What is CBT for insomnia (CBT-I)? Five methods, evidence, sleep hygiene
CareOps editorial team · · 6 min read
Mental wellness information and service guidance published by CareOps.
Translated from our Korean guide. Korean public services, insurance, and helpline numbers refer to South Korea. For urgent help elsewhere, contact local emergency services or a crisis line in your country.
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 is usually shortened to CBT-I. It changes both the daily habits that get in the way of sleep and the worries and beliefs you hold about sleep. Rather than something that only works while you take it, it's closer to helping your body relearn the rhythm of falling asleep.
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 means setting your time in bed from a sleep diary and adjusting it over several weeks, so do it with a professional at a psychiatry or sleep clinic. Don't cut your time in bed sharply on your own.
Does CBT for insomnia work?
A meta-analysis of 20 randomized controlled trials with 1,162 adults with chronic insomnia (Trauer et al., 2015) found that after CBT-I, the time to fall asleep dropped by about 19 minutes and time awake during the night by 26 minutes on average, and the share of time in bed actually spent asleep (sleep efficiency) rose by about 10 percentage points. These changes seemed to last after treatment ended.
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?
A simple version of stimulus control, sleep hygiene, and writing worries down early are things you can try on your own. If you're still awake about 20 minutes after lying down, get out of bed, do something quiet in dim light, and lie down again when you feel sleepy. Keeping a sleep diary of when you fall asleep and wake for about two weeks shows you the pattern of your sleep. Methods to try tonight are covered in more detail in When your mind races at bedtime.
Try a self-assessment without signing inAIS · Sleep difficultiesIf falling asleep or feeling rested has been difficultStart the check →See a clinician first if
Get checked at a psychiatry or sleep clinic first if you snore heavily or have been told you stop breathing in your sleep, if you're so sleepy during the day it's hard to bear, if you work shifts, or if sleep problems happen more than three times a week for three months or longer.
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?
- Lying awake in bed for a long time can teach your body that the bed is a place for tossing and turning. Getting up briefly if you're still awake after about 20 minutes and coming back when sleepy is the heart of stimulus control.
- 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
This article shares general mental wellness information. For urgent help, contact local emergency services or a crisis line in your country. In South Korea, the suicide prevention helpline is 109 (24 hours), and the mental health crisis line is 1577-0199.