What is CBT-I?

Cognitive Behavioral Therapy for Insomnia is a short-term, evidence-based treatment that addresses the patterns keeping chronic insomnia in place. It's recommended as the first line treatment for chronic insomnia by the American College of Physicians and the American Academy of Sleep Medicine.

Why CBT-I works when other things haven't

Many of the things we try when we can't sleep accidentally make insomnia worse.  Strategies such as going to bed earlier, sleeping in on weekends, staying in bed longer in the morning all add to insomnia instead of making you feel better.

What happens in treatment

CBT-I is structured, organized, and time limited. Most people finish in four to eight weekly sessions. Each session builds on the last.

Session 1 — Assessment

We take a thorough look at your sleep history, current patterns, medical and psychiatric factors, and what you've already tried. You'll start keeping a simple sleep diary.

Sessions 2–3 — Consolidate sleep

Using your sleep diary, we set a personalized sleep schedule designed to consolidate your sleep into a solid block and let your body's natural sleep pressure rebuild. This is the part of treatment that does most of the heavy lifting.

Sessions 4–5 — Cognitive work

We address the thoughts that keep your nervous system on alert at night such as worrying, clock-watching, and agonizing about how difficult things will be if you don't sleep.You'll learn techniques to defuse these thoughts.

Sessions 6–8 — Fine-tuning and relapse prevention

As your sleep consolidates, we gradually expand your sleep window and plan for the inevitable bad nights. You'll leave with a written plan for handling future disruptions on your own.

The evidence

CBT-I has been studied in hundreds of clinical trials over four decades. Roughly 70–80% of people who complete treatment experience significant improvement, and gains tend to hold up over time better than with sleep medication. Telehealth CBT-I has been shown to be as effective as in-person treatment.

What CBT-I is not

• It's not sleep hygiene tips. Sleep hygiene alone rarely resolves chronic insomnia.
• It's not medication. I'm not a prescriber but I'll coordinate with yours if you want to stop or modify your medication.
• It's not open-ended therapy. CBT-I has a beginning, a middle, and an end.
• It's not relaxation training, though relaxation tools may be part of it.

Is CBT-I right for you?

CBT-I is a good fit if your primary concern is insomnia, meaning trouble falling asleep, staying asleep, or waking too early that lasts more than a few weeks. It's effective even when insomnia coexists with depression, anxiety, or chronic pain. Some conditions (untreated sleep apnea, certain circadian rhythm disorders, severe unmanaged psychiatric illness) call for different or additional care first; we'll sort that out in the consult.