Cognitive Behavioral Therapy for Insomnia (CBT-I) | Sleep Foundation

CBT-I is often called a multicomponent treatment because it combines several different approaches. Sessions may include cognitive, behavioral, and educational components. 

• Cognitive interventions: Cognitive restructuring attempts to change inaccurate or unhelpful thoughts about sleep.
• Behavioral interventions: Relaxation training, stimulus control, and sleep restriction promote relaxation and help to establish healthy sleep habits.
• Psychoeducational interventions: Providing information about the connection between thoughts, feelings, behaviors, and sleep is central to CBT-I.

1. Cognitive Restructuring - inaccurate or dysfunctional thoughts about sleep may lead to behaviors that make sleep more difficult. Cognitive restructuring begins to break this cycle through identifying, challenging, and altering the thoughts and beliefs that contribute to insomnia.
2. Stimulus Control - During treatment, the bed is only used for sleep and sex. Clients are instructed to get out of bed when it’s difficult to fall asleep or when they lie awake for more than 10 minutes.

People with insomnia often spend too much time lying in bed awake. Sleep restriction limits time spent in bed in order to reestablish a consistent sleep schedule.

This technique is intended to increase the drive to sleep and can temporarily increase daytime fatigue.

Sleep restriction begins by calculating the total time spent asleep on a typical night using a sleep diary. Time in bed is then adjusted to reflect this amount, plus 30 minutes.

Here are a few relaxation techniques commonly taught in CBT-I:

• Breathing exercises: These exercises typically involve taking slow, deep breaths. Research has demonstrated that focused breathing can increase slow heart rate and breathing, and reduce feelings of anxiety, anger, and depression.
• Progressive muscle relaxation (PMR): PMR is a technique that involves tensing and relaxing different muscle groups. 
• Autogenic training: This technique adjusts focus to different parts of the body and notices specific sensations. A person may focus on sensations such as heaviness, warmth, or relaxation.