What is CBT-I?

CBT-I (cognitive behavioral therapy for insomnia) means a structured course that changes the habits and thoughts that keep insomnia going. It usually runs over a handful of weekly sessions, and US and European guidelines recommend it as the first treatment for long-term insomnia, meaning trouble sleeping three or more nights a week for three months or more, ahead of sleeping pills.

Each part of CBT-I goes after one thing that keeps you awake, and most programs combine several. You keep a sleep diary the whole way through.

Why does insomnia keep going?

Insomnia often starts with something you can point to, like stress, illness, a new baby or a move, and then outlasts it. The model most CBT-I is built on blames the habits people pick up to cope. Going to bed earlier, sleeping in, napping, lying in bed hoping sleep will come.

Those habits make sense on a bad night. Kept up for weeks, they weaken the pressure to sleep that grows through the day, and they teach your body that bed is a place to toss and turn. Worry feeds it too. One well-known idea in sleep research, with some experiments behind it, is that the harder people try to sleep, the more alert they get.

What is stimulus control?

Stimulus control rebuilds the link between bed and sleep. The usual instructions go like this:

• Go to bed only when you're sleepy, meaning your eyes are closing, rather than just tired.
• Get up when lying awake starts to feel like work, and do something quiet in low light until you're sleepy again.
• Keep the bed for sleeping and sex, and take screens and work somewhere else.
• Keep the same get-up time every morning, whatever the night was like.

If a fall at night is a risk for you, or you take something for sleep, stay in bed and sit up with a low light instead. Our guides to getting up in the night and a fixed get-up time go further.

What is sleep restriction?

Sleep restriction is the part of CBT-I people tend to find hardest, and one of the best supported. In a 2024 analysis of 241 trials, it was one of the parts that made CBT-I work better, along with stimulus control and changing unhelpful thoughts about sleep.

A clinician uses your sleep diary to trim your time in bed back toward the hours you're actually asleep, never below a safe minimum, and widens it again as sleep improves. With less time in bed you're sleepier when you get there, and sleep gets steadier.

It's one to do with a clinician, because the first weeks are tough. In a small study of 16 people starting it, sleep measured in a lab fell by more than an hour in the first three weeks, daytime sleepiness rose and reactions slowed. By three months the sleepiness and slow reactions had gone, and their insomnia was much better. If you're drowsy, don't drive.

Talk to your doctor before trying anything that limits your sleep if you have bipolar disorder or epilepsy, or if sleepiness at work could put people at risk.

The thinking side

The cognitive part of CBT-I deals with what goes on in your head at night. People with insomnia tend to watch the clock, count the hours left and predict how awful tomorrow will be. Those thoughts are understandable, and they keep the body on alert.

A therapist helps you test them against what really happens. Many people find a bad night costs them less the next day than they feared, and many people with insomnia sleep more than they'd guess, though not everyone does. Small changes help too. Turn the clock away from the bed. Well before bedtime, write down your worries with one first step for each, so they're less likely to be waiting for you in bed. The guide to waking at 3am has more for the small hours.

Relaxation and sleep habits

Many CBT-I programs teach a relaxation method, such as slow breathing, or tightening and releasing your muscles one group after another. The 2021 US guideline on behavioral treatments suggests relaxation on its own too, with a weaker recommendation than the full course, though the 2024 analysis found adding it to CBT-I didn't help and might even get in the way. A short wind-down before bed is where most people use it.

Sleep hygiene, the familiar advice about cutting caffeine and keeping the bedroom dark, usually gets a session as well. The same guideline advises against using it as the only treatment for insomnia.

How well does CBT-I work?

In a 2015 review of 20 trials of in-person CBT-I with 1,162 adults whose insomnia didn't come with other health problems, people who had it fell asleep about 19 minutes faster by their sleep diaries and spent about 26 fewer minutes awake during the night, compared with people who didn't. The share of time in bed spent asleep rose by about 10 percentage points. Total sleep barely changed by the end of treatment.

A 2019 review of 30 trials found CBT-I still did better than inactive comparisons, like a waiting list, 3, 6 and 12 months later, though the gap narrowed over time. Guidelines put CBT-I ahead of sleeping pills for that staying power and its fewer side effects, since a pill's benefit usually stops when the pills do. We go through that evidence in sleeping pills over the long term. If you take something for sleep, take it only as prescribed and talk to your doctor before changing it.

What the first few weeks feel like

The first weeks of CBT-I are often the roughest. Getting out of bed at night and holding your get-up time after a bad night both feel wrong at first, sleep restriction even more so, and the tiredness is real. Progress is uneven, and the diary is how you see the trend across weeks when a single night looks bad. Give it the whole course before judging, since most run several weeks.

How to get CBT-I

A trained therapist can take you through CBT-I in person or over video. You can also do it through a digital program or from a book. The 2023 European guideline rates digital CBT-I as a first choice, along with therapy in person. We keep a list of free CBT-I apps and courses, with how to find a therapist.

For a book, we'd start with Gregg Jacobs's Say Good Night to Insomnia, which lays CBT-I out as a six-week plan. Do its time-in-bed and sleeping-pill steps with your doctor.

See a doctor first if anyone has seen you stop breathing while you sleep, you snore loudly or wake gasping, your legs feel restless at night, you fall asleep during the day without meaning to, or your low mood is getting worse. CBT-I is for insomnia, and those need a separate check. If you're having thoughts of suicide or harming yourself, call or text 988 in the US, or your local emergency number.

How Goodmorrow uses CBT-I

We turn a few pieces of CBT-I into single habits and coach you through them one by one. Your first might be "Get up if bed stops feeling like rest," "Wake at the same time every day" or "Write worries and first steps, after dinner." Each gets fourteen days, with a check-in from us every morning. In your first two weeks there's also a short lesson every other day around lunch, with titles like "Bed can learn to mean awake."

We don't do sleep restriction, and we'll never put a limit on your hours in bed. Goodmorrow is a wellness app, so if insomnia has lasted months, a full CBT-I course is worth doing with or without us.