Cognitive behavioral therapy for insomnia (CBT-I)

Reviewed by Susan Radzilowski, MSW, LMSW, ACSW

Written by

therapist.com team

Last updated: 04/16/2026

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Insomnia is a sleep disorder that involves regularly having trouble falling or staying asleep. People often use medication, supplements, or lifestyle changes to help manage insomnia, but a specialized form of cognitive behavioral therapy (CBT) may offer a more structured, well-rounded approach.

What is cognitive behavioral therapy for insomnia?

CBT is a therapy approach that centers on the ways thoughts, behaviors, and emotions connect to and affect each other. It helps clients identify and change patterns or distortions that negatively affect their lives. Cognitive behavioral therapy for insomnia (CBT-I) is a form of CBT that specifically focuses on addressing the underlying thoughts, emotions, behaviors, and patterns that contribute to sleep problems.

CBT-I uses a few key strategies to help people improve their sleep patterns:¹

• Sleep hygiene focuses on establishing a regular sleep schedule and creating a restful sleep environment. It includes recommendations such as avoiding naps, minimizing caffeine and alcohol intake, and keeping the bedroom dark, quiet, and comfortable. This step is foundational in creating an environment conducive to sleep. 
• Stimulus control helps you learn to associate the bedroom with sleep, encouraging you to use your bed only for sleep and intimacy. It includes avoiding activities like watching TV or using electronic devices in bed.
• Sleep restriction (or “sleep consolidation”) involves limiting the time you spend in bed so it more closely matches the actual amount of sleep you get. Staying awake and out of bed builds your sleep drive, improving sleep efficiency.
• Cognitive restructuring involves challenging and replacing negative thoughts and beliefs about sleep with more positive and realistic ones. For example, you might learn to notice thoughts like “If I don’t sleep eight hours tonight, I’ll be useless tomorrow” and replace them with “I’m capable of managing my day even when I’m tired.” This can help reduce anxiety and worry related to sleep.
• Relaxation techniques such as deep breathing, progressive muscle relaxation, and guided imagery help promote relaxation and quiet the mind and body before bedtime.

CBT-I can be delivered in various formats including face-to-face individual or group sessions, telephone sessions, and on digital platforms with therapist guidance or through self-led modules.

The CBT-I process

CBT-I usually begins with a structured assessment. Your therapist will ask about your bedtime routine, sleep schedule, nighttime awakenings, naps, and other factors like caffeine, alcohol, or screen use. The therapist will also review your medical and mental health history and any medications that could affect sleep. Based on this information, you’ll work together to set clear goals and begin treatment.

Treatment typically involves a daily sleep diary. Outside of sessions with your therapist, you’ll be asked to keep track of your sleep patterns, including when you went to sleep, when you woke up, the quality of the sleep, and other similar questions.

The length of CBT-I treatment varies depending on the person and the format, but you can expect it to last several weeks. Standard CBT-I treatment is usually delivered over the course of six to eight sessions, with sessions ranging from 30 to 90 minutes in length.² But CBT-I delivered via phone, mobile app, or other digital platforms may involve 8 to 12 sessions of differing lengths.³

Using the strategies discussed above, as well as any additional techniques you and your therapist collaboratively find effective, CBT-I will help you slowly build new habits around sleep. You’ll likely identify thoughts, feelings, and behaviors related to sleep and test them to find out if they’re true. If they’re not, you’ll work on replacing them with more accurate thoughts or helpful behaviors.

Actively participating in the therapy process both in and outside of sessions is crucial. This can mean a good deal of “homework,” including keeping the sleep diary, practicing relaxation techniques on your own regularly, adhering to a set sleep schedule, and actively challenging negative thoughts about sleep. It requires commitment and consistency, but CBT-I has shown promising results.

How much does CBT-I cost?

The cost of CBT-I varies widely depending on the delivery format, your location, provider credentials, and insurance coverage. Research comparing treatment costs found that digital CBT-I programs were the most cost-effective option.⁴

You can explore our guide on how to find free or affordable therapy options here or search our directory for mental health professionals that accept your insurance.

CBT-I effectiveness

CBT-I is the most effective non-pharmacological treatment option for chronic insomnia, showing results that are similar to medication.⁵ Additionally, CBT-I is associated with better sleep long after the last session has ended. While medication can be effective, it tends to work by masking the symptoms of insomnia. CBT-I, on the other hand, helps patients understand and learn how to support their body’s natural sleep cycle.

In some cases, CBT-I may be used alongside medication.⁶ It’s sometimes used as an alternative for people who want to stop taking medication or when the medication isn’t producing the desired results. When medication is involved, it’s important to include your healthcare team in decisions and discuss any changes before making them.

Though CBT-I is effective, many people don’t know about it as an option for treating insomnia. In addition to doctors being more likely to prescribe medication, there’s also a shortage of trained CBT-I practitioners, which makes it more difficult for people to access this form of therapy.⁷

Who can benefit from CBT-I?

CBT-I is a viable option for almost anyone who wants to improve their sleep patterns, regardless of the underlying cause of their insomnia. However, it may be particularly beneficial for people with chronic insomnia or those who may be experiencing insomnia alongside other mental health conditions, such as depression or anxiety^.8,9

CBT-I has also been shown to help people whose insomnia is related to certain physical or mental health conditions, including pregnancy, posttraumatic stress disorder (PTSD), cancer, alcohol use disorder (AUD), osteoarthritis, and age-related cognitive decline.^{10,11,12,13,14,15}

How to get started with CBT-I

If you’re interested in individual CBT-I sessions online or in-person, visit our directory to search for a therapist in your area. You can refine your search by filtering results by therapist specialties and checking the box for sleep disorders.

If you’re open to exploring digital options, you may want to consider an app or online platform like Sleepio or Stellar Sleep. Some digital CBT-I programs are covered by employers or health insurance plans, are HSA-eligible, or offer limited free versions for those without coverage. Be sure to research the specific platform you’re interested in, as not all platforms are appropriate for all users.

Lastly, the US National Center for PTSD offers two free mobile apps that can help with insomnia. The first, Insomnia Coach, was designed as a self-care tool to be used by adults without certain co-occurring concerns. The second, called CBT-i Coach, is built to be used while in treatment with a CBT-I therapist.

Unsure which option is best for you? It’s always a good idea to consult with your doctor or a mental health professional who specializes in sleep disorders. They can help determine the most appropriate treatment plan for your specific needs.