CBT for insomnia: how does it work?

What is CBT?

Cognitive behavioural therapy, known as CBT, is an umbrella term for several types of talking therapies. These therapies emphasise that how you think affects how you feel and behave. By challenging unhelpful thought patterns, CBT can help you address, manage, and resolve a range of problems.

One such problem could be insomnia, which means poor sleep. Insomnia can affect people in different ways. Perhaps you struggle to fall asleep, wake up too early, or wake for long periods during the night. In any case, if you frequently miss out on a good night's sleep and feel that tiredness and other related symptoms are affecting your day-to-day, CBT could help you break the cycle.

How does CBT work for insomnia?

CBT for insomnia is a well-established and evidence-based treatment. Heather Darwall-Smith, psychotherapist and spokesperson for the UK Council for Psychotherapy (UKCP), says: "This therapy aims to help you establish healthy sleep habits and break the cycle of insomnia by addressing the underlying thoughts, behaviours, and habits that contribute to sleep difficulties."

Dr Sarah Bateup is a leading cognitive behavioural therapist and chief clinical officer at Oliva. She adds that acceptance and commitment therapy (ACT) is an important part of CBT for insomnia:

“In ACT, we dig deep into all the things you might have tried to overcome insomnia so far - whether that's sleeping pills or getting a new mattress. We then assess together how effective these strategies have been at easing your symptoms."

Dr Bateup's patients often find that the things they’ve been doing to get rid of insomnia are actually making it worse - even just by making them focus on their sleep problems more.

"So, in ACT we also look at this vicious cycle and explore alternative strategies - which will often be the very opposite of what somebody has been trying previously. For example, we might explore what happens if, when trying to get to sleep, you were more mindfully aware of what it's like to be awake. Or, if instead of trying to get rid of insomnia, you try to make room for insomnia in your life."

How effective is CBT for insomnia?

As with all therapies, how well CBT works will depend on many factors. Your engagement and commitment to your sessions is important, but it can also depend on whether your insomnia is a symptom of something else that needs to be addressed.

If it's just that you're not great at sleeping, Dr Bateup says that ACT can be an incredibly effective treatment because "normalising, validating, and taking stock of the vicious cycle of trying to get rid of the symptom can help you to adjust and feel less helpless."

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Many studies have proven just how effective CBT can be for insomnia. For example:

• Research involving 1,162 participants found that CBT for insomnia significantly improved their sleep outcomes, including how long it took to fall asleep, how early they woke up, and their total sleep time¹.

• Studies have shown that the effects of CBT for insomnia can last for up to two years following treatment².

• A review of 75 studies found that the combination of cognitive therapy and behavioural techniques, such as sleep restriction, were the most effective components of CBT for insomnia for improving sleep outcomes³.

How long does it take for CBT for insomnia to work?

According to Darwall-Smith, the benefits of CBT for insomnia can typically be seen within a few weeks of starting treatment - which generally goes on for a six-to-eight-week period, in sessions lasting 60 to 90 minutes. The improvements in your sleep should continue after your therapy ends.

"This can vary depending on your needs, the severity of your insomnia, and whether there are co-existing conditions," adds the psychotherapist. "Some individuals may require additional sessions, and the length of treatment can be adjusted to accommodate your needs."

The availability of CBT for insomnia may vary, depending on where you live and your healthcare provider. Therefore, if you are interested in accessing this therapy, it's important to discuss your options with your healthcare provider or seek a reputable provider specialising in CBT for insomnia.

Is CBT for insomnia suitable for everyone?

There can be a whole host of reasons why this therapy can work wonders for some, but not so well for others. Darwall-Smith explains that CBT for insomnia may not be right for the following groups:

• People with untreated medical or psychiatric conditions - disorders that are not well-managed may interfere with the effectiveness of this therapy. In such cases, it may be necessary to address these conditions before starting CBT for insomnia.

• People with sleep disorders other than insomnia - this therapy is specifically designed to treat insomnia and may not be effective for other sleep disorders, such as sleep apnoea or restless leg syndrome.

• People with severe insomnia - while CBT for insomnia can be effective for individuals with mild to moderate insomnia, it may not be sufficient for individuals with severe insomnia. In such cases, additional treatment may be necessary.

• People with limited cognitive or emotional resources - this therapy requires active engagement and participation, which may be challenging for individuals with limited cognitive or emotional resources. In such cases, alternative treatment options may be necessary.

• People who are unwilling or unable to commit to the treatment - CBT for insomnia requires a significant commitment of time and effort.

Further reading

1. Morin et al: Psychological and behavioural treatment of insomnia: update of the recent evidence.

2. Ritterband et al: Initial evaluation of an Internet intervention to improve the sleep of cancer survivors with insomnia.

3. Miller et al: The evidence base of sleep restriction therapy for treating insomnia disorder.