In short
- The American College of Physicians recommends CBT-I as the initial treatment for all adults with chronic insomnia disorder.
- The American Academy of Sleep Medicine gives multicomponent CBT-I its only strong recommendation among behavioral and psychological insomnia treatments.
- CBT-I combines changing unhelpful thoughts about sleep with behavioral steps such as stimulus control and sleep restriction, usually over four to eight sessions.
- Sleep hygiene tips on their own are not recommended as a treatment for chronic insomnia, according to the AASM.
- CBT-I is available face to face, in groups and through digital programs, which helps because trained therapists are in short supply.
CBT-I, or cognitive behavioral therapy for insomnia, is a short, structured treatment that changes the thoughts and habits that keep people awake. It's the first treatment the American College of Physicians recommends for adults with chronic insomnia, and the American Academy of Sleep Medicine gives it a strong recommendation. Most courses last four to eight sessions and don't involve medication.
What counts as chronic insomnia?
The AASM describes insomnia as trouble falling asleep, staying asleep or waking earlier than you want, despite allowing enough time in bed. It comes with daytime symptoms such as fatigue, poor concentration, low mood or irritability. Chronic insomnia disorder means this happens at least three times a week for at least three months, and the AASM says it affects about 10 percent of adults.
The NHS uses a similar three-month line to separate short-term from long-term insomnia. If you're having a rough couple of weeks, the self-help advice further down is the place to start. CBT-I is designed for the stubborn, long-running kind.
What do the guidelines say?
Research: strong (what this means)Two major guidelines put CBT-I at the front of the line.
In 2016, the American College of Physicians reviewed randomized trials and recommended that all adults with chronic insomnia disorder receive CBT-I as the initial treatment. It graded this a strong recommendation based on moderate-quality evidence. Its second recommendation was that if CBT-I alone doesn't work, doctors and patients should decide together whether to add medication, after discussing the benefits, harms and costs of short-term use.
In 2021, the American Academy of Sleep Medicine published its own guideline on behavioral and psychological treatments. It made one strong recommendation, for multicomponent CBT-I. Lead author Jack Edinger said CBT-I is the most supported therapy. The AASM also made conditional recommendations for shorter multicomponent therapies and for three single techniques: stimulus control, sleep restriction and relaxation therapy.
The AASM notes that its separate guideline on insomnia medication says drugs should mainly be considered for people who can't take part in CBT-I, who still have symptoms after it, or who need a temporary add-on.
How well does it work?
The Sleep Foundation reports that when the techniques are used together, as many as 70% to 80% of people with primary insomnia see improvements, including falling asleep faster, sleeping longer and waking less. It says results often hold up over time, but that CBT-I doesn't always work right away, because the skills take practice.
What happens in CBT-I?
The AASM describes CBT-I as one or more cognitive strategies combined with education about how sleep is regulated and behavioral steps such as stimulus control and sleep restriction. The Sleep Foundation breaks the main parts down like this.
Cognitive restructuring looks at the thoughts that feed insomnia, such as worry about not sleeping or unrealistic expectations about how much sleep you need. Those beliefs can lead to habits like spending extra time in bed trying to force sleep, which makes sleep harder and strengthens the worry.
Stimulus control rebuilds the link between bed and sleep. The bed is used only for sleep and sex. If you can't fall asleep, you get up and return only when you feel sleepy. You set an alarm for the same time every morning and avoid daytime naps.
Sleep restriction sounds odd but is central. Using a sleep diary, your time in bed is set close to the amount you actually sleep, plus a little extra. The Sleep Foundation's example is someone aiming for 8 hours but sleeping 5, who would start with 5 hours and 30 minutes in bed. Once most of that time is spent asleep, time in bed is gradually increased. A gentler version, sleep compression, is often used with older people.
Relaxation training teaches techniques such as slow breathing exercises and progressive muscle relaxation to calm the racing thoughts and tension that come with lying awake. Our guide to slow breathing for sleep covers one approach.
Education and homework round it out. Expect to keep a sleep diary and practice the skills between sessions.
Is CBT-I safe?
CBT-I's risks are likely to be mild, according to the Sleep Foundation, but it can be uncomfortable at times. Sleep restriction makes you more tired for a while, and the Sleep Foundation says it isn't recommended for people with conditions that lost sleep can make worse, such as bipolar disorder and seizures. Working with a trained provider helps you handle those bumps.
Why isn't sleep hygiene enough?
Sleep hygiene means habits like a regular schedule, a dark and quiet bedroom and less caffeine late in the day. It's part of CBT-I, and it's useful. But the AASM guideline suggests clinicians not use sleep hygiene as a stand-alone treatment for chronic insomnia, and Edinger said that although these practices are well understood, they don't work as a stand-alone therapy. Our sleep hygiene tips are still a good foundation.
How do you get CBT-I?
The Sleep Foundation says CBT-I is often provided by doctors, counselors, therapists or psychiatrists trained in it, and points to the Society of Behavioral Sleep Medicine and the American Board of Sleep Medicine as places to find one. It also acknowledges there aren't enough trained providers to meet demand.
That's led to group, self-help and digital formats. The Sleep Foundation says digital CBT-I appears to produce improvements similar to face-to-face treatment, though only a few studies have compared them directly. In the UK, the NHS says a GP may offer CBT either face to face or through an online self-help program.
The U.S. Department of Veterans Affairs offers a free app, CBT-i Coach. The VA describes it as a tool for people working through CBT-I with a health provider, with a sleep diary, relaxation tools and guidance on sleep routines. The Sleep Foundation notes it's suitable for non-veterans as well.
What can you do while you wait?
The NHS suggests going to bed only when you're sleepy, getting up at the same time every day, relaxing for at least an hour before bed, and not sleeping in after a bad night. Several of these overlap with CBT-I. How to fall asleep faster and screens before bed have more.
The NHS also says you may be referred to a sleep clinic if you have symptoms of another sleep disorder such as sleep apnoea. It lists snoring or interrupted breathing while sleeping among the things that can keep you from a good night's sleep, so mention either to your doctor, since waking up tired can have causes CBT-I won't fix.
When should you see a doctor?
The NHS says to see a GP if changing your sleep habits hasn't helped, if you've had trouble sleeping for months, or if insomnia is making it hard to cope with daily life. Ask specifically about CBT-I. It's the treatment the guidelines recommend first.
Read next
Common questions
What is CBT-I?
Cognitive behavioral therapy for insomnia is a structured treatment that targets the thoughts and habits that keep insomnia going. It combines education about sleep, cognitive strategies and behavioral steps such as stimulus control and sleep restriction.
How long does CBT-I take?
The AASM says treatment typically involves four to eight sessions. The Sleep Foundation says it often takes six to eight, depending on a person's needs.
Is CBT-I better than sleeping pills?
The American College of Physicians recommends CBT-I as the first treatment for chronic insomnia, and says medication can be considered through shared decision-making if CBT-I alone hasn't worked. The NHS says GPs now rarely prescribe sleeping pills for insomnia.
Can I do CBT-I online or with an app?
Yes. The NHS says CBT for insomnia may be offered face to face or through an online self-help program. The Sleep Foundation says digital CBT-I appears to give improvements similar to face-to-face therapy, though few studies have compared them directly.
Is sleep restriction safe?
For most people it's a temporary, planned reduction in time in bed. The Sleep Foundation says it isn't recommended for people with conditions that lost sleep can make worse, such as bipolar disorder and seizures, which is why it's best done with a trained provider.
Isn't CBT-I just sleep hygiene?
No. Sleep hygiene is one part of it. The AASM guideline suggests clinicians not use sleep hygiene as a single-component therapy for chronic insomnia, because on its own it isn't an effective treatment.
Sources
- Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians
- Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline
- New guideline supports behavioral, psychological treatments for insomnia
- Cognitive behavioral therapy for insomnia (CBT-I): how it works
- Insomnia
- CBT-i Coach
About this article
- Research
- 6 published sources, listed above.
- Evidence
- Strong. How we rate it
- Last checked
- October 4, 2026
- Funding
- Paid partner of Titan Recovery. Their ads are labeled.
- Found an error?
- Tell us. We log fixes on the corrections page.
* This content is for informational and educational purposes only and is not medical advice. It is not intended to diagnose, treat, cure or prevent any disease or health condition. Talk to a qualified healthcare provider about your health.
