Sleep hygiene is mostly a list of things not to do. For someone whose sleep is basically fine, avoiding caffeine late and keeping a consistent bedtime can make the difference between good nights and great ones. For someone with chronic insomnia, the problem usually isn't habits, it's that the brain has learned to associate the bed with being awake, and long stretches in bed have weakened the body's natural sleep pressure.
Tightening hygiene doesn't unwind those associations. You can do everything "right" and still lie awake.
CBT-I addresses the two things sleep hygiene can't reach: the learned association between bed and wakefulness, and the scattered sleep schedule that has weakened your sleep pressure. Resolving both is what turns chronic insomnia back into restful sleep.
It means the problem isn't a character flaw or a sign you need to try harder. There's a specific, well-studied treatment that works — and you haven't tried it yet.
]]>Both the American College of Physicians and the American Academy of Sleep Medicine recommend CBT-I as the first-line treatment for chronic insomnia, before medication. The reasons are practical: CBT-I works as well or better in head-to-head trials, and its effects last longer after treatment ends.
Hypnotics can help you get through an acute rough patch — the week after a death, the first nights in a new country, a short-term crisis. In those situations, they're a real tool.
If you want to come off sleep medication, CBT-I gives you a framework to do it while the conditions for natural sleep are restored. I work alongside your prescriber on the taper — I don't ask anyone to stop medication to start treatment.
This article is general information, not medical advice. Don't change prescribed medication without talking to the prescriber.
]]>After you book, you'll get an email with secure paperwork to complete online — consent forms, a practice policy, and a sleep questionnaire. You'll also start a simple sleep diary that takes about a minute each morning.
We spend most of this session on your sleep history and what you've already tried. I'll ask about your medical history, any medications, caffeine and alcohol, shift schedules, and what a typical night looks like now. By the end, you'll have a clear picture of what we're working with and a plan for the next two weeks.
Each session starts with your sleep diary from the previous week. We use it to fine-tune your plan, troubleshoot what isn't working, and adjust the approach as your sleep responds. Most of the change happens between sessions, in the small, specific shifts we plan together.
Sessions run on a HIPAA-compliant video platform. You'll get a unique link before each appointment. All you need is a private space, a stable connection, and a device with a camera. Earbuds help with privacy if others are home. If the video cuts out, we switch to phone.
Because CBT-I is built around schedule and behavior, it doesn't need an office. You can do it from your own bedroom — which, honestly, is often helpful. Seeing your setup lets us make it part of the work.
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