Cognitive behavioral therapy for insomnia (CBT-I) is a treatment for chronic insomnia that addresses the habits and thought patterns that interfere with sleep. CBT-I is often recommended as the initial treatment for chronic insomnia.

Around 10% to 15% of adults in the United States experience chronic insomnia. Chronic insomnia is a sleep disorder in which a person has difficulty falling or staying asleep three or more times each week for at least three months. If left untreated, chronic insomnia can cause daytime sleepiness, mood changes, and increase the risk of other health conditions.

CBT-I helps to identify and correct the underlying causes of insomnia while establishing more helpful sleep habits. Experts believe that there are a variety of causes of chronic insomnia, which fall into several categories:

• Predisposing Factors: Factors such as genetics, childhood experiences, and certain health conditions can increase your risk of developing chronic insomnia.
• Precipitating Factors: Factors like a stressful or traumatic event, an illness, or an injury may trigger sleep issues.
• Perpetuating Factors: These are behaviors or ideas that make it more difficult to sleep, like watching television in bed, napping excessively, or staying in bed too long after having trouble falling asleep.
• Conditioned Arousal: This occurs when your bed or bedroom is no longer associated with sleep and is instead associated with anxiety and sleep difficulties.
  

CBT-I addresses both the perpetuating factors and conditioned arousal that contribute to chronic insomnia. CBT-I uses a combination of cognitive and behavioral interventions to address the way you think about sleep as well as your actions and habits around bedtime.

Treatment often involves working directly with a mental health professional. CBT-I can be administered by psychiatrists, psychiatric nurse practitioners, therapists, or nurses. In addition to one-on-one talk therapy, group, telephone, and online CBT-I formats can be effective.

Most people diagnosed with chronic insomnia are good candidates for CBT-I. It's also a good choice for people who want to avoid medications and for those with other mental or physical health conditions.

Research shows that CBT-I is an effective treatment for chronic insomnia and for people experiencing insomnia who have other health issues. Insomnia symptoms usually improve slowly as the therapy progresses over several weeks, with improvements often persisting even after treatment ends.

Most research has focused on CBT-I provided through one-on-one, in-person therapy sessions. Other delivery methods have been found to have promising results, including video sessions, telephone sessions, group therapy, and web-based therapy.

CBT-I is more effective for treating insomnia than medication alone. Both short- and long-term studies have shown that CBT-I is equally effective with or without medication. Many professional organizations recommend starting with only CBT-I because it helps people develop healthy sleep habits and avoid potential side effects of medications.

CBT-I is widely accepted as the first-line treatment for chronic insomnia. However, not everyone responds to CBT-I. In these cases, medication can be added to further improve symptoms.

While CBT-I is a safe treatment for chronic insomnia, certain groups of people may be at a higher risk for unwanted side effects. The initial stages of sleep restriction therapy can result in temporary sleep loss. Some people are more sensitive to sleep loss and, as a result, are more likely to have an adverse reaction. This includes:

• People with seizure disorders
• People with untreated bipolar disorder
• Anyone recovering from an injury, surgery, or illness
• People already experiencing excessive daytime sleepiness
• People facing occupational safety risks such as transportation workers

People starting CBT-I should discuss any concerns or pre-existing health conditions with their healthcare team. The therapist or provider can adapt the treatment plan to accommodate a person’s individual needs.

For some people, starting CBT-I treatment can cause anxiety. It may be uncomfortable for people who have never tried therapy, but many people find it helpful to remember that they will be working with a trained professional.

This is an 8-week program, with most people seeing results in as little as 2 weeks.