CBT-i (cognitive behavioural therapy for insomnia)
First-line treatment for chronic insomnia per the AASM. More effective than sleeping pills long-term.
Why
CBT-i combines stimulus control, sleep restriction, and cognitive restructuring across 4-8 sessions. The American Academy of Sleep Medicine 2021 clinical practice guideline rates it a STRONG recommendation for chronic insomnia disorder in adults, stronger than any pharmacological treatment.
The program
- 1
Start a daily sleep diary: bedtime, wake time, awakenings.
- 2
Calculate your average sleep efficiency (sleep / time-in-bed × 100%).
- 3
Sleep restriction: shrink your time-in-bed to match average sleep, then grow as efficiency rises.
- 4
Stimulus control: bed = sleep only. Out of bed if not asleep within ~20 minutes.
- 5
Cognitive restructuring: address sleep-effort and catastrophising thoughts.
- 6
Maintenance phase: continue diary, expect occasional regressions.
Practical
Cadence
4-8 weekly sessions plus daily sleep diary
What you'll need
Insomnia ≥3 months. Find a CBT-i provider (BSM-trained psychologist) or digital programme (Sleepio, Somryst).
Ideal for
Anyone with insomnia lasting more than three months.
Markers this may influence
Evidence
Trauer 2015 Ann Intern Med meta-analysis (20 RCTs, n=1,162): CBT-i shortened sleep-onset latency by ~19 min, reduced wake-after-sleep-onset by ~26 min, and raised sleep efficiency by ~10 percentage points, with gains sustained at follow-up. AASM 2021 gives it a STRONG recommendation, stronger than any drug.