CBT-I for Insomnia
topic
Cognitive Behavioral Therapy for Insomnia (CBT-I) is the evidence-based first-line treatment for chronic insomnia — comprising sleep restriction therapy (consolidating sleep into a shorter, more efficient window), stimulus control (rebuilding bed-sleep association), sleep hygiene education, cognitive restructuring (addressing dysfunctional beliefs about sleep), and relaxation training — producing durable improvements in sleep onset, sleep maintenance, and sleep quality without the tolerance, dependence, or withdrawal effects of pharmacological treatment.
Role
CBT-I has higher remission rates at 6-month follow-up than sleep medication and produces durable changes rather than symptom management contingent on continued medication use — yet it is the minority treatment for insomnia because it requires behavioral engagement over 4–8 weeks rather than pill consumption. Most people with chronic insomnia have never been offered CBT-I, have never heard of it, or have been offered medication as the first intervention by a clinician managing a primary complaint in a brief appointment. Making CBT-I the default first-line response to insomnia — as clinical guidelines recommend — would improve the long-term sleep health of the majority of the approximately 15% of adults with chronic insomnia.