Co-authored by Monica Parham, MHC-LP and Amy Vigliotti, Ph.D.
Most of us have dealt with occasional sleepless nights, often a natural response to life’s stressors. For about one in three adults, though, sleep difficulties can persist and develop into chronic insomnia. If you find yourself struggling to fall asleep, stay asleep, or wake up feeling unrefreshed, you’re not alone. Chronic insomnia can take a serious toll, and can contribute to irritability, low energy, trouble focusing, and a decline in overall well-being. It can feel exhausting, frustrating, and isolating, but the good news is that help is available. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a short-term and non-invasive approach that, according to the BMC Family Practice journal, has been shown to have longer-lasting effects than sleep medications, without the side effects.
What Is CBT-I?
CBT-I is a highly effective, evidence-based treatment that helps people overcome chronic sleep difficulties without medication. Research shows that about 75% of people who complete CBT-I experience significant improvements in their sleep, with benefits that often last for years.
What makes CBT-I so successful is its focus on identifying and changing the underlying thoughts and behaviors that perpetuate insomnia, not just managing its symptoms. Chronic insomnia often continues because of unhelpful beliefs and habits that we’ve learned over time. Fortunately, these can be unlearned. Some common patterns and behaviors that interfere with sleep include:
- Worrying excessively about sleep or how little you’re getting
- Spending too much time in bed while awake
- Scrolling through your phone or checking social media in bed
- Going to bed too early, too late, or at inconsistent times
- Using your bed for work, TV, or other non-sleep activities
- Drinking caffeine too late in the day
- Relying on alcohol to fall asleep
- Trying to “force” sleep instead of letting it come naturally
- Associating the bed with frustration, anxiety, or restlessness
In as few as five structured sessions, CBT-I can help people gently rewire these patterns. From this, many people find that their sleep becomes deeper, more consistent, and less anxiety-inducing.
How CBT-I Works
In utilizing CBT-I, we don’t just talk with clients about their sleep disruptions; we teach them applicable tools to make sleep feel less stressful, less frustrating, and more restorative. Here’s what clients can expect from treatment:
- Cognitive Restructuring: We’ll identify, challenge, and replace unhelpful beliefs about sleep with more realistic and compassionate ones, often called “positive sleep thoughts.” This doesn’t mean pretending insomnia isn’t difficult. Rather, it helps shift the narrative from fear and frustration to something more grounded and empowering, reducing the emotional weight of insomnia itself.
- Sleep Scheduling Techniques: Together, we’ll develop a personalized sleep schedule based on your patterns, needs, and lifestyle. This includes adjusting the times you go to bed, wake up, and how much time you spend in bed to help restore your natural sleep rhythm.
- Stimulus Control Techniques: Our brains form strong associations between environments and behaviors. For example, you might feel a jolt of anticipation or anxiety just from hearing your phone’s ping because your brain has learned to associate it with stress or urgency. Similarly, if you’ve spent many nights awake and frustrated in bed, your brain may start to associate your bed with sleeplessness. Stimulus control helps you retrain your brain to connect your bed with sleep again.
- Sleep Hygiene Practices: You’ll learn simple, evidence-informed habits that support restful sleep like managing screen time, creating a calming bedtime routine, and adjusting caffeine intake or light exposure. These strategies are always adapted to your specific concerns and daily realities.
During therapy for anxiety, Sarah* (name changed for privacy) shared she was sleeping just 3–4 hours a night. Evenings were spent scrolling on her phone, followed by hours of tossing and turning. Mornings left her fatigued, irritable, and hopeless. We incorporated CBT-I and began addressing the unhelpful thoughts fueling her sleep anxiety. One belief stood out: “If I don’t fall asleep right now, tomorrow will be a disaster.” We gently challenged it, reframing it into something more balanced: “Even if I don’t sleep well tonight, I can still get through tomorrow because I have tools to help.” That shift eased the pressure she placed on sleep, making rest come more naturally. We also introduced small behavioral changes, like limiting phone use before bed and creating a consistent wind-down routine. After around five CBT-I sessions, Sarah was sleeping 6–7 hours a night and felt more alert during the day. Just as important, her relationship with sleep transformed from a nightly struggle to something she approached with calm and confidence.
CBT-I Is a Versatile and Complementary Short-Term Therapy Approach
CBT-I is a valuable, short-term approach to improving sleep—many people see significant results in just five sessions. It works well as a standalone treatment or as part of a broader therapy plan. CBT-I can also complement treatment for anxiety, depression, or medical concerns, where sleep issues often worsen symptoms by creating a cycle of poor rest, low energy, and increased stress. By improving sleep early on, CBT-I can help break that cycle and support your overall progress.
While CBT-I follows a structured approach, it’s never one-size-fits-all. Treatment is tailored to your unique needs, and we’ll work collaboratively to adapt it as we go. You can still expect warmth and compassion—just like in any other form of therapy. The goal is to integrate CBT-I seamlessly into your care so you can experience lasting results without losing momentum in other areas.
Good Sleep Can Be Yours
CBT-I is an evidence-based approach that can help you sleep better in just a few sessions. Good sleep is absolutely within reach, and you don’t have to face it alone.
