What Is CBT-I (Cognitive Behavioral Therapy for Insomnia)?
CBT-I is a structured, short-term, research-backed treatment designed specifically to treat chronic insomnia by targeting the mechanisms that maintain insomnia.
It is recommended as the first-line treatment for chronic insomnia by major medical organizations including the American College of Physicians and the American Academy of Sleep Medicine - even before prescription sleep medication.
When something is called “gold standard” in medicine, it means:
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It has the strongest research support
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It works for the majority of people
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Its benefits last after treatment ends
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It carries lower long-term risk than alternatives
CBT-I meets all of those criteria.
Why Insomnia Becomes Chronic
(And Why Willpower Doesn’t Fix It)
Online Therapy for Insomnia for clients in all of Massachusetts, Washington, Connecticut, and Florida.
Insomnia rarely starts as a permanent condition.
It often begins with trauma, stress, illness, travel, grief, hormonal shifts, or anxiety. But what turns short-term sleep disruption into chronic insomnia is not the original trigger - it’s what the brain learns afterward.
Over time, your nervous system can begin to associate:
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Bed = wakefulness
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Night = vigilance
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2am = threat
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Not sleeping = catastrophe
Your brain becomes hyper-alert at night. This is called conditioned arousal.
The more you try to force sleep, the more alert your system becomes.
CBT-I works because it directly interrupts this conditioning process.
Why CBT-I Is Different From Other Therapies
Many people try traditional talk therapy for insomnia.
Talk therapy can be helpful for anxiety, depression, stress, or relationship concerns - all of which can affect sleep. But most therapies are not designed to retrain the sleep system itself.
CBT-I is different in three critical ways:
1. It Targets Behavior, Not Just Thoughts
Most insomnia is maintained by subtle behavioral patterns:
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Spending extra time in bed trying to “catch up”
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Going to bed earlier out of exhaustion
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Staying in bed awake and frustrated
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Napping unpredictably
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Clock-watching
These behaviors are completely understandable - and they accidentally keep insomnia alive.
CBT-I makes precise, data-driven adjustments to sleep timing and routines to rebuild sleep pressure and consolidate rest.
2. It Reconditions the Brain
When someone has chronic insomnia, their brain has learned that nighttime is a time to be alert.
CBT-I uses stimulus control and sleep scheduling to reverse that conditioning.
We re-teach your brain that the bed is for sleep - not for worrying, rehearsing conversations, or bracing for tomorrow.
This is neurological retraining, not insight-oriented processing.
3. It Has Durable Results
Unlike medication, CBT-I changes the underlying patterns that drive insomnia.
Research consistently shows that improvements from CBT-I last months and years after treatment ends - because the brain has relearned how to sleep.
Sleep medication can sedate the brain.
CBT-I restores the brain’s natural sleep regulation.
What CBT-I Actually Involves
CBT-I is structured and collaborative. It typically includes:
Sleep Tracking
You’ll complete a brief daily sleep log so we can make precise adjustments.
Sleep Scheduling (Sleep Restriction Therapy)
We temporarily match time-in-bed to actual sleep time to strengthen sleep drive and improve consolidation.
Stimulus Control
We break the association between bed and wakefulness.
Cognitive Work
We address catastrophic thinking about sleep (“If I don’t get 8 hours, tomorrow is ruined.”) in a targeted, practical way.
Nervous System Regulation
We help your body downshift from hyperarousal into rest.
Nightmare Rescripting and IRT
If you're also experiencing nightmares your treatment plan will include CBT-N - evidence backed treatment for nightmares.
Most treatment plans last 6–8 sessions. Session by session information can be found on my Therapy for Insomnia and Therapy for Nightmares pages.
FAQs about CBT-I
Why is CBT-I considered the gold standard?
CBT-I has been studied for decades in clinical trials.
It has been shown to:
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Reduce time to fall asleep
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Reduce nighttime awakenings
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Improve sleep efficiency
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Improve daytime functioning
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Reduce reliance on sleep medication
Because of this strong evidence base, organizations like the American College of Physicians recommend CBT-I as the first treatment to try - not as a last resort.
It works for:
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Primary insomnia
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Insomnia with anxiety
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Insomnia with depression
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Menopause-related insomnia
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Chronic pain-related insomnia
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Long-term insomnia lasting years
It is effective across age groups, including older adults.
If I’ve been a “bad sleeper” my whole life, can this still work?
Yes. What often feels like a lifelong trait is actually a learned pattern reinforced over time. The brain remains highly adaptable - even after years of insomnia.
What if I’m exhausted already - won’t this make it worse?
The first 1–2 weeks can feel challenging. But most people notice deeper, more predictable sleep quickly once their sleep pressure builds. I monitor this closely so we don’t push too hard and you always get a say in how treatment proceeds. Sometimes it's helpful to be reminded that you deserve good sleep - and some amount of discomfort is normal when learning new skills.
What if my insomnia is tied to anxiety or trauma?
We address that directly. Hyperarousal is often a key part of insomnia. We work with your nervous system, not against it.
Will I have to give up naps forever?
Not necessarily. Early in treatment, naps may need to be limited so your sleep drive can rebuild. Later, we evaluate what’s sustainable for your life.
How fast does this work?
Many people see meaningful changes within 2–3 weeks. Full consolidation typically happens over 6–8 sessions, depending on severity.
What if I wake up at 3am every single night?
That’s incredibly common. We don’t treat 3am awakenings as mysterious - we treat them as conditioned sleep patterns that can be retrained.
Your first session includes a comprehensive sleep assessment. If your night waking appears related to a medical sleep disorder - such as sleep apnea - you’ll have that information early, and I’ll refer you for appropriate evaluation and treatment (for example, CPAP therapy) before beginning CBT-I.
Do I have to track my sleep?
Yes - but it’s simple and takes about 2–3 minutes each morning. The sleep log helps us make precise, evidence-based adjustments.
Can I do CBT-I if I’m taking sleep medication?
Yes. Some clients choose to stay on medication. Others gradually taper with medical oversight once sleep stabilizes. CBT-I can work alongside medication.
I’m afraid of lying awake in the middle of the night. What happens then?
You won’t just be told to “relax.” You’ll have a structured plan for what to do during awakenings so the fear-response cycle weakens instead of strengthens.
What if I’m too exhausted to follow the plan?
That makes sense. When you’re not sleeping, everything feels harder.
CBT-I does require commitment - because the best outcomes come from following the plan consistently. But you won’t be doing this alone or in a rigid, sink-or-swim way.
We move strategically and thoughtfully. I’ll guide you, adjust as needed, and help you "remember your why" through the harder stretches. The structure is what helps your sleep reset - and my role is to support you through it so you don’t have to muscle through on willpower alone.