Cognitive Behavioural Therapy for Insomnia (CBT) is a structured, time-limited psychotherapy that treats insomnia disorder. It is an effective and cost-effective treatment for insomnia disorder and should be offered as a first-line treatment.[1][2] Research evidence has also shown that CBT-I should also be a first-line treatment for insomnia in mid-life women experiencing menopause with hot flashes.[3] With the advent of the internet, CBT-I has become widely accessible online (see table below), and is of similar efficacy with in-person CBT-I.
CBT-I is more advantageous than medications for 3 key reasons:
CBT-I can be delivered in various formats with similar success rates, including through:
The three “Ps” (3P) model of insomnia describes how predisposing, precipitating, and perpetuating factors can lead to the development of insomnia:
The use of cognitive and behavioural strategies in CBT can help modify these above factors.
Providing the patient education that the beginning of CBT-I helps frame the structure of the therapy. This includes providing education about the role of sleep and the body clock, and the basic principles of CBT-I.
The principles of CBT-I is to correct unhelpful sleep-related beliefs and anxiety as well as common sleep-disruptive habits that maintain or contribute to insomnia. Patients are advised to adhere to basic rules regarding their sleep, including:
Treatment during CBT-I involves all or some of the following components:
Sleep restriction involves:
Stimulus control is one main technique of CBT-I. The goal of stimulus control is to train the mind to associate the bed and bedroom with being asleep. This includes making it a point to get out of bed if one has not fallen asleep after a certain amount of time (e.g. - 20 minutes). The more often one does other things in bed (e.g. - watching TV, reading, lying down without sleeping, ruminating/being anxious) the weaker the association gets between bed and sleeping. The goal is to re-establish a strong association between being in bed and sleeping.
Stimulus control involves:
Relaxation therapy involves reducing the somatic and/or mental ruminations that interferes with sleep and include techniques such as:
Cognitive therapy involves correcting faulty expectations, cognitive distortions, and false beliefs that interfere with sleep by:
Sleep hygiene involves correction of lifestyle and environmental factors that interfere with sleep. While good sleep hygiene is important for any healthy sleep, chronic insomnia rarely is due to only poor sleep hygiene alone.
Name | Description | Cost |
---|---|---|
Slumber Camp | Excellent simple to use, weekly guided CBT-I course | $29 USD |
Free CBT-I | Website providing general CBT-I sleep tips in multiple languages | Free |
CBT for Insomnia | 5-session on-line cognitive behavioural therapy (CBT) program for insomnia. | $24.95 US to $49.95 US |
CBT-i Coach | Structured program that teaches strategies to improve sleep and help alleviate symptoms of insomnia. | Free |
Sleepio | Evidence-based CBT-I online and mobile app program | $300 US for a 12-month subscription |
SlumberPRO | Self-help program from Queensland Australia, requires 30-60 minutes each day and program lasts 4-8 weeks | $39 AUS |
Go! To Sleep | 6-week CBT-I program (and mobile app) available through Cleveland Clinic of Wellness | $3.99 US for app, or $40 US for web |
SHUTi | 6-week CBT-I program, evaluated in 2 randomized trials involving adults with insomnia and cancer survivors | $135 US for 16 weeks access, or $156 US for 20 weeks access |
Restore CBT-I | A 6-week CBT-I program evaluated in a randomized trial | £99 to £199 |
Sleep Training System | 6-week on-line CBT-I program with money-back guarantee and personalized feedback | $29.95 US |