What is CBT-I? Understanding Cognitive Behavioural Therapy for Insomnia
Sleep is a biological need, yet for many people, it becomes a nightly struggle. Insomnia is one of the most common health complaints worldwide, affecting health and wellbeing, physical wellbeing, work performance, relationships, and overall quality of life. An effective and evidence-based treatmentsfor chronic insomnia is Cognitive Behavioural Therapy for Insomnia (CBT-I).
CBT-I is not a sleeping pill, a relaxation app, or a quick fix. It is a structured, therapeutic approach that helps people understand sleep, change unhelpful patterns, and naturally rebuild healthy sleep.
What is CBT-I?
CBT-I is a psychological and behavioural treatment designed specifically for insomnia. It works by addressing the thoughts, behaviours, habits, and physiological responses that keep sleep problems going — even when the original cause of poor sleep may have passed.
Insomnia might begin for many reasons, including stress, illness, trauma, work pressures, or life changes. Over time, however, the problem becomes maintained by:
Anxiety about sleep
Hyperarousal (a constantly “switched on” nervous system)
Irregular sleep patterns
Excessive time spent in bed awake
Unhelpful coping strategies
Conditioned associations between the bed and wakefulness
CBT-I helps reverse these patterns and retrains the brain and body to associate the bed with sleep rather than struggle.
What Does CBT-I Involve?
CBT-I is a structured programme, usually delivered over several sessions. It typically includes:
Sleep Education
Understanding what regulates sleep - how the pressure to sleep builds up, how circadian rhythms operate and what can disrupt the balance between them
Stimulus Control
Re-establishing the bed and bedroom as cues for sleep rather than wakefulness, anxiety, or alertness.
Sleep Restriction / Sleep Scheduling
Restricting time in bed to improve sleep efficiency by consolidating sleep, strengthening the sleep drive, and stabilising sleep-wake rhythms.
Cognitive Therapy
Addressing unhelpful beliefs and fears about sleep (e.g. “If I don’t sleep, I won’t cope tomorrow”).
Arousal Reduction Strategies
Reducing physiological hyperarousal and performance anxiety around sleep.
Behavioural Change
Developing sustainable routines that support healthy sleep in the long-term.
Rather than “forcing” sleep, CBT-I creates the conditions in which sleep can happen naturally.
Why CBT-I Works
CBT-I is effective because it targets the mechanisms that maintain insomnia, not just the symptoms. Instead of sedating the brain, it helps regulate sleep biologically and psychologically.
Importantly, CBT-I encourages natural sleep and does not create dependency, tolerance, or withdrawal effects.
What Does the Research Say?
CBT-I is one of the most well-researched psychological treatments in healthcare.
Large-scale clinical trials and systematic reviews have shown consistently that CBT-I[AG6] can:
Improve sleep onset latency (time taken to fall asleep)
Reduce night-time awakenings
Improve total sleep time
Improve sleep quality
Improve daytime functioning
Reduce fatigue
Improve mood
Improve concentration
Research has also shown that CBT-I is as effective as sleeping medication in the short term, and more effective in the long term, because its benefits are maintained after treatment ends.
CBT-I has also been shown to be effective for people with:
Anxiety disorders
Depression
PTSD
Chronic pain
Neurodevelopmental conditions
Long-term health conditions
Shift work-related sleep disruption
National and international clinical guidelines now recommend CBT-I as the first-line treatment for chronic insomnia.
Who Is CBT-I For?
CBT-I is suitable for people who:
Struggle to fall asleep
Wake frequently in the night
Wake too early
Experience anxiety around sleep
Experience anxiety about sleep
Have long-standing insomnia
Want a non-medication-based approach
It can be used as a standalone treatment or alongside other psychological or medical care.
A Different Way of Thinking About Sleep
Sleep is not something that can be forced. The harder we try to sleep, the more alert we become.
CBT-I helps people shift from trying to control sleep to creating the right conditions for sleep — physically, psychologically, and behaviourally.
It supports people to:
Trust their body’s natural sleep system again
Reduce fear around sleep
Build confidence in their ability to sleep
Restore a healthy relationship with rest
CBT-I at Attention to Health
At Attention to Health, CBT-I is delivered as a structured, evidence-based approach that recognises sleep as a core foundation of health and functioning. Sleep difficulties are explored in the context of physical health, neurodevelopmental conditions, work patterns, stress, and lifestyle factors.
A short sleep consultation is the first step, providing an opportunity to discuss sleep concerns, understand what may be maintaining the problem, and decide whether CBT-I or another approach is appropriate. Consultations and therapy are available online, with booking via our online booking system.
Final Thought
CBT-I offers a compassionate, evidence-based pathway to restoring natural sleep — not by forcing the body, but by working with it.
Better sleep is not just about nights — it changes days, relationships, health and wellbeing, and quality of life.