asleep, or find that sleep is unrefreshing. CBTI is a scientifically proven, highly effective way to end insomnia without relying on medications such as sleeping pills. This goal-directed therapy will also teach you a set of skills that can be useful if insomnia recurs later in life, as it often does. CBTI has long-lasting benefits and most participants report improved sleep satisfaction.

CBTI is more than just basic sleep advice. It is directed by a trained medical professional with expertise in treating sleep disorders. The therapy may be administered by a psychologist, psychiatrist, or another medical doctor who has received specialized training. Increasingly, it may be delivered in alternative ways as well.

The Components of CBTI

One of the most important cornerstones of CBTI is education on normal sleep and the factors that affect both sleep quality and quantity. This includes a review of the circadian rhythm and homeostatic sleep drive and how these normal functions impact sleep. In addition, an overview of various sleeping pills and how tolerance reduces their effectiveness often occurs.

In assessing your individual situation, the specific triggers that contribute to your insomnia can be identified and defused. With careful guidance, you will learn to develop healthy and effective sleep behaviors. By mastering skills to calm the mind and manage stress, it will be possible to ease into sleep and not wake with your mind racing. As part of this, efforts will be made to help recognize and eliminate thoughts, behaviors, and feelings that compromise sleep.

Finally, coping strategies are typically introduced to help you to respond to sleep loss and preserve daytime function. The individualized nature of the program also incorporates a sleep-wake schedule that meets your personal sleep needs.

What to Expect

A typical CBTI program is generally scheduled as 4 to 6 consecutive one-on-one sessions with the specialist. These sessions are typically scheduled weekly or bi-weekly and may last 30-60 minutes. Each week, your progress will be closely monitored with the use of sleep logs. Feedback and specific guidance will be provided to advance you toward your goals.

Who Benefits?

No matter why you have insomnia, or for how long you have had it, CBTI can effectively help to end it. It even helps those who have a general medical condition that interferes with sleep, including those afflicted with pain or mood disorders such as anxiety or depression.

This individualized program will address the specific goals you have related to your insomnia. For some, this may mean falling asleep more easily, sleeping through the night, sleeping without the use of pills, or improving daytime fatigue.

The program can also help young children who are resistant to bedtime, adolescents or adults who stay up late and sleep in due to delayed sleep phase syndrome, or people with recurrent nightmares.

How to Find a CBTI Specialist

The specialized training required for CBTI ensures patient success, but it also limits the number of medical professionals who can provide the service. If you are interested in finding a CBTI specialist near you, consider the list provided by the American Board of Sleep Medicine. Larger hospital groups or academic centers associated with major universities may also offer group therapy classes or workshops in your area.

There are also several online programs to consider. In addition, there are a handful of books based on therapy techniques.

It can also be helpful to ask for a referral to a local board-certified sleep doctor who may be able to provide you additional guidance on resources in your area. Our Doctor Discussion Guide below can help you start that conversation with a doctor.

Insomnia Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Download PDF

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A Word From Verywell

Insomnia can indeed be successfully treated without the use of sleeping pills, and it is worth learning about the options available to you. Select the best CBTI delivery method for you and it can lead you down the path to success.