Cognitive behavioural therapy for insomnia (CBT-I)

What is cognitive behavioural therapy for insomnia?

Cognitive behavioural therapy for insomnia, also called ‘CBT for insomnia’ or ‘CBT-I’ for short, is a type of sleep therapy. It helps people experiencing persistent sleeping difficulties, including insomnia. 

Rather than relying on sleeping medication, CBT-I focuses on the thoughts, behaviours, and habits that may be keeping insomnia going. It can help you develop healthier bedtime patterns and get to the root of any behavioural or psychological causes of sleeplessness. CBT-I is also recommended by NICE as a first-line treatment for chronic insomnia in adults.

Over time, many people find they can respond differently to the thoughts and habits affecting their sleep, enabling them to build healthier nighttime routines that support a good night's rest.

How does CBT for sleep work?

Insomnia doesn’t look the same for everyone. Some people find it challenging to fall asleep, others wake up repeatedly during the night, and some sleep through but never feel truly rested. CBT-I brings together several techniques that target the thoughts and behaviours that may contribute to insomnia and reinforce poor sleep over time.

These main elements often include:

Cognitive interventions

In many people with insomnia, unhelpful thoughts about sleeping may unintentionally lead to behaviours that make sleep more difficult, creating a cycle. For instance, someone might worry about not being able to drift off and then lie awake trying to force sleep. Unfortunately, this may make falling asleep feel even more difficult and frustrating, making it harder to relax and settle down. 

CBT-I aims to break this cycle by encouraging you to notice and challenge the thoughts that keep it going. 

Behavioural interventions

CBT-I also looks at your bedtime habits to support you in creating healthier routines. Some of these interventions may include:

• Stimulus control before bed: Reducing activities that keep your mind and body alert before bed.
• Sleep restriction and compression: Temporarily reducing time in bed to strengthen your natural sleep drive. 
• Relaxation techniques: To reduce racing thoughts and the physical tension that often come with lying in bed awake. 

Psychoeducational interventions

Learning about healthy nighttime habits is an important part of CBT-I. By noticing the effects that diet, exercise, and environment have on falling and staying asleep, you can create more helpful routines. 

It’s important to understand that CBT-I is a collaborative process between you and your therapist. Together, you’ll explore what’s affecting your sleep, practise new skills, and develop strategies to use between sessions. 

There may also be homework, such as keeping a sleep diary, making changes at home to improve sleep hygiene, or noticing and questioning thoughts or beliefs around sleep.

What issues can CBT-I for insomnia help with? 

Most people experience the occasional sleepless night. But when poor sleep becomes a pattern, it can leave you feeling exhausted and emotionally drained.

CBT-I is an insomnia treatment recommended by NICE for treating sleep issues including:

• being unable to fall asleep;
• frequently waking up in the night;
• having racing worries or anxiety about not getting sleep;
• dreading sleep.

CBT-I can also be adapted for people whose sleep is affected by other health conditions, such as chronic pain or menopause, when appropriate. 

What happens in a CBTi session?

CBT-I supports you in developing healthier, more sustainable sleep patterns without relying on medication. Therapy usually lasts between six and eight sessions, and is highly practical, structured, and focused on sleep. 

In the first session, your therapist will typically ask about your sleep difficulties, how long they’ve been happening, and any factors that may be contributing to them.

They may also suggest you keep a sleep diary to help you track the following information:

• When you go to bed.
• How long you’re awake before falling asleep.
• How many times you wake up in the night.
• When you wake up.
• How long it takes you to get back to sleep after waking up.

Sessions often begin by reviewing your sleep diary before introducing new techniques and setting goals for the week ahead. For instance, you may spend some time exploring anxious thoughts or beliefs about sleep, or consider how to make practical adjustments such as sleep restriction. 

Who might benefit from CBTi sleep therapy?

For many people, CBT-I provides an effective, medication-free route to a better night’s sleep. CBT-I may be a good fit if you:

• lie in bed worrying that you won’t be able to fall asleep;
• feel anxious or frustrated about sleep;
• find yourself watching the clock during the night;
• dread going to bed;
• frequently wake during the night and find it difficult to get back to sleep;
• feel exhausted during the day because poor sleep has become a regular part of life;
• have tried sleep aids or self-help strategies without lasting success;
• want an alternative to relying on medication for sleep.

Things to consider about CBTi for insomnia 

While CBT-I is the first-line treatment for long-term insomnia, it isn’t necessarily the right approach for everyone. Before starting CBT-I, it may be helpful to consider the following.

• CBT-I focuses on long-term improvements, so it requires time, consistency, and practice rather than offering an immediate fix. 
• Keeping consistent bedtimes and wake-up times is often part of CBT-I, so if your work involves changing shifts, frequent travel, or unpredictable routines, some strategies may need to be adapted. 
• Changing habits and routines around sleep can take commitment, which may feel challenging if you are already managing other demands in your life. 
• Not every sleep problem is caused by insomnia; some have a physical cause, so it’s important to rule out any physical factors with a healthcare professional. 

Finding a therapist for CBT-I

If persistent insomnia is affecting your daily life, it may be worth speaking to a therapist who is trained in CBT-I. They can assess what’s contributing to your sleep difficulties and tailor treatment to your personal needs. While improving sleep takes time, many people find that learning practical, evidence-based strategies helps them build helpful sleep habits and regain confidence in their ability to sleep naturally.

We list verified counsellors and therapists across the UK, making it easier to find a qualified practitioner to work with, whether in person or online. Whenever you feel ready, you can use our search tool to find a therapist who meets your needs.