CBT for insomnia (CBT-I)

Cognitive behavioral therapy for insomnia, or CBT-I, is a short, structured treatment for long-lasting trouble sleeping. It does not use pills. Instead, you change the habits and thoughts that keep poor sleep going, one step at a time.

Major U.S. doctors' groups recommend CBT-I as the first treatment for chronic insomnia, ahead of sleep medicine.^1,2,3 It works for many people of all ages, including older adults.^4,11 Our free five-lesson course walks you through it.

What CBT-I is

Insomnia is trouble falling or staying asleep, or waking too early, that leaves you worse in the daytime. Over months, it often keeps itself going. People spend longer in bed, nap, and worry about sleep, which makes sleep lighter and more broken. Our insomnia page explains this cycle.

CBT-I breaks that cycle. It is a type of cognitive behavioral therapy, adapted just for sleep. A doctor, nurse, or therapist can deliver it, usually over 4 to 8 sessions.^2,5

CBT-I is more than "sleep hygiene" tips, like avoiding late caffeine. The American Academy of Sleep Medicine (AASM) advises against using those tips as the only treatment.² See healthy sleep habits.

Why guidelines put CBT-I first

Three major guidelines agree:

• American College of Physicians (2016): All adults with chronic insomnia should get CBT-I as the first treatment. This was a strong recommendation. If CBT-I alone is not enough, you and your doctor can talk about adding a medicine for a short time.¹
• American Academy of Sleep Medicine (2021): Strongly recommends CBT-I for adults with chronic insomnia.²
• Veterans Affairs and Defense Department (2025): Strongly recommends CBT-I. It also suggests CBT-I over sleep medicine as the first choice.³

One reason is safety. The physicians' guideline noted that studies have linked sleeping pills to rare but serious harms, such as fractures, injuries and dementia. Those studies cannot prove the pills caused the harm. The FDA labels also support only short-term use.¹ CBT-I teaches skills you keep after treatment ends.

If you take a sleep medicine now, do not stop it suddenly. Talk with your doctor or pharmacist before changing anything. Guidelines advise doctors to talk with you about a plan for slowly cutting back sleep medicine over time.³ See sleep medicines: what to know.

How well does it work?

A 2015 review pooled 20 trials with 1,162 adults, average age 56.⁴ Compared with no active treatment, in-person CBT-I helped people:

Source for the table: Trauer and others, 2015.⁴

What this means in daily life. Most people do not sleep many more hours. Instead, sleep becomes steadier and less broken, and nights feel less of a struggle. The gains seemed to last after treatment ended, and no harms were reported.⁴ One limit is that these trials mostly left out people with other medical, sleep or mental health conditions.⁴

The five parts of CBT-I

The AASM lists the core parts as sleep education, a sleep schedule, stimulus control, and changing unhelpful thoughts. Relaxation and sleep habits are often added.² Our course gives each part its own lesson.

1. The sleep diary. Each morning, you jot down when you went to bed, about how long it took to fall asleep, how long you were awake, and when you got up. This shows your real pattern and guides every other step. Lesson 1: the sleep diary
2. A sleep window. You limit time in bed to about the time you actually sleep. Then you widen it slowly as sleep gets more solid. Doctors call this sleep restriction, or the gentler sleep compression.² Lesson 2: setting your sleep window
3. Bed is for sleep. You go to bed only when sleepy, and get up if you lie awake for a long time. This teaches your brain to link the bed with sleep, not with tossing and turning. Doctors call this stimulus control.² Lesson 3: retraining bed for sleep
4. Calming sleep thoughts. You learn to notice and loosen worried thoughts, like "If I don't sleep, tomorrow is ruined." Lesson 4: calming thoughts about sleep
5. Wind-down and staying on track. You build a relaxing pre-bed routine and a plan for bad nights, so one rough night does not undo your progress. Lesson 5: wind-down and staying on track

The AASM also suggests some of these parts on their own, with less certainty.² For relaxation, see relaxation training and our muscle relaxation practice.

CBT-I in later life

Sleep patterns change with age, but insomnia is not a normal part of aging that you must accept. CBT-I can still help.

In a trial of 74 older adults aged 59 to 92, six weekly sessions of sleep compression worked best. One year later, 60% of that group had a clear improvement in how long it took to fall asleep, compared with 14% for relaxation and none in the placebo group.¹¹ These gains were in people's own reports. Sleep lab tests did not show changes.¹¹

A few adjustments matter for older adults:

• Gentler sleep windows. Sleep compression shrinks time in bed in small steps instead of all at once.¹¹
• Falls. Getting out of bed at night is part of stimulus control. If you are unsteady, use a night light and a safe chair nearby. Clinicians may adapt this step for people at risk of falls.²
• Filling the extra time. Staying up later can be hard if days feel empty. Plan calm, pleasant evening activities.²

See sleep in later life for more. For sleep problems in a person living with dementia, see sleep problems in dementia. CBT-I in its usual form is meant for people who can follow the plan on their own.

Digital CBT-I: apps and online programs

You can also get CBT-I through a phone app or website. Some are self-guided. Others are medical devices that the FDA has cleared and that need a prescription.

In the main trial of a web version of Somryst, 1,149 adults used it or a comparison program. After nine weeks, about 6 in 10 people (63%) in the CBT-I group had a meaningful drop in insomnia symptoms, compared with about 1 in 7 (14%) in the comparison group.⁷

The AASM found too little evidence to say one delivery method is best. It advises choosing based on what is available, cost, and what you prefer.² Products change, so ask your clinician what is current. For privacy and safety tips, see online therapy and mental health apps.

How to find CBT-I and pay for it

• Ask your primary care doctor for a referral to a sleep psychologist or a behavioral sleep medicine clinic.
• Search a directory. The Society of Behavioral Sleep Medicine keeps a provider directory that lists hundreds of providers in North America.¹²
• Check telehealth. CBT-I can be done by phone or online, which helps if no specialist is nearby.⁵
• Medicare. Part B covers individual and group psychotherapy from many licensed professionals, including psychologists, clinical social workers, marriage and family therapists and mental health counselors. You usually pay 20% after the yearly deductible.¹⁰ Part B also covers certain FDA-cleared digital mental health devices if you meet other conditions. Ask whether a prescription CBT-I app qualifies.¹⁰

See how to find a therapist and paying for therapy.

Who should get a checkup first

If you also feel down or anxious, see sleep, mood and anxiety.

Common questions

Can I do CBT-I on my own?

Yes, for many people. The VA's Insomnia Coach app, for example, is built to work as a self-care tool on its own.⁸ A trained clinician is a good idea if you have other health conditions, have struggled for years, or get stuck.

Is it the same as brief behavioral therapy for insomnia?

Brief behavioral therapy (BBT-I) is a shorter, simpler version with fewer sessions. Guidelines suggest it with less certainty than full CBT-I, because there is more evidence for CBT-I.^2,3

Start the course

Begin with Lesson 1: the sleep diary. Keep the diary for one to two weeks before moving on. Then work through the lessons in order, about one a week.

To see how CBT-I compares with other approaches, visit our therapies overview and the evidence guide.

In this section

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.