If you are lying awake at night, watching the hours disappear, insomnia can start to feel personal. Like your body is betraying you. The harder you try to sleep, the more awake you become. Then the next day turns into a fog of tiredness, frustration, and dread about the next night.
CBT for insomnia, often called CBT I, is designed for exactly this cycle. It is not about forcing sleep. It is about retraining your brain and body so sleep becomes something that happens naturally again.
Medical bodies have repeatedly recommended CBT I as the first option for chronic insomnia in adults, ahead of sleeping tablets, because it targets the causes of insomnia and tends to hold up better long term.
What CBT For Insomnia Is And Why It Works
CBT for insomnia is a structured, evidence-based therapy that focuses on the thoughts, behaviours, and routines that keep insomnia going. It does not knock you out like a pill. Instead, it helps you rebuild a stable sleep pattern by changing what happens before bed, in bed, and in your head.
Why insomnia becomes a cycle
Many cases of insomnia start with something real: stress, a baby, shift work, illness, grief, anxiety, travel, money worries. But even after the original trigger fades, insomnia can continue because of “coping” habits that accidentally train the brain to stay alert at night, such as:
- Going to bed much earlier to “catch up”
- Sleeping in late on weekends
- Napping to survive the day
- Spending long periods awake in bed scrolling, worrying, or clock-watching
- Relying on alcohol or sedating meds more often
Over time, your bed can become associated with wakefulness, worry, and frustration rather than sleep. CBT I breaks that association and builds a new one.
CBT I is widely recommended as first line treatment
A major clinical guideline from the American College of Physicians recommends CBT I as the initial treatment for chronic insomnia in adults.
The American Academy of Sleep Medicine also provides clinical practice recommendations for behavioural and psychological treatments for chronic insomnia, including key CBT I components such as stimulus control and sleep restriction therapy.
That is a big deal because it reflects a simple truth: insomnia is often maintained by patterns that can be changed.
What CBT I looks like in real life
CBT I is usually delivered over several sessions (in person, online, or via a digital programme). It often includes:
- Sleep education and a sleep diary
- Stimulus control
- Sleep restriction therapy (sometimes called sleep compression)
- Cognitive techniques to reduce sleep anxiety
- Relaxation strategies
- Targeted sleep hygiene changes (not a huge list of “rules”)
You can think of it as sleep training for adults, but respectful and practical.
Who CBT I Helps And When To Seek Medical Advice
CBT I is mainly used for chronic insomnia, meaning sleep problems that happen at least three nights per week and last for months. It can also help with shorter-term insomnia, especially if you want to stop the problem from becoming long-term.
CBT I can help if you relate to any of these
- You take a long time to fall asleep most nights
- You wake up often and struggle to get back to sleep
- You wake too early and cannot return to sleep
- You feel tired, irritable, unfocused, or low in mood because of poor sleep
- You have started fearing bedtime
CBT I can also work alongside treatment for anxiety, depression, chronic pain, menopause symptoms, and other conditions that impact sleep. The key is making sure nothing dangerous is being missed.
When you should speak to a GP before doing CBT I techniques
Some insomnia symptoms suggest another sleep disorder or medical issue that needs checking, such as:
- Loud snoring, choking, gasping, or witnessed breathing pauses (possible sleep apnoea)
- Strong urge to move legs at night with unpleasant sensations (possible restless legs syndrome)
- Regularly acting out dreams with movement or violence
- Severe daytime sleepiness, falling asleep while driving
- Sudden mood elevation, reduced need for sleep, racing thoughts (possible mania or hypomania)
Also, sleep restriction therapy can temporarily increase sleepiness. If you drive for work, operate machinery, or have safety-critical duties, do not DIY this aggressively. A CBT I clinician can tailor it safely.
The Core CBT I Methods That Retrain Your Sleep
CBT I works because it targets the biggest “fuel sources” for insomnia: conditioned wakefulness, irregular sleep timing, and sleep anxiety.
Below are the core methods you will see again and again in CBT I programmes.
Sleep diary and sleep efficiency
A sleep diary is the starting point because insomnia often distorts perception. You might feel you slept “barely at all,” but the diary reveals patterns you can work with.
One NHS talking therapies workbook outlines a simple structure:
Step 1 fill in a sleep diary, Step 2 review sleep efficiency, Step 3 decide on a sleep window, Step 4 apply your sleep window and keep recording.
Sleep efficiency is essentially:
time asleep ÷ time in bed × 100
If you spend 9 hours in bed but sleep 6 hours, your sleep efficiency is about 67%. That tells you the bed has become a place for wakefulness too.
In the same workbook, sleep efficiency thresholds are used to guide whether sleep restriction is needed and how to adjust it (for example, below 85% may suggest continuing the process with a therapist).
Stimulus control
Stimulus control is about re-linking your bed with sleep, not wakefulness.
A UK specialist care page summarises the idea clearly: the bed should be used for sleep and sex only, and if you cannot sleep after a period of time, you get up and do something quiet until sleepy again.
Typical stimulus control rules include:
- Go to bed only when sleepy (not just “it’s 10pm”)
- Use the bed only for sleep and intimacy (no scrolling, emails, intense TV)
- If you are awake for a while, get out of bed and do something calm
- Wake at the same time every day
- Avoid naps while retraining sleep
It feels strict, but it is powerful because it breaks the nightly pattern of struggling in bed.
Sleep restriction therapy
Despite the name, sleep restriction is not about depriving you forever. It is about temporarily matching time in bed to actual sleep so your sleep becomes deeper, more continuous, and more efficient.
The NHS workbook approach uses the sleep diary to set a consistent “sleep window,” with practical guardrails such as keeping a stable window, setting it based on average sleep time (not time in bed), and adjusting gradually.
Important: sleep restriction can increase sleepiness at first. You must treat this seriously, especially with driving.
Cognitive techniques for sleep anxiety
Insomnia often comes with thoughts like:
- “If I do not sleep, tomorrow will be a disaster.”
- “I will never fix this.”
- “I need 8 hours or I cannot function.”
A CBT I approach challenges catastrophic thinking and replaces it with more balanced thoughts. The same NHS workbook includes an example of shifting from a fearful thought cycle to a more helpful one, reducing anxiety and unhelpful behaviours.
This matters because anxiety activates your stress response. And stress is the enemy of sleep.
Relaxation and wind-down strategies
Relaxation is not about “trying harder” to sleep. It is about lowering arousal so sleep can arrive. Techniques often include:
- Breathing exercises
- Progressive muscle relaxation
- Body scans
- Gentle stretching
- Calm audio
Many CBT I programmes pair relaxation with stimulus control so you are not lying in bed forcing it.
Sleep hygiene that actually matters
Sleep hygiene is helpful, but it is rarely enough on its own. Still, certain basics make CBT I easier:
- Keep the bedroom cool, dark, and quiet
- Avoid clock-watching
- Avoid stimulating activities right before bed
- Build a consistent pre-sleep routine
The NHS workbook lists similar “top tips for bedtime,” including routine, bedroom conditions, avoiding clock-watching, and getting up if you cannot sleep after roughly 30 minutes.
A Step By Step CBT I Plan You Can Start This Week
If you want a practical structure, here is a CBT I-style plan you can start immediately. Keep it simple. Consistency beats intensity.
Days 1 to 7 Build your sleep baseline
- Pick a fixed wake-up time (including weekends).
Choose a time you can maintain most days. - Track a sleep diary for at least a week.
Estimate, do not obsess or clock-watch. Record:- Bedtime and lights-out time
- Estimated time to fall asleep
- Wake-ups
- Final wake time
- Naps, caffeine, alcohol, and stress notes
(This aligns with standard sleep diary guidance used in NHS talking therapies resources.)
- Stop trying to “make up” sleep in bed.
If you currently spend 9 hours in bed to get 6 hours sleep, you are training wakefulness. - Reduce naps (or keep them short and early, if you must).
For many people, naps keep insomnia alive.
What you are looking for at the end of the week:
- Average total sleep time
- Average time in bed
- Your sleep pattern (late bedtime, early waking, frequent awakenings)
Week 2 Introduce stimulus control
Start with these rules:
- Bed is for sleep and intimacy only
- Go to bed when sleepy, not when you “should”
- If you are awake for a while, get up and do something calm in dim light
- Return to bed only when sleepy
- Keep your wake time fixed
This can feel annoying at first, but it is one of the fastest ways to reduce the bed equals awake association.
Week 3 Sleep window approach the safe way
If you want to experiment with a “sleep window,” do it conservatively:
- Base it on your average sleep time, not how long you spend in bed
- Keep a consistent wake time
- Keep your bedtime consistent with the window
NHS talking therapies guidance describes setting a sleep window and adjusting it gradually depending on sleep efficiency results, ideally with a therapist.
Safety reminders
- Expect sleepiness early on
- Do not drive if you are dangerously sleepy
- If you have bipolar disorder, seizures, or serious mental health risks, do this only with clinical support
Week 4 Work on the thoughts that sabotage sleep
Pick one common thought that shows up at night, and practise replacing it.
Examples:
- Instead of “If I do not sleep, I will fail tomorrow,” try “Tomorrow might be harder, but I have coped before.”
- Instead of “I must get 8 hours,” try “My body will take what it needs over time if I protect my routine.”
This sounds simple, but it lowers the emotional charge around bedtime.
Keep a realistic timeline
Most people notice changes in a few weeks if they are consistent, but the goal is not perfect sleep. The goal is reliable sleep.
Finding A CBT I Therapist Or Using Digital CBT I Options
You have three main routes:
Option 1 Work with a CBT I trained therapist
This is ideal if:
- You have complex insomnia with anxiety or trauma
- You have multiple medical issues
- You want personalised sleep window adjustments and accountability
In the UK, access can vary, but CBT I principles show up within talking therapies services and sleep clinics.
Option 2 Use a structured digital CBT I programme
Digital CBT I can be a strong option if you want structure and consistency without waiting lists.
For example, Sleepio is a digital sleep improvement programme based on CBT principles and has been recommended by NICE (noting NICE recommended it in May 2022).
However, access across the NHS has been uneven at times, with reports that availability can differ by region and commissioning.
Option 3 Combine self-help CBT I with professional support
A realistic approach for many people is:
- Start a sleep diary and stimulus control now
- Use a digital CBT I programme for structure
- Speak to a GP if symptoms suggest another sleep disorder or if insomnia is severe
This combined approach can reduce suffering quickly while you pursue more support.
Keeping Results Long Term And Handling Relapses
The biggest fear people have is: “What if I fix my sleep, then it breaks again?”
Relapses happen. Life happens. The goal is to become the kind of person who knows exactly what to do when sleep starts wobbling.
The long-term rules that protect your sleep
- Protect your wake time.
A consistent wake time stabilises your body clock. - Do not extend time in bed to chase sleep.
This is how insomnia often sneaks back in. - Use a mini reset when needed.
If sleep goes off for a few nights, return to:- stimulus control
- a simplified sleep window
- reduced naps and caffeine
- Keep your wind-down boring.
Sleep loves boredom. Your brain does not.
What to do on a bad night
- If you cannot sleep, stop negotiating with the bed
- Get up, keep lights low, do something calm
- Return when sleepy
- Do not punish yourself the next day with extra time in bed
This is how you stay in control.
FAQs
Is CBT I better than sleeping pills
Many guidelines recommend CBT I as the first option for chronic insomnia because it addresses maintaining factors and has durable benefits.
How long does CBT I take to work
Many people notice improvements within a few weeks when they follow a structured plan consistently. Digital programmes are often built as multi-week courses.
What if I wake up at 3am every night
This is common. CBT I targets the behaviours that keep that wake-up pattern going, especially time-in-bed habits, stimulus control, and sleep anxiety.
Can I do CBT I if I work night shifts
Yes, but it needs tailoring. Your “wake time” and “sleep window” may be anchored to your shift pattern. If your schedule rotates, professional support helps.
Medical Disclaimer
This article is for educational purposes only and does not replace medical advice. If you have symptoms like loud snoring, choking or gasping in sleep, breathing pauses, severe depression, mania, seizures, or you feel unsafe, contact a GP or urgent services.