Digital CBT for insomnia

Domain IX · Biomedical, neuro & digital

What it is

Digital CBT for insomnia (dCBT-I) is CBT-I, the guideline first-line treatment for chronic insomnia in adults, delivered through a website or app, either fully automated or with some human guidance. It is a delivery format, not a separate therapy: the components are the same as face-to-face CBT-I…

Format

• Typical course:
• Face-to-face CBT-I reference point: usually 4–8 sessions, individual or group, delivered by trained professionals (mainly clinical psychologists), in person, by telehealth or digitally, with or without guidance.

Who practises it, and how they are trained or regulated

• Regulatory and access status (as of October 2026):
• USA (FDA): SleepioRx received FDA 510(k) clearance (reported 15 August 2024) as a prescription digital therapeutic for chronic insomnia/insomnia disorder, as an adjunct to usual care, for patients aged 18 and older, available on the order of a licensed healthcare provider. The consumer Sleepio product states it has not been FDA-cleared for the insomnia disorder indication. CMS created billing codes for FDA-cleared…
• Guideline position: ACP (2016) recommends CBT-I as initial treatment for chronic insomnia disorder in all adults (strong recommendation, moderate-quality evidence); AASM (2021) makes a strong recommendation for multicomponent CBT-I; the European Insomnia Guideline 2023 recommends CBT-I as first-line for adults of any age, in person or digitally (grade A), prefers guided over fully automated dCBT-I (automated…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• 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

• self-directed stopping during the programme. Working: prescriber involved.
• the person disclosing distress in a community forum instead of to a clinician. Working: a known plan.
• partial responders who drop the techniques once sleep improves. Working: maintained gains at follow-up.
• relapse around life events, illness, travel or mood episodes. Working: the person can describe their own plan.
• the person feeling dismissed; delays in sleep services. Working: referral made, decision about the programme documented.

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.