CBT for insomnia

Domain II · Behavioural & cognitive · Morin, Edinger, Espie

What it is

CBT-I is not one technique but a short, diary-driven package for chronic insomnia. It combines sleep-regulation education, sleep restriction and stimulus control (the behavioural core), usually sleep hygiene and counter-arousal methods, and cognitive work on sleep-related beliefs, worry and…

Format

• Format. Typically 4–8 sessions (AASM: CBT-I 4–8, brief therapies 1–4), weekly or fortnightly, 15–90 minutes, individual or group; also delivered via telehealth and digital programmes. Penn slides advise staying open to more than 8 sessions, as many patients have not recovered baseline sleep time by…

Who practises it, and how they are trained or regulated

• Move on when: 1–2 weeks of usable diary data exist (Penn: diaries are "the price of therapy"), the patient is medically and psychiatrically stable enough, and no unmanaged sleep disorder better explains the complaint. Refer for polysomnography when apnoea, periodic limb movements or parasomnia is suspected.
• CBT-I is not one technique but a short, diary-driven package for chronic insomnia. It combines sleep-regulation education, sleep restriction and stimulus control (the behavioural core), usually sleep hygiene and counter-arousal methods, and cognitive work on sleep-related beliefs, worry and monitoring. Its model of change is Spielman's 3P model: whatever predisposed and precipitated the insomnia, it is kept going by…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Dozing while sitting up (sleep in bed is fine, but the aim is to lie down only when sleepy); bright screens.
• Bipolar or psychotic disorders, regular drivers and machine operators, falls in older adults (window at least 6 h).
• Unexpected results (debrief the sequence of events openly); vague delayed reports; repeat key conclusions in later sessions.
• Ending while daytime sleepiness persists; leftover hypnotic tapering (coordinate with the prescriber; no dosing guidance here).
• Dozing during the wind-down (common in older adults and depression); the wind-down turning into effortful "sleep preparation" rituals.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.