Cognitive Behavioral Therapy for Insomnia (online CBT-I) is an evidence-based treatment that focuses on changing thoughts and behaviors that cause difficulties. CBT-I for sleep addresses the underlying issues contributing to insomnia. Here’s an overview of CBT for insomnia and the components typically involved. Other forms of psychotherapy for insomnia can also be woven in.
Please feel free to contact me or set up a free consultation to discuss whether CBT-I for sleep difficulties might be helpful for you or a loved one. We can also discuss how other therapeutic techniques could be mixed in if you have other goals.
The Emergence of Cognitive Behavioral Therapy for Insomnia
Understanding the history of this method helps you see how its effectiveness and strength have emerged over time. Here’s an overview of that history:
Early Foundations of CBT for Insomnia
- 1960s-1970s: Behavioral approaches to insomnia emerged, rooted in classical conditioning principles. Psychologists recognized that poor sleep often became associated with certain bedtime behaviors or settings (e.g., anxiety linked to the bedroom).
- Stimulus Control Therapy: Developed by Dr. Richard Bootzin in 1972, this approach emphasized breaking negative associations with the bedtime environment and reinforcing positive behaviors. It remains a cornerstone of the approach.
Development of Cognitive Approaches
- 1980s: Cognitive techniques addressing unhelpful thoughts about sleep (e.g., “If I don’t sleep eight hours, I’ll fail tomorrow”) began to supplement behavioral strategies.
- Researchers linked insomnia to hyperarousal, both physiological and cognitive, further justifying the use of therapies aimed at calming the mind.
Emergence of CBT-I as a Unified Model
- 1990s-2000s: CBT-I for sleep was formally established as a combination of behavioral techniques (stimulus control, sleep restriction) and cognitive interventions (addressing worry and unrealistic sleep expectations).
- Studies showed CBT-I for sleep to be as effective as, or superior to, medication for long-term insomnia management, with fewer side effects.
Modern Advancements in CBT for Insomnia
- Digital Delivery: The 2010s saw the rise of online CBT for insomnia courses, making the therapy more accessible. These include apps and online courses guided by AI or professionals.
- Inclusion in Guidelines: Organizations like the American Academy of Sleep Medicine and the National Institute for Health and Care Excellence (NICE) recommend CBT-I as the first-line treatment for insomnia.
- Integration with Comorbidities: CBT for insomnia has been adapted for individuals with insomnia alongside other conditions, such as treatments for depression and anxiety, PTSD, and chronic pain.
CBT-I continues to evolve today, incorporating mindfulness-based techniques and focusing on personalizing interventions for greater effectiveness. It remains a gold standard treatment for insomnia.
Key Components of Online CBT-I for Sleep 
The following are the basic tenets of cognitive behavioral therapy for insomnia:
Step 1: CBTI for Sleep Education
We will start by discussing slumber cycles and what constitutes good sleep hygiene. This includes learning about biological processes such as circadian rhythms and pressure. This education prepares you for setting goals. What outcome do you want from cognitive behavioral therapy for insomnia? We’ll break this up into measurable steps so you can track your progress and stay motivated to improve.
We’ll also discuss things more generally, including creating an environment conducive to slumber (e.g., dark, quiet, and cool bedroom), avoiding caffeine, alcohol, and heavy meals before bedtime, and establishing a routine.
Step 2a: Cognitive Psychotherapy for Insomnia
Next, we will dive into the CBT portion of treatment. This revolves around identifying and challenging negative thoughts and beliefs. You’ll develop a more positive mindset about sleep capabilities and address anxiety related to insomnia. Along with the cognitive portion, you’ll also learn progressive muscle relaxation, deep breathing exercises, and meditation to reduce physical and mental tension.
Step 2b: Behavioral Psychotherapy for Insomnia
The next step is working to associate the bed and bedroom with slumber rather than wakefulness and to reduce the daytime-related anxiety that stays with you when you go to bed. Homework may include going to bed only when sleepy, getting out of bed if unable to doze, and maintaining a consistent wake-up time. You’ll limit the time spent in bed to the actual time spent sleeping to build a drive, gradually increasing time in bed as efficiency improves.
Effectiveness of Online CBT for Insomnia
1. Clinical Evidence *
- Short-term improvements: Studies show that online CBT-I significantly reduces the time it takes to fall asleep (sleep onset latency), decreases nighttime awakenings, and increases total sleep time.
- Sustained benefits: Unlike medication, online CBT-I provides long-term benefits. Many individuals maintain improvements in sleep quality for months or years after completing therapy.
- Efficacy across populations: Online CBT-I is effective for primary insomnia and for insomnia comorbid with conditions like anxiety, depression, or chronic pain.
2. Comparisons with Sleep Medications *
- Similar or superior outcomes: Research indicates that online CBT-I is as effective as, or more effective than, sleep medications in the short term.
- Fewer side effects: Unlike medications, online CBT-I has no pharmacological side effects or risks of dependency.
- Durability of results: While medications often provide temporary relief, online CBT-I addresses underlying issues, resulting in sustained improvements.
* Citation
Cognitive Behavioral Therapy for Insomnia Example
Cognitive Behavioral Therapy for Insomnia (online CBT-I) is a structured, evidence-based program, and Casey, a 28-year-old medical student, pursued it because of this. This fictional example shows how a online CBT-I for sleep program might be structured.
Online CBT for Sleep Assessment Phase
I start with a comprehensive interview to assess Casey’s history, current nighttime habits, and potential contributing factors to her insomnia. I ask questions about whether other family members have experienced the same issues and whether any other psychological challenges exist in her family. We cover all aspects of her life, including work, social, and hobbies, looking for possible sources of stress and contentment.
As part of the assessment, I asked Casey to track her sleep patterns for the next week with a specific journal covering quality, daytime sleepiness, and other related factors. She also uses an app that tracks the quality of her slumber and aspects that she may not be aware of.
Online CBT-I for Sleep: Psychoeducation
In our next session, I will educate Casey about practices that promote good rest, such as maintaining a regular schedule, creating a comfortable environment, and avoiding caffeine and electronics before bed. We go over the basics of circadian rhythm and the importance of rest. Then, we review the approach and what it will entail, including the types of homework she will be asked to do. Cognitive behavioral therapy for insomnia is a perfect choice for Casey, given how smart, insightful, and organized she is.
CBT for Insomnia: Behavioral Interventions
We learn from her journaling that Casey is having the most difficulty falling asleep, and then she wakes up once or twice and has trouble relaxing when this happens. We talk about some behavioral interventions that are typically used in CBT for insomnia, including:
- Stimulus Control: Strengthen the bed-rest connection by only using the bed for sleep, going to bed only when tired, and getting out of bed if unable to fall back after 20 minutes, even if it is late at night.
- Restriction: Limit the time spent in bed to match the amount of sleep one gets, gradually increasing it as efficiency improves. Specifically, she will change her bedtime to a little later and watch TV in another room until she feels tired.
- Relaxation Techniques: I teach Casey relaxation exercises like progressive muscle relaxation, deep breathing, or guided imagery to induce greater restfulness.
CBT for Insomnia: Cognitive Interventions
In addition to the behavioral interventions, there are cognitive techniques that are used with CBT for insomnia, including
- Cognitive Restructuring: We work to identify and challenge Casey’s unhelpful thoughts and beliefs (e.g., “I must get 8 hours of sleep to function”) and replace them with more realistic and positive ones (e.g., “I can do fine with less sleep as long as it is restful.”)
- Paradoxical Intention: We reduce the pressure of bedtime by encouraging her to stay awake and avoid trying too hard to sleep. The homework after session two is to stay up a full hour later than usual and continue to journal to see what effects that produces.
CBT for Sleep Difficulties and Hygiene
Along with the specific CBT-I techniques above, Casey will more generally work to improve her nighttime routine, including:
- Maintaining a consistent sleep schedule (any changes we make, she’ll do for at least a week or two).
- Create a restful bedtime environment using apps to promote rest and mindfulness.
- Limiting exposure to screens and bright lights before bed.
- Avoiding caffeine and heavy meals close to bedtime. She realizes, for example, that she should not have desserts containing chocolate after dinner.
- She incorporates regular physical activity into her day, but not too close to bedtime.
Online CBT-I for Sleep Sessions
Here is how the example above is broken down into sessions.
Session 1: Initial Assessment and Sleep Education
- Objective: Gather information and educate.
- Activities:
- Review her sleep diary and questionnaires.
- Discuss her sleep history and current issues as far back as childhood.
- Explore her family history of insomnia, anxiety, and stress management concerns.
- Discuss other stressors now and in her recent history
- Educate her about sleep hygiene and the basics of rest
Session 2: Introduction to Cognitive Behavioral Therapy for Insomnia
- Objective: Implement stimulus control and rest restriction.
- Activities:
- Introduce stimulus control and other CBT methods.
- Develop a sleep restriction schedule based on the diary.
- Teach relaxation, mindfulness techniques, and simple meditations.
Session 3: Cognitive Techniques (CBT for Insomnia)
- Objective: Address unhelpful thoughts and beliefs about sleep.
- Activities:
- Introduce cognitive restructuring – how it works and what will be involved.
- Practice identifying and challenging unhelpful thoughts.
- Continue to monitor her sleep diary and adjust behavioral techniques as needed.
Session 4: Review and Adjust
- Objective: Evaluate progress and make necessary adjustments.
- Activities:
- Review her progress with her diary and questionnaires.
- Adjust the restriction schedule if necessary, but not more often than weekly.
- Reinforce cognitive and behavioral techniques, what is working, and what could work better.
- Introduce paradoxical intention if needed.
Session 5: Maintenance Strategies
- Objective: Plan for long-term maintenance of good sleep habits.
- Activities:
- Discuss strategies for preventing relapse based on the triggers she’s learned.
- Create a plan for maintaining sleep improvements.
- Schedule follow-up sessions if needed – she decides to continue to come in every two weeks until she feels that she has made all the gains she set out to make.
This structure provides a comprehensive approach to CBT-I for sleep, focusing on the behavioral and cognitive aspects of her difficulties.
CBT-i for Sleep Q&A
Q: What is CBT for Insomnia (Online CBT-I)?
A: Cognitive Behavioral Therapy for Insomnia (CBT-I) is a scientifically proven, non-medication treatment for chronic insomnia. It is designed to help individuals identify and change the thoughts, behaviors, and habits that interfere with healthy sleep.
CBT-I works by addressing the root causes of insomnia rather than just the symptoms. Many people with insomnia develop anxiety around sleep, irregular sleep schedules, or habits, like using screens in bed or spending too much time awake in bed, that unintentionally make sleep worse. CBT-I helps reverse these patterns through a combination of strategies, including:
- Cognitive techniques to challenge negative thoughts like “I’ll never be able to fall asleep” or “If I don’t sleep 8 hours, I can’t function.”
- Behavioral strategies such as:
- Sleep restriction to improve sleep efficiency by limiting time in bed
- Stimulus control to strengthen the mental link between bed and sleep
- Relaxation training to calm the mind and body before bedtime
- Sleep hygiene education to adjust habits around caffeine, alcohol, screen use, and bedtime routines
CBT-I is typically delivered over 4 to 8 weekly sessions and can be done in-person, via telehealth, or through guided online programs. Unlike sleeping pills, which can lose effectiveness over time, CBT-I offers long-term improvements and often eliminates the need for medication altogether.
Leading medical organizations, including the American Academy of Sleep Medicine and the American College of Physicians, recommend it as the first-line treatment for chronic insomnia.
Q: What is CBT-i used for?
A: CBT-I is primarily used to treat chronic insomnia—difficulty falling asleep, staying asleep, or waking up too early. It’s also helpful for people who experience sleep anxiety, rely on sleep medications, or struggle with irregular sleep patterns due to stress, anxiety, or other mental health concerns.
Q: What is CBT therapy for insomnia?
A: CBT therapy typically includes:
- Sleep education – Understanding how sleep works
- Cognitive strategies – Challenging negative thoughts about sleep
- Sleep restriction – Matching time in bed with actual sleep time
- Stimulus control – Strengthening the bed-sleep connection
- Relaxation techniques – Reducing mental and physical tension before bed
- Sleep hygiene – Adjusting lifestyle habits that affect sleep
Q: What is the best therapy for insomnia?
A: Yes. Research shows CBT-I is more effective and longer-lasting than sleeping pills for most people. It’s considered the gold standard treatment for insomnia by organizations like the American College of Physicians.
Most people begin to see improvement within 4 to 8 weeks. Some notice better sleep within the first two weeks, especially when following the plan consistently.
Q: Is there online CBT for sleep?
A: Absolutely. I offer online CBT for sleep, including:
- Using a Secure Telehealth Platform
- I conduct online CBT for sleep via a HIPAA-compliant video platform
- Online CBT for sleep sessions are typically 45–60 minutes and occur weekly over 4–8 weeks.
- Following a Structured online CBT for sleep Protocol
This includes:
- Assessment & Sleep Diary: Start with a sleep history and daily sleep logs.
- Psychoeducation: Teach clients how sleep works and what affects it.
- Stimulus Control: Help clients associate bed with sleep only.
- Sleep Restriction Therapy: Align time in bed with actual sleep time.
- Cognitive Restructuring: Address and reframe unhelpful sleep-related thoughts.
- Sleep Hygiene & Relaxation Techniques: Optimize lifestyle and mental habits that impact sleep.
- We May Use Digital Tools to Enhance Treatment
I incorporate online tools such as:
- Sleep diaries (via email or online apps)
- CBT therapy for sleep apps (as homework supplements)
- Automated reminders or sleep log review between sessions
- We’ll Track Progress
- Review sleep diary data weekly (use spreadsheets or apps)
- Adjust time-in-bed recommendations based on sleep efficiency
- Monitor cognitive and behavioral changes over time
- Provide Follow-Up and Maintenance
- Offer booster sessions or check-ins after the main treatment phase
- Encourage continued use of learned strategies
Q: How do I do CBT therapy for sleep?
A: You can work with a trained therapist like me who does online CBT therapy for sleep. The process typically involves:
- Tracking your sleep habits with a diary
- Creating a consistent sleep-wake schedule
- Limiting time in bed to build strong sleep pressure
- Avoiding stimulating activities in bed (like phone use)
- Practicing relaxation or mindfulness before bed
- Replacing negative thoughts with realistic sleep expectations
Online CBT therapy for sleep is usually as effective as in-person therapy.
CBT-I for Sleep in My Practice
The following are the steps involved in CBT-I for sleep difficulties and what to expect with each:
- Assessment: This is the initial evaluation of your patterns, habits, and potential causes of insomnia. We’ll trace this back as far as you’ve had these challenges.
- Goal Setting: We will establish specific, measurable goals for improvement. This will help you see your progress and stay motivated throughout treatment.
- Intervention: Next, we will implement CBT-I techniques for insomnia. Usually, this means meeting weekly for 4-6 weeks before potentially moving to an every-other-week model. You will keep a diary between sessions to track progress and identify patterns.
- Adjustment: We will modify CBT for insomnia techniques based on your response to treatment.
- Maintenance: When you have seen satisfactory improvement, we’ll develop a long-term plan to sustain your improvements. This may include coming in for booster sessions as necessary.
Cognitive Behavioral Psychotherapy for Insomnia: Possibilities
I offer several possibilities for clients to receive CBT therapyfor sleep:
- Individual Therapy: One-on-one sessions are the most frequent type of cognitive behavioral therapy for insomnia. These sessions are easy to deliver virtually, so I serve most states in the US.
- Couples Therapy: CBTI for sleep challenges can be delivered to couples if both people are experiencing insomnia or one person is experiencing issues and the other person wants to help.
- Family Therapy: Similar to couples therapy, CBT-I for sleep can work in family treatment to help one or more members while others provide support.
- Integrated Therapy: CBT for insomnia can be one part of a more comprehensive treatment plan. Many people who receive cognitive behavioral therapy for insomnia also want to address other challenges and barriers.
Referrals for CBT Therapy for Sleep
I would happily set up a free consultation if you’re considering online CBT-I for sleep problems. We can discuss whether cognitive behavioral therapy for insomnia suits your situation. If not, we can discuss whether another psychotherapy for insomnia technique may work, or I can refer you to outside providers with other specialties.
