Medically reviewed by:
Dr. Shiyan Yeo, MD | Internal Medicine Physician
School of Medical Sciences, University of Manchester
Cognitive Behavioral Therapy for Insomnia (CBT-I) is the gold-standard treatment for chronic insomnia, recommended by the American Academy of Sleep Medicine as the first-line treatment—even before medication.
Clinical studies show that 70-80% of people with insomnia see significant improvements, and unlike sleeping pills, the benefits last long after treatment ends. CBT-I works by retraining your brain's sleep patterns through proven techniques developed at leading sleep centers like Stanford and Harvard.
At Sleep Reset, our CBT-I program is led by sleep medicine physicians and psychologists with specialized training in behavioral sleep medicine. Here's everything you need to know about how CBT-I works, what to expect, and whether it's right for you.
Cognitive behavioral therapy for insomnia (CBT-I) is an evidence-based therapeutic approach that looks at the way you think, what you do, and how you sleep. Using this method, you'll be treated by a CBT-I provider who will try to pin down what thoughts and behaviors are potentially causing your insomnia. The American Academy of Sleep Medicine recognizes CBT-I as an effective treatment for chronic insomnia disorder in adults.
CBT-I works on the principle that issues like insomnia are based, in part, on unhelpful behavior and unhelpful ways of thinking. When certain thoughts and beliefs about sleep that hinder rest are identified, you'll work to change those thoughts and overcome those obstacles to sleep, helping patients with insomnia get deeper sleep and sleep through the night. If you're wondering "does CBT-I work for insomnia," the answer is a resounding yes.
Cognitive behavioral therapy requires increased self-awareness, and cognitive restructuring to be effective. Research published in Sleep Medicine Reviews demonstrates that this psychological treatment takes time, but a good night's sleep is well worth the effort.
When you're suffering from chronic insomnia, you may be up most of the night or your sleep may not be restful. With CBT-I treatment, you'll replace the habits and thoughts that cause these problems with healthy sleep patterns. CBT-I treats your sleep problems at the source, so you can sleep without sleep medication or supplements. Learn more about how CBT works for sleep improvement.
According to clinical trials published in the Journal of the American Medical Association, cognitive sleep therapy follows a basic structure and uses multiple tactics, including:
Studies in Sleep Medicine show that this comprehensive approach significantly improves sleep efficiency in adults with insomnia.
Negative thoughts or associations with sleep can be a vicious cycle for insomnia sufferers. When someone with chronic insomnia disorder goes to sleep at night, they may be thinking about their insomnia or the consequences of not getting enough sleep that night. This can cause them stress and anxiety that prevents them from falling asleep.
Through cognitive restructuring, these negative thoughts will be identified and discussed. Research in Behavior Research and Therapy shows that the key is to change these thoughts and restructure them to be more positive. Cognitive restructuring can greatly reduce your sleep anxiety and help you to calm your thoughts and your racing mind at night. Through CBT-I, you'll learn to reset your expectations, recognize and overcome negative thoughts when they occur, and sleep more soundly.
Your bedroom should be a calm and restful place. For people suffering from insomnia, it can be the opposite. Stimulus control in CBT-I involves removing wakeful stimuli from the bedroom. Studies published in Sleep Medicine Clinics demonstrate that this means no TV in the bedroom, no eating, no working, etc. Instead, your bed should be used exclusively for sex and sleep in order to create a positive and stress-free association with your bedroom.
Removing stimuli also means that someone with insomnia shouldn't linger in their bedroom when their condition is keeping them up. If you're not able to fall asleep in about 10 to 15 minutes, it's time to go to another room and try again when your eyes are heavy and you feel like you're about to fall asleep.
It also helps to get out of bed at the same time every morning and avoid longer naps. Research in the Journal of Clinical Sleep Medicine shows this will help you manage your sleep schedule and only sleep in your bedroom.
Speaking of your sleep schedule, sleep restriction and compression can help make it more regular. Lying in bed awake can keep insomnia sufferers from achieving regular sleep patterns and optimal sleep efficiency.
Sleep restriction or compression involves setting a new stricter sleep schedule that limits a person's time in bed. At its most rigid, an individual's temporary sleep schedule is roughly 5 hours. Clinical research published in Sleep demonstrates the effectiveness of this approach. For a detailed explanation of how sleep restriction therapy works, you can explore our comprehensive guide.
While it may seem counterintuitive to sleep fewer hours when you're already struggling to get enough sleep, SRT adjusts your internal sleep drive (your natural hunger for sleep), and your circadian rhythm. Studies in the American Journal of Psychiatry show this process improves sleep efficiency significantly.
Through this process, your sleep quality will improve and you begin to fall asleep quickly after getting into bed. Your sleep schedule will also begin to expand, until you're back and getting the appropriate amount of sleep for you.
Relaxation training can help you relax your body and mind, making it easier to fall into a deep sleep. Insomnia can usually cause your thoughts to race and your body to feel stressed, so these techniques can help you calm down at the end of the night.
Research published in Applied Psychology: Health and Well-Being shows that relaxation exercises are recommended during the course of cognitive behavioral therapy for insomnia:
Breathing exercises can help to increase your mindfulness and get your body to a restful state. Studies in Psychosomatic Medicine show that typically, you'll do exercises where you take slow, deep breaths. With mindful breathing, you can regulate stressful emotions and bring your heart rate down before heading to bed.
Meditation can help you focus your mind, allowing you to let go of stressful thoughts for the night. Research in JAMA Internal Medicine demonstrates that meditation also helps with your breathing, so you can combine this with your breathing exercises if you want. When you meditate, you can reduce your stress and mental health concerns before bed. This makes it easier to fall asleep and avoid thinking negative thoughts.
Biofeedback monitoring can track your heart rate, temperature, breathing, and more. Studies published in Biofeedback and Self-Regulation show that with biofeedback data, you can monitor how your sleep is changing from night to night, and you can find out if you're improving. Using biofeedback devices can also help you see if your other relaxation techniques are making a difference.
Progressive muscle relaxation helps you relax your body. Research in Behaviour Research and Therapy shows it involves tensing and relaxing your different muscle groups. You can also incorporate breathing exercises into your progressive muscle relaxation routine.
Autogenic training is a technique that helps you be more aware of your body and the sensations it feels. Studies in International Journal of Clinical and Experimental Hypnosis demonstrate that during autogenic training exercises, you'll focus on specific parts of the body and let yourself feel and notice the sensations that occur.
Incorporating these habits before bed can help get your body and mind ready for sleep. Your body and mind will also begin to associate these rituals with bedtime, helping you to relax even further.
Having good sleep hygiene is another way to improve your sleep quality and combat symptoms of insomnia. Sleep hygiene is the habits and routines you have that involve sleep. But that doesn't just mean changing your habits and routines right before bed. Research published in Sleep Medicine Reviews shows that having mindful habits throughout the day helps to promote better sleep at night.
Here are some habits you can follow to get better sleep hygiene, supported by sleep medicine research:
Exercise regularly - Studies in Sleep Medicine show that exercise helps your body tire and crave rest. Try to exercise 30 minutes per day, but make sure it's not too close to bedtime.
Limit caffeine - No, you don't have to cut out your morning coffee. But research in the Journal of Clinical Sleep Medicine shows it is a good idea to avoid consumption in the afternoon. Caffeine can stay in the system for up to 7 hours, depending on the person.
Avoid late night eating - Digestion makes your body work pretty hard, so avoid eating before bed, especially if it's a big meal. Studies published in Nutrients demonstrate that normal eating habits help prevent hunger before going to bed. Learn more about eating before bed and its effects on sleep.
Avoid alcohol right before bed - There's nothing wrong with a glass of wine, but research in Sleep Medicine Reviews shows that drinking close to bedtime could cause you to wake up and get lower quality sleep. For more information, check out our detailed guide on alcohol and sleep.
Create a comfortable bedroom - Drop your thermostat somewhere between 60°F and 67°F, invest in comfortable bedding and a good mattress, and keep your room dark and quiet. Studies in Sleep Medicine support these environmental factors for better sleep. For specific guidance, read our article on the best temperature for sleep.
These are just a few examples of sleep hygiene. The more you can incorporate into your daily life, the better your sleep will be. The American Academy of Sleep Medicine provides comprehensive guidelines for optimal sleep hygiene practices. For additional tips, explore our guide on improving sleep hygiene.
Cognitive behavioral therapy for insomnia can be incredibly effective as a treatment for insomnia. According to a comprehensive study from the National Library of Medicine, 70% to 80% of individuals noticed improvements to their insomnia. These improvements included falling asleep faster and sleeping more, with significant improvements in sleep efficiency.
The American College of Physicians also recommends cognitive behavioral therapy for insomnia as the first treatment option for those with chronic insomnia. Research shows that CBT-I is effective even for complex cases, including patients with bipolar disorder and other mental health conditions.
One of the biggest benefits of cognitive behavioral therapy is it doesn't require pills or sleep medication. Studies published in Sleep show it can also be more effective than medication and the results can be more permanent. CBT can be beneficial for sleep problems in general, particularly as psychological treatments that address the root causes of sleep disorders.
With that being said, cognitive behavioral therapy isn't an overnight process. It does take time and effort on the part of the patient. The results will come gradually, and incorporating the above techniques will require changes to your routine. Research recommends keeping a daily sleep diary to track your progress and see what kind of improvements you're making and how long it takes for those improvements to occur.
Cognitive behavioral therapy is often the first course of action for chronic insomnia disorder in adults. Sleep medicine specialists recommend trying to change your habits and your lifestyle before resorting to different measures, like medication. If you're considering your options, our comparison of CBT-I vs sleeping pills can help you make an informed decision.
Both cognitive behavioral therapy for insomnia and sleep medications can improve sleep, but they work in fundamentally different ways and have distinct advantages and disadvantages. Understanding these differences can help you make an informed treatment decision.
CBT-I:
Sleep Medications:
✅ No physical dependence or addiction risk
✅ No side effects (beyond temporary sleepiness during initial treatment)
✅ Benefits persist after treatment ends
✅ Teaches lifelong skills for managing sleep
✅ Addresses root causes of insomnia
✅ No morning grogginess or cognitive impairment
✅ Safe for long-term use
✅ No drug interactions
✅ Effective for comorbid conditions (depression, anxiety, chronic pain)
✅ Recommended as first-line treatment by medical organizations
❌ Takes longer to work (2-4 weeks vs. immediate)
❌ Requires effort and adherence to behavior changes
❌ Limited availability of trained providers
❌ Can be costly (though often covered by insurance)
❌ Temporary increased sleepiness during initial treatment
❌ May be challenging for those with cognitive impairments
❌ Needs ongoing practice to maintain skills
When you're trying to improve your sleep, it can be difficult to do it on your own. Look for a personalized CBT-I program that comes with human support - i.e. a sleep coach! Here are just a few things your sleep coach can do for you:
Ready to learn more? Learn more below.
Digital cognitive behavioral therapy for insomnia (dCBT-I) makes this evidence-based treatment more accessible through online platforms, smartphone apps, and web-based programs. These digital tools can be effective alternatives when in-person therapy isn't available or affordable.
1. Fully Automated Programs
These programs guide users through CBT-I without therapist involvement:
Sleep Reset
Sleepio (Big Health)
SHUTi (now Somryst by Pear Therapeutics)
Cognitive Behavioral Therapy for Insomnia (CBT-I Coach)
Research published in Sleep Medicine Reviews indicates:
Good candidates:
May need in-person therapy:
Consider these factors:
Limitations of Digital Programs:
Professional Recommendations:
The American Academy of Sleep Medicine states that while in-person CBT-I remains the gold standard, digital CBT-I is an acceptable alternative when:
Many sleep specialists now recommend starting with digital CBT-I, then transitioning to in-person therapy if needed.
While CBT-I is considered a safe treatment with minimal risks compared to sleep medications, patients should be aware of potential temporary challenges during treatment.
1. Increased Daytime Sleepiness (Most Common)
2. Irritability and Mood Changes
3. Difficulty Concentrating
4. Initial Sleep Worsening
Emotional Discomfort:
Risk of Non-Adherence:
Reach out to your CBT-I therapist if you experience:
The temporary increase in sleepiness during treatment means patients should:
Unlike sleep medications, CBT-I does not cause:
These advantages make CBT-I particularly suitable for long-term use and for patients who cannot tolerate or prefer to avoid medications.
CBT-I (Cognitive Behavioral Therapy for Insomnia) is highly effective for many people, but it may not be suitable for everyone. Individuals with certain mental health conditions, complex sleep disorders, or medical issues should consult a healthcare professional before starting CBT-I.
While digital CBT-I is the most popular option today, some people prefer an in-person provider. Finding a qualified cognitive behavioral therapy for insomnia specialist is essential for receiving effective treatment. Here are professional resources and strategies for locating trained providers.
1. Society of Behavioral Sleep Medicine (SBSM)
2. American Board of Sleep Medicine (ABSM)
3. American Academy of Sleep Medicine (AASM)
4. American Psychological Association (APA)
5. Association for Behavioral and Cognitive Therapies (ABCT)
Ideal Credentials:
Training Programs:Providers may have trained through:
Questions to Ask Potential Providers:
Sleep Medicine Centers:
Psychology/Psychiatry Departments:
Primary Care Referral:
National Telehealth Platforms:
Limited Availability:
Cost Concerns:
Long Wait Times:
Red Flags to Avoid:
For Special Populations:
Finding the right CBT-I provider may take effort, but it's a critical step toward effective treatment. Don't hesitate to consult multiple providers to find the best fit for your needs.
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Yes, CBT-I (Cognitive Behavioral Therapy for Insomnia) is highly effective for treating insomnia. Clinical research demonstrates that 70-80% of people with chronic insomnia see significant improvements with CBT-I treatment. The American Academy of Sleep Medicine and the American College of Physicians both recommend CBT-I as the first-line treatment for chronic insomnia disorder in adults. Unlike sleep medication, CBT-I addresses the root causes of insomnia and provides long-lasting results without side effects or dependency concerns. For more detailed information, read our comprehensive guide on fighting insomnia with CBT-I.
CBT-I includes several evidence-based exercises and techniques:
These techniques work together as psychological treatments to address the behavioral and cognitive factors that contribute to insomnia symptoms. For specific guidance on managing sleep anxiety, explore our article on how to get rid of sleep anxiety.
CBT-I works by targeting the thoughts, behaviors, and habits that contribute to poor sleep. The therapy addresses three main areas:
Sleep medicine research shows that CBT-I improves sleep efficiency by helping people fall asleep faster, stay asleep longer, and spend less time lying awake in bed. The treatment typically takes 6-8 sessions and provides lasting improvements in sleep patterns without the need for sleep medication. This approach is particularly effective for adults with insomnia because it teaches sustainable skills for long-term sleep health and improved mental health outcomes.
Dr. Shiyan Yeo, MD | Internal Medicine Physician
Dr. Shiyan Ooi is a medical doctor with over 10 years of experience treating patients with chronic conditions. She graduated from the University of Manchester with a Bachelor of Medicine and Surgery (MBChB UK) and spent several years working at the National Health Service (NHS) in the United Kingdom, several Singapore government hospitals, and private functional medicine hospitals. Dr. Ooi specializes in root cause analysis, addressing hormonal, gut health, and lifestyle factors to treat chronic conditions. Drawing from her own experiences, she is dedicated to empowering others to optimize their health. She loves traveling, exploring nature, and spending quality time with family and frie``
Fax number: (984) 888-8385