Cognitive Behavioral Therapy for Insomnia (CBT-I): What to Expect & How It Works
La Lune’s Nichole Accetta, a board-certified psychiatric nurse practitioner in Oregon and Washington who specializes in supporting individuals struggling with insomnia, talks about the gold-standard therapy modality to help get a better night’s rest.
What is insomnia?
Do you have trouble falling or staying asleep? Do you wake up feeling tired and unrested, which negatively affects your well-being and daily functioning?
If so, you're not alone.
These issues are characteristic of insomnia, one of the most common reasons adults seek medical help. As many as one in ten adults experiences chronic insomnia (McNamara et al, 2025), defined as sleep problems occurring more than three days a week for three months or longer.
Insomnia is subjective, so there isn't a specific number of hours that defines it. If you find your sleep is non-restorative despite believing you've slept the “ideal” amount, it's still classified as insomnia.
What Is Cognitive Behavioral Therapy for Insomnia (CBT-I)?
Cognitive behavioral therapy for insomnia (CBT-I) is a highly effective, multifaceted treatment that addresses both the behavioral and cognitive factors that interfere with sleep.
Organizations such as the American Academy of Sleep Medicine (AASM), the American College of Physicians (ACP), and the American Psychological Association (APA) recommend CBT-I as a first-line, gold-standard treatment for adults with chronic insomnia.
Today, we're constantly bombarded with messages emphasizing the importance of sleep and the so-called “magic numbers” we should strive to achieve. This often heightens sleep anxiety and effort, which can worsen insomnia for many.
Everyone has unique optimal sleep needs. Our bodies instinctively know how to sleep, thanks to innate biological processes. CBT-I aims to restore the body’s natural sleep mechanisms by targeting the behavioral and cognitive factors that can lead to insomnia.
What to Expect in Cognitive Behavioral Therapy for Insomnia (CBT-I)
CBT-I is typically delivered in 4 to 8 sessions (45-60 minutes each) by providers specially trained in this technique.
It involves tracking your sleep using sleep diaries or logs to identify cognitive or behavioral targets for improving sleep.
Interventions are designed specifically for you, keeping your unique needs in mind. They may include behavioral and/or cognitive strategies, based on your initial assessment and your sleep diaries or logs.
Examples of Cognitive Interventions of CBT-I
Interventions to modify unhelpful thoughts about sleep
Client education offers a comprehensive understanding of sleep and dispels any myths that may be causing sleep anxiety.
Examples of Behavioral interventions Of CBT-I
Interventions designed to alter negative associations with the bedroom and bed, which are common in individuals with insomnia, such as feelings of wakefulness and frustration.
Encouraging activities that boost the sleep drive to improve deep sleep, which is crucial for physical restoration, repair, and refreshment of the body.
Working with your unique body clock for the regulation of optimal sleep and wakefulness, which may have become unbalanced.
What about sleep medications?
Major clinical guidelines, including those from the American Academy of Sleep Medicine and the American College of Physicians, recommend Cognitive Behavior Therapy for Insomnia (CBT-I) as the first-line treatment for chronic insomnia.
Research indicates that CBT-I is just as effective and helps you avoid medication-related risks such as adverse side effects, psychological tolerance, and physical dependence. Additionally, it provides you with lifelong skills. Many patients also prefer CBT-I over medications.
That said, if you're already using over-the-counter or prescription sleep aids, you are not required to stop them to start CBT-I. Evidence shows that combining CBT-I with medications is an acceptable option, but it is important to note that it has not been found to be more effective than CBT-I alone.
If your goal is to reduce or stop your sleep meds, CBT-I can help with that, too. Ultimately, the decision to continue or stop prescribed or OTC sleep medication is yours and can be discussed with your provider and integrated into your personalized treatment plan.
Insomnia and Other Health Conditions
Sleep disturbances are linked to various health issues. Well-managed conditions often improve sleep, though insomnia may persist.
CBT-I has proven helpful for many people with depression, generalized anxiety disorder, panic disorder, chronic pain, PTSD, obstructive sleep apnea, menopause, and more. Keep in mind that approximately 40% of people with insomnia also face other mental health challenges (Roth, 2007).
By addressing insomnia, we may see benefits not just for sleep but also for overall health and quality of life.
Does CBT-I treat all sleep issues?
No, CBT-I should not be considered a generic sleep treatment. It was specifically developed to treat chronic insomnia.
Acute insomnia, defined as insomnia occurring on fewer than half the days of the week or for less than three months, is not an indication for CBT-I.
Other sleep disorders may require referral to a sleep clinic for assessment, including involuntary falling asleep, sleep-disordered breathing, restless legs syndrome, and circadian rhythm disorders.
Start CBT-I for Chronic Insomnia
If you're experiencing ongoing insomnia, remember you're not alone in your struggle or in seeking effective treatment.
I am here to listen to your experiences, understand your concerns, and assess how insomnia has affected your life.
Together, we can create a personalized treatment plan within the CBT-I framework. If you're ready to improve your sleep and possibly your quality of life, I invite you to schedule a consultation.
References
McNamara S, Spurling BC, Bollu PC. Chronic Insomnia. [Updated 2025 Mar 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526136/
Roth T. (2007). Insomnia: definition, prevalence, etiology, and consequences. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 3(5 Suppl), S7–S10.
Nichole Accetta is a board-certified psychiatric nurse practitioner at La Lune Integrative Psychiatry and she is currently accepting new adult patients in Oregon and Washington. She provides compassionate, evidence-based therapy and medication management, and specializes in treating conditions such as anxiety, depression, bipolar disorder, OCD, insomnia, eating disorders, PTSD, and panic attacks. Nichole has post-graduate training in cognitive behavioral therapy for insomnia (CBT-I), accelerated resolution therapy (ART) for trauma, and grief therapy.
We have board-certified providers in WA, OR, AZ, CO, and NH who are specialized in different therapeutic modalities. Here at La Lune Integrative Psychiatry, we prioritize a holistic approach to care. We dive deeper to understand the core cause of your struggles and provide an individualized approach. Fill out our 5-minute intake form below and we can match you with someone today.
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