Cognitive Behavioral Therapy for Insomnia (CBT-I): An Effective, Pill-Free Treatment for Sleep Problems

Do you lie in bed awake staring at the ceiling or constantly checking your clock because you just can’t fall back asleep? Do you feel sluggish or sleepy during the day? If you have experienced multiple sleepless nights, chances are you are familiar with some of the challenges of insomnia.

The occasional bad night’s sleep is OK. But when sleep problems become frequent, they can affect your physical and mental health. 

More than 1 in 3 adults in the U.S. sleep less than 7 hours a night. Studies estimate that anywhere from 6% to 30% of people have insomnia. And when you have trouble sleeping, it can sometimes feel like the only treatment is sleeping pills. 

But there is actually a safer, more effective way to treat insomnia. 

What is CBT-I?

CBT-I is a type of therapy that helps people with insomnia sleep better. CBT-I is usually done in person or online, either one-on-one or in a group setting. During CBT-I treatment, you will: 

• Learn how your thoughts, feelings, and behaviors may be causing poor sleep

• Learn how to change these unhelpful thoughts and behaviors that affect your sleep

• Keep a sleep log to identify and track sleep patterns, which you and your CBT-I therapist will use to develop a personalized treatment plan to help you sleep better

How does CBT-I treat insomnia?

CBT-I uses three main techniques to treat insomnia. They involve:

1. Retraining your brain and the subconscious thoughts it has around your bed and sleep

2. Changing your sleep schedule

3. Reframing any unhelpful thoughts or anxiety you have about sleep

Retraining your brain 

This technique is sometimes called stimulus control. It retrains your brain to link your bed with restful sleep.

Here are some ways you can do this:

• Go to bed only when you feel sleepy. Sleepy is different from tired. When you are tired, your energy level feels low. When you are sleepy, you will have trouble keeping your eyes open.

• Avoid any activities in bed that keep you awake. These include watching TV, using your phone, or working in bed. Use your bed only for sleeping and sex.

• Don’t look at the clock. If you cannot fall asleep within 10 minutes, leave your bed and go to another room without checking the time.

• Wait until you’re sleepy. Return to bed only when you feel sleepy again. 

• Keep doing it. Repeat the above steps as often as needed.

• Maintain a good sleep schedule. Set an alarm to wake up at the same time each morning.

Sleep scheduling

Sleep scheduling involves reducing time spent in bed. This may seem strange at first, but it actually can:

• Increase your body’s natural sleep drive

• Improve sleep quality

• Reduce broken sleep

Which would you pick, 6 hours of deep sleep or 9 hours of broken sleep? With sleep scheduling, you will be in bed for a shorter time, but your sleep will be more restful, with fewer interruptions. Short-term side effects like daytime sleepiness and irritability are possible. But they usually improve as the quality of your sleep improves. 

For this sleep scheduling part, it is best to get help from a CBT-I specialist. This is because it requires a plan that is specific to you and your sleep needs. And it is not recommended in some medical and psychiatric conditions. We go through this in more detail below.

Changing your thoughts

This is sometimes called cognitive restructuring. It involves changing unhelpful thoughts and beliefs about sleep that increase anxiety and make it harder to rest.

For example, when you’re sleeping poorly, it is easy to think thoughts like: 

• “I probably won’t sleep well tonight.” 

• “I need to get 8 hours of sleep tonight in order to get through tomorrow.” 

But these thoughts can increase sleep-related anxiety.

With CBT-I, people learn how to replace these thoughts with more realistic and accurate ones that can lessen sleep-related anxiety. For example, you might start saying to yourself: 

• “Not every person needs 8 hours of sleep each night.”

• “CBT-I improves sleep in most people. With practice, it can help me sleep better too.”

Additional CBT-I techniques

Two other strategies that can help during CBT-I are sleep hygiene and relaxation techniques.

While it cannot cure insomnia, sleep hygiene helps create a better sleep environment and build healthy habits that promote sleep. Here are some helpful sleep hygiene tips:

• Create a consistent routine. Wake up at the same time daily, including on weekends, to train your body’s internal clock. Create a nightly wind-down routine to help your brain and body ease into bedtime.

• Be active. Daytime physical activity can help you sleep better.

• Avoid naps, or limit naps to 20 to 30 minutes. Long daytime naps make it harder to sleep at night.

• Put away electronics at least 30 to 60 minutes before bedtime. This will reduce mental stimulation and blue light exposure and create a healthier sleep environment.

• Avoid substances that can interfere with sleep. These include caffeine, nicotine and alcohol.

• Avoid large meals before bedtime. A heavy meal can lead to digestion issues — like bloating or acid reflux — and interfere with sleep. 

• Create a comfortable sleeping environment. A cool, dark, and quiet environment is best. Set the thermostat around 65°F to 68°F. Use black-out curtains, an eye mask, and earplugs to keep out light and sound.

• Remove clocks from the bedroom. You can also just turn them away from you. This will prevent you from checking the time if you wake up in the middle of the night. Constantly checking the clock creates stress and anxiety, making it harder to fall asleep. 

Relaxation techniques help your body unwind before bedtime. Commonly used relaxation strategies include:

• Progressive muscle relaxation: This involves tensing and then relaxing different muscles one by one for 5 to 10 seconds each. Start with your feet and slowly work your way up to your head. 

• Deep breathing exercises: Practice slow, deep belly breathing for 2 to 5 minutes before bedtime.

• Meditation: Sit in a quiet place with your eyes closed. Clear your mind and focus on your breathing. If distracting thoughts pop up, calmly let them pass and refocus on your breathing. Continue for 5 minutes. 

You may use some or all of the CBT-I techniques detailed above, based on your needs. When you have a CBT-I therapist, they will help guide you through the strategies most beneficial for you.

How effective is CBT-I?

“CBT-I is one of the most effective treatments available for insomnia,” says Dr. Rachel Kantor, a CBT-I expert who teaches psychiatry at the University of Massachusetts and Harvard Medical School. Even better, its benefits continue after you finish treatment, she says.

How does CBT-I compare to sleeping pills?

Research shows CBT-I is often more beneficial in treating insomnia than prescription sleeping pills. Its benefits may last longer than medications too. CBT-I also has fewer risks compared to prescription sleeping pills. This is why sleep experts now recommend CBT-I as the first-choice treatment for insomnia.

How long does CBT-I take to work?

With CBT-I, you can expect to meet with a therapist 4 to 8 times, on a weekly or biweekly basis, with each session lasting 45 to 50 minutes, says Dr. Kantor. On average, it takes 3 to 4 weeks to notice improvements. She points out that regularly practicing the skills learned during CBT-I is key to improving and maintaining good sleep.

What if CBT-I doesn't work? 

If CBT-I is not improving your symptoms, Dr. Kantor recommends consulting with a healthcare professional about getting a sleep study. This can help figure out if you have other causes of insomnia, such as sleep apnea. 

Is CBT-I right for me?

CBT-I may not be right for everyone. And some people may need to take extra precautions. This may be true if you have: 

• Bipolar disorder

• Uncontrolled seizures

• Sleep apnea

• Parasomnias such as sleepwalking or sleep terrors

• A job that requires sustained attention and alertness (like a bus driver)

If you have one of these conditions, this doesn’t mean you can’t try CBT-I. The sleep restriction technique poses the greatest risk in such cases. But a CBT-I therapist can change your treatment plan to make it safer for you.

How to find a CBT-I specialist

There are several ways to find a CBT-I specialist in your area. An online search is a good place to start. You can also request a referral from your psychiatrist, primary care physician, or other healthcare professional.

Due to a growing need for CBT-I, digital CBT-I program offerings are expanding. If you’re not having luck finding a CBT-I specialist, Dr. Kantor recommends the free CBT-i Coach app from Veterans Affairs (VA). 

“It provides a lot of information and guidance that can help you improve your sleep,” says Dr. Kantor.

Why trust our experts?

Written by:

Sparsha S. Reddy, MD

Sparsha S. Reddy, MD, is a physician with a strong interest in mental health and medical education. She is board-certified by the American Board of Psychiatry and Neurology (ABPN).

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

Our editorial standards

Meet our experts