Cognitive Behavioural Therapy (CBT) for Sleep. What Is It and Does It Work?

sleep affects our healthHave you suffered with insomnia for a long time? Do you feel tired all the time and find your quality of living is poor because you just don’t have the energy to enjoy it? If the answer’s yes, then you’ve probably done a lot of reading about sleep and how to sleep better, you may have taken sleeping pills and you may feel you’ve reached a dead end.

CBT for insomnia, or CBT-I, is not a new idea, but it is more recently getting a reputation for being a good and reliable long-term cure for insomnia. That’s what we’re going to look at in this article.

What is CBT?

Cognitive Behavioural Therapy helps people

  • look at,
  • explore
  • and understand the thoughts, beliefs, behaviours and emotions they have about a particular problem in their lives
  • so that they can better manage them and ‘free’ themselves from the power those thoughts/beliefs have.

CBT is usually given in a short course (about 6-8 weeks) in face-to-face sessions with a trained therapist. It’s a powerful and effective cure for many anxiety-related problems and mental health issues such as depression.

What is CBT for sleep?

CBT for sleep helps you understand the factors around insomnia, such as what stops a person sleeping – like a racing mind, worry and anxiety – and overcome them. That way you get good quality sleep, can rely on getting a good night’s sleep and then feel more awake during the day.

CBT-I has about 30 years’ research information surrounding it, so it’s not some new idea. The National Institute of Health in the US says it’s a “safe and effective means of managing chronic insomnia and its effects”.

Therapists and clients who use CBT-I report a 75% success rate in helping people get better, longer and more reliable sleep. This includes long-term follow up, but there are tips and tricks if you notice you’re starting to lose sleep again.

The innovation with CBT-I is that instead of having to visit a therapist 6 or 8 times, it is now available on the internet as a course you can download and do at home. More about this at the bottom of the page.

CBT-I is not a cure for other sleep disorders such as sleep apnea, snoring (or a snoring partner), sleep walking or night terrors etc.

What does CBT-I involve?

You may be asked to keep a sleep journal for 1-2 weeks, so that you and your therapist can examine anxieties/patterns that are specific to you.

Expect a structured course, with different elements. Each therapist will run CBT-I courseswriting2 a little differently, but will probably involve:

  • Stimulus Control Therapy, which simply means setting boundaries for the mind – having a consistent bed time and wake time, not napping during the day, only using the bedroom for sleep and sex, etc.
  • Sleep Restriction. This sounds counter-productive but people with chronic insomnia often lie in bed, awake, hoping for sleep. This becomes a bad habit and sleep becomes more elusive. You’ll be coached to perhaps stay up longer and only go to bed when you’re tired. Some people find this tough, but it will be done along side point 1, above, and gets easier.
  • Sleep Hygiene involves making sure you’re not losing out on good sleep by sabotaging your body. That means having alcohol, caffeine and taking exercise at the right times of day – improving lifestyle habits that will help improve your sleep.
  • Sleep Environment Improvement is all about making your bedroom right for sleep. You can read more about this in our bedroom tips guides here.
  • Remaining Passively Awake, or Paradoxical Intention, involves taking the effort out of falling asleep. Your therapist will help you train your mind to let go of anxiety etc.
  • Biofeedback helps you recognise your body’s signs of stress and relaxation – muscle tension, heart rate, breathing etc, and shows you how to change them at will.   Your therapist may have biofeedback devices that show you this, which then allows you to practise at home.

(info source Mayo Clinic)

CBT and CBT-I take steady practice, but armed with the essentials you are then in charge of your sleep destiny, rather than lack of sleep bringing you down.

Does CBT-I really work?

Professor Colin Espie is Professor of Sleep Medicine at the University of Oxford, UK and the founder of a new online course of CBT for insomnia (see below). He says that our society’s understanding of sleep is poor and therefore so is research into why we suffer from insomnia and how to put it right.

His new program of CBT-I has been rigorously tested in the same way new drugs are tested before they are given to patients, and has been show to:

  • Improve sleep problems for 75% people who tried it, even in people with long term insomnia
  • Help people fall asleep 50% more quickly
  • Cut the time people spend awake during the night by 60%
  • More than doubled people’s quality of sleep
  • Improved daytime energy levels by nearly 60%
  • Give lasting improvements at the 2 month follow up point of the studies. Some of these improvements get better over time.

How can I prevent relapses of insomnia?

Some people will find that worries, anxiety and new stresses make a mess of their sleeping pattern again. In this case the Sleep Foundation recommends:

  1. Don’t use catch-up naps and early bedtimes to compensate for lost sleep.
  2. Make sure you’re not having caffeine, alcohol or exercising at the wrong times.
  3. Re-start the sleep restriction (see above) if you find the sleeplessness goes on beyond a few days.

Find out more about Professor Espie’s CBT-I course at

Black Belt CBT for sleepOur affiliate partners The Richmond Sleep Centre have Black Belt CBT for sleep courses which we also recommend.  Click the link or scan the QR code to find out more.



Elspeth Raisbeck

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