CBT-I (Cognitive Behavioral Therapy for Insomnia)

Chronic insomnia is maintained by a feedback loop, not a single cause. Poor sleep creates anxiety about sleep, which raises nighttime arousal, which makes sleep harder, which deepens the anxiety. CBT-I breaks this loop through three core mechanisms that work simultaneously.

Sleep restriction is the first mechanism. By temporarily limiting time in bed to closely match actual sleep duration, the technique intensifies sleep pressure and consolidates fragmented sleep into a shorter, more efficient window. This is uncomfortable for the first week but highly effective: sleep efficiency typically rises from below 80% to above 90% within two to three weeks as the pressure to sleep outweighs the conditioned arousal.

Stimulus control retrains the association between bed and sleep. When someone has had insomnia for months, the bed has become a cue for wakefulness and anxious thinking. Stimulus control breaks this by restricting all waking activities from the bed, requiring the person to leave when unable to sleep, and return only when sleepy. Over two to four weeks, the bed-sleep association rebuilds. The third component, cognitive restructuring, addresses the thought patterns that perpetuate insomnia: catastrophic predictions about a bad night, clock-watching, and hypervigilance about sleep quality. Identifying and challenging these beliefs reduces the arousal they generate.