Cognitive behavioural therapy for insomnia (CBT-I)
Patients with chronic insomnia
are often anxious about not sleeping as much as they perceive to be necessary (see Recommended sleep times for healthy adults for recommended sleep durations). This can lead to distorted beliefs about adverse consequences of sleep deprivation and sleep anxiety (a cycle in which worrying about not sleeping increases arousal at bedtime and contributes further to insomnia). Cognitive behavioural therapy for insomnia (CBT-I) aims to address unhelpful beliefs and worries about sleep, reduce nocturnal hyperarousal and change behaviours that impair sleep. It is a multicomponent treatment involving cognitive behavioural therapy, education about good sleep practices and, as relevant:
Cognitive behavioural therapy for insomnia can be delivered face-to-face (individually or in a group setting) by an experienced and trained clinician, or self-administered (eg using an online format). Ideally, cognitive behavioural therapy for insomnia is delivered face-to-face over 4 to 6 sessions. If a digital format is preferred, products available include:
- This Way Up: Managing Insomnia—a free Australian CBT-I program that has been evaluated in an observational study; it can be self-administered or combined with clinician supervision
- Sleepio—a validated, subscription-based CBT-I program that can be self-administered or combined with clinician supervision
- CBT-i Coach—a validated free phone application intended for use in conjunction with face-face therapy with a clinician; developed by the United States Department of Veteran Affairs.
The use of cognitive behavioural therapy for insomnia has been limited because of cost, number of trained practitioners, lack of patient willingness to commit time to the program, and lack of awareness and acceptance of the potential benefits by patients and health practitioners.