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  • Writer's pictureWilliam Hoekstra, PsyD, LP DBSM

The Enduring Power of CBT-I: A First-Line Therapy to Treat Insomnia




Insomnia, the persistent inability to fall asleep or stay asleep, plagues millions worldwide. It disrupts daily functioning, diminishes quality of life, and increases the risk of chronic health problems. According to the National Center for Health Statistics (NCHS), 14.5% of adults had trouble falling asleep every day in 2020. Another 17.8% had trouble staying asleep every day in 2020. 


Traditionally, medication has been the go-to solution. In many primary care practices, ones where patients receive care from a physician, medications are often the primary treatment intervention. However, Cognitive Behavioral Therapy for Insomnia (CBT-I) has emerged as a powerful, non-pharmaceutical approach with lasting benefits. In this post, I will explore the significance of CBT-I in the treatment of insomnia, highlighting its effectiveness, long-term advantages, and positive impact on overall well-being.


CBT-I tackles insomnia at its root by addressing the behavioral and cognitive factors that perpetuate sleep difficulties. Through a collaborative process with a therapist trained in behavioral sleep intervention, individuals learn to identify and modify unhelpful thoughts and habits surrounding sleep. This multifaceted approach incorporates several key components:

  • Stimulus Control: Creating a sleep-conducive environment by establishing a regular sleep schedule, using the bed solely for sleep and intimacy, and avoiding stimulating activities before bed.

  • Sleep Compression: Decreasing the time spent in bed based on actual sleep time, promoting sleep consolidation, and reducing time spent awake in bed.

  • Relaxation Techniques: Learning and practicing relaxation methods like progressive muscle relaxation or deep breathing to quiet the mind and promote sleepiness.

  • Cognitive Restructuring: Challenging and replacing negative beliefs about sleep (e.g., "If I don't get 8 hours, I'll be ruined") with more realistic and helpful ones.


Extensive research has established CBT-I as an effective, first-line intervention for both short-term and chronic insomnia. Studies repeatedly demonstrate significant improvements in sleep quality, including reduced sleep onset latency (time to fall asleep), decreased wakefulness after sleep onset, and increased total sleep time. These improvements are comparable to those achieved with sleep medication, but with a crucial distinction: CBT-I offers lasting benefits. Unlike medication, which can lead to psychological dependence, rebound insomnia, and a return of symptoms when medications are discontinued, CBT-I equips individuals with the skills to maintain healthy sleep patterns throughout their lives. CBT-I  treatment benefits are durable over time as well.


The advantages of CBT-I extend beyond sleep. By addressing the underlying anxieties and negative thought patterns that contribute to insomnia, CBT-I can have a positive impact on mental health. Studies suggest that CBT-I can improve symptoms of depression and anxiety, conditions often comorbid with insomnia. Additionally, by promoting better sleep, CBT-I can enhance daytime alertness, energy levels, and overall well-being.


Overall, CBT-I stands as a powerful and enduring approach to combating insomnia. Its effectiveness in improving sleep quality, long-term benefits, and positive impact on mental health solidifies its position as the first-line treatment for this prevalent sleep disorder. As you consider recovery from your underlying sleep challenges, CBT-I  should be viewed as a beacon of hope, empowering you to take control of your sleep and reclaim your well-being.

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