What is CBT-I and should I try it for insomnia?
Cognitive Behavioral Therapy for Insomnia (CBT-I) is the clinical first-line treatment for chronic insomnia, preferred over medication by both AASM and ACP guidelines. It addresses the root causes of insomnia rather than masking symptoms.
- Combine relaxation techniques with CBT-I principles4
Integrate one or more relaxation practices into your pre-sleep routine: progressive muscle relaxation (PMR), diaphragmatic breathing (4-7-8 pattern), or body scan meditation. Practice nightly for 10-15 minutes.
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- Use a digital CBT-I program4
Enroll in a structured digital CBT-I program if in-person therapy is unavailable or unaffordable. Options include Insomnia Coach (free, developed by the VA), Sleepio, and Pear Therapeutics Somryst (FDA-authorized).
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🛠️ Smartphone or computer
- Challenge catastrophic thoughts about sleep4
Identify and restructure the anxious thoughts that fuel insomnia. Common examples: "I will never function tomorrow," "I must get 8 hours or I'll get sick," "My insomnia is permanent." Replace them with evidence-based alternatives.
📌 best practice2/8/2026, 3:31:54 PM
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- Apply stimulus control rules5
Stimulus control retrains the brain to associate the bed exclusively with sleep. Lying awake in bed for extended periods creates a learned association between the bed and wakefulness, frustration, and anxiety. Breaking this cycle is essential for long-term insomnia recovery.
📌 best practice2/8/2026, 3:31:47 PM
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- Try sleep restriction therapy to consolidate sleep5
Limit your time in bed to match your actual sleep time. If you sleep 5 hours but spend 8 in bed, restrict your window to 5 hours (e.g., 1 AM - 6 AM). When sleep efficiency exceeds 85% for a week, extend the window by 15 minutes. Repeat until you reach your target duration.
📌 best practice2/8/2026, 3:31:41 PM
🛠️ Sleep diary