# What is CBT for insomnia, and what would it ask of me?

> Perhaps the nights have been going wrong for months now, and you've tried the blinds, the apps and the early nights, and someone keeps telling you to try CBT for insomnia. What would it ask of you, and do you have it in you right now?

**In short:** CBT for insomnia (CBT‑I) is the treatment guidelines recommend first[^1][^2] for insomnia that has lasted months. It works with the nights you're really having, and nobody will tell you they're imagined. Over four to eight sessions[^3] you keep a sleep diary and a set window in bed that starts short, and you learn to get up when sleep won't come and to ease the worry and effort around it.

It may be 3am as you read this, after another night of watching the clock, or the morning after, with the day already looking long. Being told yet again to try CBT‑I can sound like being told it's all in your head, or like being asked to sleep even less when you're running on so little. It does ask for less time in bed at first, and there's a good reason for that. If you're awake now, one small thing is enough for tonight.

**If you’d like to try something tonight**

If you've been lying awake a long while, it's all right to get up, go somewhere away from the bed, in another room or a chair in the corner, and stay there until you feel sleepy again[^3][^4]. If you've taken a sleeping pill tonight or feel unsteady on your feet, it may be wiser to rest where you are, since getting up in the night needs care for anyone taking sleeping pills or at risk of falls[^3]. Everything else here will keep until morning.

If your nights are short because the hours simply aren't there, because of a baby, someone you care for, night shifts or long days, this piece is about something else, and its advice would only take more from you. The insomnia CBT‑I treats means trouble sleeping at least three nights a week for three months or more, despite enough time and the right conditions to sleep[^5]. And if your bad nights began only a few weeks ago, after something hard, you're probably not there yet. By the usual account, a short spell like that needn't become a long one unless certain coping habits keep it going[^6]. Those habits are what the rest of this is about, so you can read on knowing what to watch for.

## What is CBT for insomnia, and what isn't it?

CBT‑I is a short, practical course in which most of what it asks of you happens at the edges of the night: when you go to bed, when you get up and what you do with the time you'd otherwise spend lying awake. It brings together a little learning about how sleep is regulated, a set window in bed, getting up when sleep won't come and some work on the thoughts that keep you awake, with a sleep diary kept all the way through[^3]. The window is called sleep restriction and getting up belongs to stimulus control, and each has more to it than its name suggests.

Of all the ways to treat insomnia that has gone on for months, this is the one with the strongest backing. The guideline American sleep doctors work from gives it its only strong recommendation for chronic insomnia in adults[^3], and that's true if you live with other health conditions too, and whether it's given in person or digitally[^1][^2].

If you've already cut caffeine, darkened the room and kept the phone away from the bed, you've been following sleep hygiene, which is sensible advice and a different thing. When researchers took CBT‑I apart to see which pieces made the difference, the hygiene advice wasn't one of them: it added nothing clear, while changing unhelpful thoughts, newer acceptance-based parts, the window in bed and getting up mattered most[^7]. Offered on its own, it did less well than active treatments, and the same guideline suggests not relying on it for chronic insomnia[^3]. So if the hygiene advice hasn't been enough, that's what the trials would lead anyone to expect, and it says nothing about how hard you've tried.

## Why hasn't my insomnia gone away by now?

Perhaps it began with something you can name, a loss or a hard winter at work, and that has eased while the nights stayed bad. Chronic insomnia often lasts years, fewer than half of people recover without treatment, and it tends to become a problem in its own right, whatever set it off[^5].

What keeps insomnia going is mostly what anyone would do. After a few rough nights you go to bed a little earlier to make up for them, lie in when the morning allows, nap if you can and stay in bed trying, since getting up feels like giving in. In the model most clinicians teach from, extra time in bed, napping and a growing dread of bedtime are the habits that turn a short spell of insomnia into a long one, and they're what the behavioral parts of CBT‑I set out to undo[^6]. It's a working model more than a tested finding.

Perhaps you doze off on the sofa in the evening and then lie wide awake the moment you get into bed, sleepy everywhere except the one place you're meant to sleep. Night after night of lying awake there, the bed comes to mean wakefulness, and stimulus control is designed to break that link[^3]. Meanwhile the hours in bed stretch while the sleep inside them stays much the same, so it's spread thin: in a small study in Glasgow, people with long-standing insomnia were spending about eight hours in bed and sleeping for about sixty-eight percent of it[^8].

**If I go to bed early, I'll catch up on the sleep I lost.**

After a bad night an early bed seems to promise a way to get back what the night took, and it makes sense on paper: more time in bed, more chances to sleep.

With insomnia the extra time tends to fill with waking, and in the usual explanation it's one of the habits that keeps the problem going[^6]. CBT‑I works the other way round, drawing time in bed in to fit the sleep you're getting and then letting it out again as sleep fills it[^3].

## Why would it ask me to spend less time in bed?

This is the part that sounds hardest when you're already worn out. You and your therapist, or the program if you're working through one, start from your diary: roughly how long are you sleeping now? You set your time in bed close to that[^3], with the same getting-up time every morning. Each week you look at the diary together and decide whether to let the window out step by step as sleep comes to fill it, or draw it in a little when it doesn't[^3]. It doesn't go below a floor, such as five hours, or four and a half in some programs[^8][^9].

The thinking is that staying up until the window opens lets sleep pressure build. It may also steady the body clock and turn down the alertness that keeps you awake[^8][^10]. How it does all that is still an open question, because the evidence for the mechanism was thin and mostly from poor-quality studies[^10]. What most studies saw is clearer. A review of fifteen of them found that in most, time in bed shrank and sleep came more quickly once people lay down[^10], which is the change you'd be hoping for.

So what are those first weeks like? That same Glasgow study is one of the few that set out to measure them. Its sixteen volunteers agreed to four weeks of sleep restriction, and in the first week they went from about eight hours in bed to a little under six[^8]. The first night was the roughest: they slept about an hour and a half less than usual[^8]. For the next three weeks they were sleepier than usual during the day[^8].

The guideline describes the same early stretch for CBT‑I as a whole. Tiredness, irritability and trouble concentrating are its main downsides early on, and they usually ease by the end of treatment[^3]. Until they do, the shorter nights and the sleepiness can make it hard to keep going[^3].

Please don't drive or use heavy machinery on days when you feel very sleepy during these weeks. In an earlier study by the same team, more than a third of people keeping audio diaries said their driving was affected, and one said, “I felt, really, I was a danger on the road.”[^8]

By three months the people in Glasgow were back to their usual daytime alertness[^8]. They were asleep for about ninety-one percent of their time in bed, and sleeping about fifty-six minutes longer each night than before they began[^8], in a window that had widened to make room for it.

Is that worth a few hard weeks? The guideline's authors set the early tiredness against what follows and judged that the benefits strongly outweigh it[^3]. On this evidence that looks right. The weeks are still hard, and it's better to go in knowing they will be.

**Time in bed and time asleep, before and during sleep restriction**

Each outline is time in bed and the solid bar inside it time asleep, from the sleep diaries of fifteen adults with long-standing insomnia in a small Glasgow study with no comparison group[^8]. The first outline has a lot of empty room in it; by week four the window has closed around much the same sleep, and by three months both have grown together. At week four the outline is the window people were given; at three months time in bed is worked out from the sleep and the share of it spent asleep[^8].

Time in bed

Time asleep

- **Before treatment** 68% of it asleep

- **Week four** the window set for that week

- **Three months on** about 91% of it asleep

For a few people the window is something to do only with a clinician beside them. Guidelines say sleep restriction may not suit people prone to mania or hypomania, such as those with bipolar disorder; people whose seizures aren't well controlled; people already very sleepy in the day; or people in jobs such as driving or operating heavy machinery[^3]. The caution about mania has trial evidence behind it: in a large trial of UK university students, a digital sleep course brought a small, lasting rise in manic symptoms[^11] alongside its benefits. The same guideline expects that most people, once the reasons are explained, would choose sleep restriction with a clinician keeping an eye on how it goes[^3].

**Who took part in the Glasgow study, and how was it done?**

The sixteen volunteers were adults with an average age of 47 who'd had insomnia for a long time and were sleeping six hours or less[^8]. They did sleep restriction on its own, without the other parts of CBT‑I, and their window began at about five hours and forty-seven minutes and widened by fifteen minutes over the four weeks[^8]. They slept in the laboratory on the first night, after a week and after three weeks, so their sleep was recorded as well as written down.

The window followed a rule many programs share, each with its own variations. If less than 85 percent of the window is spent asleep, it shrinks by fifteen minutes; from 85 to 89 percent it stays as it is; and at 90 percent or more it grows by fifteen minutes[^8][^9].

One person, worried about work, left in the first week, so fifteen finished[^8]. On a questionnaire where a higher score means worse insomnia, their scores fell from 17.4 to 7.7 after four weeks and to 5.1 by three months[^8], though at four weeks the sleep they reported hadn't yet grown[^8]. There was no comparison group, so the study can't say how much of the change would have come anyway. Its worth lies in measuring the hard weeks, which most trials leave unrecorded, since harms are rarely tracked systematically in insomnia trials[^3].

## And what does getting up when I can't sleep involve?

The other half of the behavioral work asks you to go to bed only when sleepy, get up when you can't sleep, keep the bed for sleep and sex, rise at the same time each morning and let daytime naps go[^3]. In one large trial in Quebec, people went to another room whenever they hadn't fallen asleep, or back to sleep, within about twenty minutes, and came back to bed only once sleepy again[^4]. The twenty minutes is a rule of thumb from that trial's protocol, so a rough sense of time is plenty and the clock can stay turned away. If you're at risk of falls, find moving about difficult or take sleeping pills[^3], getting up is worth adapting with whoever is guiding you.

## What about the thoughts that keep me awake?

After months of this, sleep can start to feel like an exam you sit every night, and the cognitive part of CBT‑I works on the thinking that grows up around it. It looks at beliefs such as needing a full eight hours every night, or putting every hard day down to the night before, which feed the habits and the pressure to perform at bedtime[^3][^4].

One leading theory traces how that worry works on the night. Worrying about sleep and about the day after raises your alertness and sets you watching for signs that sleep isn't coming[^12]. Watched that closely, a night tends to seem shorter than it was, and the growing anxiety can then cost real sleep[^12]. What happens if you give someone a clock to watch? In small experiments, researchers tried it, and people asked to watch a clock while they tried to fall asleep worried more and took longer to drop off than those who didn't[^13]. It happened to good sleepers as well as to people with insomnia[^13], and that's the striking part: nobody needed insomnia for the watching to cost them sleep. If you've spent nights checking the time, it may sound familiar.

Effort seems to work the same way. Sleep can't be put fully under willpower, so trying hard may itself help keep insomnia going[^14]. In a laboratory study, good sleepers asked to fall asleep as fast as they could while their minds were kept busy took longer than those left to drop off whenever they liked[^15]. The theory and these experiments are all early and small, but they point the same way: the harder a night is watched and worked at, the longer sleep may take.

So part of what CBT‑I offers is leave to stop working so hard at sleep. The same analysis that found little in the hygiene advice put the newer acceptance- and mindfulness-based parts among those that helped most[^7].

## What would a course be like, week to week?

Between sessions, a course asks less of you than it may sound. Much of it is a few lines in your diary each morning: when you went to bed, about how long you slept and when you got up. At each session the diary guides the window for the week ahead[^3]. Most courses run four to eight visits, and the improvement comes gradually, which can be discouraging[^3], though what you gain lasts after the course ends[^3].

Often the nights get better from the inside before they get any longer. In trials of face-to-face CBT‑I for insomnia that came without other health conditions, people were falling asleep about nineteen minutes sooner by the end of treatment and spent less of the night awake, while their total sleep had barely changed[^16].

While the window is short there are evening hours to spend somewhere other than bed, and some people, older adults or those living with pain or depression among them, find that extra time hard to fill[^3]. It may help to plan those hours in daylight, a lamp by a chair in another room or a corner away from the bed, a book you can easily put down, music turned low, so there's nothing left to decide once you're tired.

## Does it work, and does it last?

For most people it does, though not for everyone, and this is where the evidence is strongest. In Quebec, 160 adults who had lived with insomnia for an average of sixteen years met in groups for six weekly sessions of an hour and a half[^4]. By the end, about four in ten were free of insomnia, and more again were clearly better[^4].

The benefit fades a little with time, and a year on it's smaller but still clinically meaningful[^17]. That staying power is what sets it apart from sleeping pills. The two seem to work about as well in the short term, while only CBT‑I has shown lasting effects after treatment stops[^18][^19]. Even so, only a handful of trials have compared them directly, none of them with the newest sleep medicines[^19].

**How many people does it help, and how does it compare with pills?**

When the American Academy of Sleep Medicine pooled twenty-five trials, thirty-three more people in every hundred were free of insomnia after CBT‑I than after control treatments[^5], which were mostly waiting lists, minimal help or placebo therapies.

In a small Norwegian trial, forty-six adults with long-running insomnia, with an average age of 61, had six weeks of CBT, the sleeping pill zopiclone or a placebo[^20]. Six months later, those who'd had CBT were asleep for 90.1 percent of their time in bed, up from 81.4, while zopiclone left it almost where it began and on most measures did no better than the placebo[^20].

Most trials compare CBT‑I with waiting lists or minimal help, and few compare it with pills directly. It helps most people and not all: in the Quebec group course, about four in ten were free of insomnia at the end.

- **CBT‑I is the first treatment guidelines recommend for chronic insomnia in adults: the American Academy of Sleep Medicine, weighing forty-nine studies, gave it its only strong recommendation, and American physicians and the European insomnia guideline also put it first.** well-established

- **It leaves many more people free of insomnia than control treatments do.** well-established

- **It still helps when insomnia comes with depression, anxiety or a physical illness.** well-established

- **The American Academy of Sleep Medicine suggests not relying on sleep hygiene advice on its own as a treatment for chronic insomnia, because it did less well than active treatments.** good-evidence

- **In a 2024 analysis of 241 trials with more than 31,000 people, sleep-hygiene education added no clear benefit to CBT‑I, while changing unhelpful thoughts, acceptance-based parts, the sleep window and getting up mattered most.** good-evidence

- **Its benefit usually lasts after treatment ends, growing smaller over a year but still meaningful.** good-evidence

- **Sleeping pills and CBT‑I seem to work about as well in the short term, and only CBT‑I has shown lasting effects once treatment stops.** good-evidence

- **Group courses, therapist-guided books and video or phone sessions tend to work well; online programs help moderately.** good-evidence

- **Early, mostly small studies suggest sleep restriction may work by building sleep pressure, and how it works is still an open question.** early-evidence

## What if I also have depression, or take sleeping pills?

- Yes, it can still help you. In trials of insomnia that came alongside another condition, about twice as many people were free of insomnia after CBT‑I as in comparison groups[^21], and the other condition often eased a little too[^21][^5]. If your mood is low most days, it's worth telling whoever guides you, so they can help with your mood as well as your sleep.

- You can start the course before stopping the pills: in the Quebec trial, some people took the course alongside zolpidem[^4], and six months on sixty-eight percent of those who had tapered off it were free of insomnia, compared with forty-two percent of those who kept it for when needed[^4].

If you've taken them most nights for a long time and want to stop, please do it with your prescriber, since some sleeping pills cause dependence even when taken as prescribed, and stopping suddenly or cutting down too fast can bring withdrawal reactions, including seizures[^22]. Done that way, it can work: in one trial, most long-term users aged 55 and over were off their pills six months after a supervised taper with CBT‑I[^23], though with no group going without the course, it can't show what CBT‑I itself added[^23].

- It can help in pregnancy too, though the evidence so far is a single trial. Among women eighteen to thirty-two weeks pregnant who weren't depressed, more of those given CBT‑I were free of insomnia by the end than of those given a comparison therapy, and they got there sooner[^24]. The comparison group did well too, with about half free of insomnia[^24], so it's a hopeful early sign.

It's worth seeing a doctor if:

- you feel low or anxious most days, because CBT‑I can help alongside depression and anxiety[^21] and they deserve care of their own
- you have a history of mania or bipolar disorder, seizures that aren't well controlled, heavy daytime sleepiness or work that involves driving or heavy machinery, because sleep restriction is then one to plan with a clinician[^3]
- you're too sleepy in the early weeks to get through the day, so your window can be looked at again
- you've finished a course and your sleep still hasn't improved enough, since medication is then something to decide on together with a clinician[^2][^1]

## How could I get CBT‑I, and where would I start?

It comes in more forms than most people expect, and in the trials the forms with a therapist somewhere in them all worked well, whether one-to-one in person, in a group, by video or phone, or as a self-help book with some therapist contact[^25]. Online programs helped somewhat less, and smartphone versions didn't show a clear effect[^25]. One-to-one CBT‑I with a trained provider is the best studied, though such providers can be hard to find and can cost more out of pocket than pills[^3]. A doctor can talk you through in-person, group and online options to fit what's near you and what you can afford[^3].

If an online course is what's within reach, it can still be a real choice, with gains that were still there a year later, though face-to-face treatment did somewhat better[^26].

If face-to-face help isn't near you or isn't affordable, or the waiting list is long, a self-help book gives you a way to begin while you wait. People working through self-help CBT‑I sleep better, drop out no more often than with a therapist and do better still with brief phone support[^27]. A doctor may also be able to offer a brief version over one to four sessions, built around the sleep window and getting up[^3], when a full course isn't practical.

**How do the different forms of CBT‑I compare in the trials?**

When fifty-two trials were compared, one-to-one sessions, groups, video or phone sessions with a therapist and therapist-guided books all had large effects, online programs medium ones, and smartphone versions no clear effect[^25], though the ranges around each result were wide.

Across thirty-three trials of digital CBT‑I, insomnia severity fell by about five points more than with controls, on a scale that runs to twenty-eight. Face-to-face treatment did about three points better again[^26]. In one trial of a six-week automated program called SHUTi, among 303 adults, about half of whom had another health condition, fifty-seven percent of those followed up were free of insomnia a year later[^28].

- **Can I work out my own sleep window?** Books and online programs walk you through it, and each sets a floor the window doesn't go below, such as five hours, or four and a half in some[^8][^9]. Keeping to the floor your program gives you is the safer way. If you're in one of the groups named earlier for whom sleep restriction may not suit[^3], it's one to do with a clinician.

- **What if CBT‑I doesn't work for me?** It helps most people and not everyone, and if it hasn't done enough, guidelines say medication can be considered, looking at benefits, harms and costs together with a clinician[^2][^1]. Some people also do better with a different form, since in-person, therapist-led CBT‑I did best across more than two hundred trials[^7].

Wherever you find it, the beginning is the same modest thing: a few lines written over breakfast about the night before. From those lines you and your therapist or program set your first window[^3]. In the studies, the nights that followed tended to get less broken before they got longer[^16][^8].

## Related questions

- [Do I have insomnia?](https://nitez.com/insomnia)
- [Should I get up if I can’t sleep?](https://nitez.com/getting-up-at-night)
- [Are sleeping pills safe to take?](https://nitez.com/sleeping-pills)
- [What can I do when I dread going to bed?](https://nitez.com/dreading-bedtime)
- [How do I get through the day after a bad night?](https://nitez.com/after-a-bad-night)

## Sources

[^1]: Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD; Clinical Guidelines Committee of the American College of Physicians. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine. 2016;165(2):125–133. [PubMed](https://pubmed.ncbi.nlm.nih.gov/27136449/) · [DOI](https://doi.org/10.7326/M15-2175)
[^2]: Riemann D, Espie CA, Altena E, Arnardottir ES, Baglioni C, Bassetti CLA, et al. The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023. Journal of sleep research. 2023;32(6):e14035. [PubMed](https://pubmed.ncbi.nlm.nih.gov/38016484/) · [DOI](https://doi.org/10.1111/jsr.14035)
[^3]: Edinger JD, Arnedt JT, Bertisch SM, Carney CE, Harrington JJ, Lichstein KL, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine. 2021;17(2):255–262. [PubMed](https://pubmed.ncbi.nlm.nih.gov/33164742/) · [DOI](https://doi.org/10.5664/jcsm.8986) · [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC7853203/)
[^4]: Morin CM, Vallières A, Guay B, Ivers H, Savard J, Mérette C, et al. Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. JAMA. 2009;301(19):2005–15. [PubMed](https://pubmed.ncbi.nlm.nih.gov/19454639/) · [DOI](https://doi.org/10.1001/jama.2009.682) · [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC3050624/)
[^5]: Edinger JD, Arnedt JT, Bertisch SM, Carney CE, Harrington JJ, Lichstein KL, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. Journal of Clinical Sleep Medicine. 2021;17(2):263–298. [PubMed](https://pubmed.ncbi.nlm.nih.gov/33164741/) · [DOI](https://doi.org/10.5664/jcsm.8988) · [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC7853211/)
[^6]: Patel D, Steinberg J, Patel P. Insomnia in the Elderly: A Review. Journal of Clinical Sleep Medicine. 2018;14(6):1017–1024. [PubMed](https://pubmed.ncbi.nlm.nih.gov/29852897/) · [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC5991956/) · [DOI](https://doi.org/10.5664/jcsm.7172)
[^7]: Furukawa Y, Sakata M, Yamamoto R, Nakajima S, Kikuchi S, Inoue M, et al. Components and Delivery Formats of Cognitive Behavioral Therapy for Chronic Insomnia in Adults: A Systematic Review and Component Network Meta-Analysis. JAMA Psychiatry. 2024;81(4):357–365. [PubMed](https://pubmed.ncbi.nlm.nih.gov/38231522/) · [DOI](https://doi.org/10.1001/jamapsychiatry.2023.5060) · [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC10794978/)
[^8]: Kyle SD, Miller CB, Rogers Z, Siriwardena AN, MacMahon KM, Espie CA. Sleep restriction therapy for insomnia is associated with reduced objective total sleep time, increased daytime somnolence, and objectively impaired vigilance: implications for the clinical management of insomnia disorder. Sleep. 2014;37(2):229–237. [PubMed](https://pubmed.ncbi.nlm.nih.gov/24497651/) · [DOI](https://doi.org/10.5665/sleep.3386) · [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC3900612/)
[^9]: Ellis JG, Cushing T, Germain A. Treating acute insomnia: a randomized controlled trial of a “single-shot” of cognitive behavioral therapy for insomnia. Sleep. 2015;38(6):971–978. [PubMed](https://pubmed.ncbi.nlm.nih.gov/25515106/) · [DOI](https://doi.org/10.5665/sleep.4752) · [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC4434564/)
[^10]: Maurer LF, Espie CA, Kyle SD. How does sleep restriction therapy for insomnia work? A systematic review of mechanistic evidence and the introduction of the Triple-R model. Sleep Medicine Reviews. 2018;42:127–138. [PubMed](https://pubmed.ncbi.nlm.nih.gov/30177248/) · [DOI](https://doi.org/10.1016/j.smrv.2018.07.005)
[^11]: Freeman D, Sheaves B, Goodwin GM, Yu LM, Nickless A, Harrison PJ, et al. The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis. The lancet. Psychiatry. 2017;4(10):749–758. [PubMed](https://pubmed.ncbi.nlm.nih.gov/28888927/) · [DOI](https://doi.org/10.1016/S2215-0366(17)30328-0) · [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC5614772/)
[^12]: Harvey AG. A cognitive model of insomnia. Behaviour Research and Therapy. 2002;40(8):869–893. [PubMed](https://pubmed.ncbi.nlm.nih.gov/12186352/) · [DOI](https://doi.org/10.1016/s0005-7967(01)00061-4)
[^13]: Tang NK, Schmidt DA, Harvey AG. Sleeping with the enemy: clock monitoring in the maintenance of insomnia. Journal of Behavior Therapy and Experimental Psychiatry. 2007;38(1):40–55. [PubMed](https://pubmed.ncbi.nlm.nih.gov/16793001/) · [DOI](https://doi.org/10.1016/j.jbtep.2005.07.004)
[^14]: Broomfield NM, Espie CA. Towards a valid, reliable measure of sleep effort. Journal of Sleep Research. 2005;14(4):401–7. [PubMed](https://pubmed.ncbi.nlm.nih.gov/16364141/) · [DOI](https://doi.org/10.1111/j.1365-2869.2005.00481.x)
[^15]: Ansfield ME, Wegner DM, Bowser R. Ironic effects of sleep urgency. Behaviour Research and Therapy. 1996;34(7):523–31. [PubMed](https://pubmed.ncbi.nlm.nih.gov/8826759/) · [DOI](https://doi.org/10.1016/0005-7967(96)00031-9)
[^16]: Trauer JM, Qian MY, Doyle JS, Rajaratnam SM, Cunnington D. Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Annals of Internal Medicine. 2015;163(3):191–204. [PubMed](https://pubmed.ncbi.nlm.nih.gov/26054060/) · [DOI](https://doi.org/10.7326/M14-2841)
[^17]: van der Zweerde T, Bisdounis L, Kyle SD, Lancee J, van Straten A. Cognitive behavioral therapy for insomnia: A meta-analysis of long-term effects in controlled studies. Sleep medicine reviews. 2019;48:101208. [PubMed](https://pubmed.ncbi.nlm.nih.gov/31491656/) · [DOI](https://doi.org/10.1016/j.smrv.2019.08.002)
[^18]: Perlis ML, Posner D, Riemann D, Bastien CH, Teel J, Thase M. Insomnia. Lancet (London, England). 2022;400(10357):1047–1060. [PubMed](https://pubmed.ncbi.nlm.nih.gov/36115372/) · [DOI](https://doi.org/10.1016/S0140-6736(22)00879-0)
[^19]: Mitchell MD, Gehrman P, Perlis M, Umscheid CA. Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC family practice. 2012;13:40. [PubMed](https://pubmed.ncbi.nlm.nih.gov/22631616/) · [DOI](https://doi.org/10.1186/1471-2296-13-40) · [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC3481424/)
[^20]: Sivertsen B, Omvik S, Pallesen S, Bjorvatn B, Havik OE, Kvale G, et al. Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. JAMA. 2006;295(24):2851–8. [PubMed](https://pubmed.ncbi.nlm.nih.gov/16804151/) · [DOI](https://doi.org/10.1001/jama.295.24.2851)
[^21]: Wu JQ, Appleman ER, Salazar RD, Ong JC. Cognitive Behavioral Therapy for Insomnia Comorbid With Psychiatric and Medical Conditions: A Meta-analysis. JAMA internal medicine. 2015;175(9):1461–72. [PubMed](https://pubmed.ncbi.nlm.nih.gov/26147487/) · [DOI](https://doi.org/10.1001/jamainternmed.2015.3006)
[^22]: US Food and Drug Administration. FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class. Drug Safety Communication, September 23, 2020. [www.fda.gov](https://www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class)
[^23]: Fung CH, Alessi C, Martin JL, Josephson K, Kierlin L, Dzierzewski JM, et al. Masked Taper With Behavioral Intervention for Discontinuation of Benzodiazepine Receptor Agonists: A Randomized Clinical Trial. JAMA internal medicine. 2024;184(12):1448–1456. [PubMed](https://pubmed.ncbi.nlm.nih.gov/39374004/) · [DOI](https://doi.org/10.1001/jamainternmed.2024.5020) · [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC11459364/)
[^24]: Manber R, Bei B, Simpson N, Asarnow L, Rangel E, Sit A, et al. Cognitive Behavioral Therapy for Prenatal Insomnia: A Randomized Controlled Trial. Obstetrics and gynecology. 2019;133(5):911–919. [PubMed](https://pubmed.ncbi.nlm.nih.gov/30969203/) · [DOI](https://doi.org/10.1097/AOG.0000000000003216) · [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC6485299/)
[^25]: Simon L, Steinmetz L, Feige B, Benz F, Spiegelhalder K, Baumeister H. Comparative efficacy of onsite, digital, and other settings for cognitive behavioral therapy for insomnia: a systematic review and network meta-analysis. Scientific reports. 2023;13(1):1929. [PubMed](https://pubmed.ncbi.nlm.nih.gov/36732610/) · [PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC9894949/) · [DOI](https://doi.org/10.1038/s41598-023-28853-0)
[^26]: Soh HL, Ho RC, Ho CS, Tam WW. Efficacy of digital cognitive behavioural therapy for insomnia: a meta-analysis of randomised controlled trials. Sleep medicine. 2020;75:315–325. [PubMed](https://pubmed.ncbi.nlm.nih.gov/32950013/) · [DOI](https://doi.org/10.1016/j.sleep.2020.08.020)
[^27]: Ho FY, Chung KF, Yeung WF, Ng TH, Kwan KS, Yung KP, et al. Self-help cognitive-behavioral therapy for insomnia: a meta-analysis of randomized controlled trials. Sleep medicine reviews. 2015;19:17–28. [PubMed](https://pubmed.ncbi.nlm.nih.gov/25104471/) · [DOI](https://doi.org/10.1016/j.smrv.2014.06.010)
[^28]: Ritterband LM, Thorndike FP, Ingersoll KS, Lord HR, Gonder-Frederick L, Frederick C, et al. Effect of a Web-Based Cognitive Behavior Therapy for Insomnia Intervention With 1-Year Follow-up: A Randomized Clinical Trial. JAMA psychiatry. 2017;74(1):68–75. [PubMed](https://pubmed.ncbi.nlm.nih.gov/27902836/) · [DOI](https://doi.org/10.1001/jamapsychiatry.2016.3249)

---
https://nitez.com/cbt-for-insomnia · What helps · updated 2026-09-03