What Is CBTi?

Some call it sleep therapy. Its full name is cognitive behavioural therapy for insomnia, which is a bit of a mouthful and makes it sound kind of complicated. We call it CBTi. CBTi uses a non-medication approach that helps get your sleep back. It is an effective technique for treating insomnia, especially for people who experience long lasting types of insomnia, not just sleep difficulties that last one or two nights every now and again.

CBTi is officially recommended as the initial (or “first-line”) treatment of insomnia. Compared to sleeping pills, CBTi is more effective, with long-lasting benefits, is much safer, and is less costly than taking sleeping pills for months or years. CBTi is effective for people who are taking sleeping pills and can help to reduce the need for them.

Access the research behind CBTi

CBTi aims to help you break old habits and patterns that interfere with sleep and replace them with new approaches that bring on sleep naturally.

CBTi can be learned and applied, whether working one-on-one with a therapist, participating in insomnia therapy group, or using one of the several excellent self-help CBTi resources recommended by Sleepwell.

CBTi has 5 components. Some people use all 5 and others rely on just one or two to get their sleep back. That is, CBTi works for different people in different ways.

CBTi is comprised of 5 main components. We have broken them down for you and provided resources that focus on each one specifically.

Control | Sleep Drive | Relax | Thoughts | Hygiene | Sleep Diary

Most self-guided CBTi programs can be completed in 4-8 weeks. They start with recording 7 or more nights of sleep in your sleep diary and then focus on time-in bed strategies, including Control and Sleep Drive components, during the first 2-3 weeks. They also offer practical tips about your sleep hygiene. The second half of many programs then help you develop other skills to prepare your mind and body for sleep, through effective relaxation and cognitive therapy techniques. CBTi is flexible. You do not need to master all 5 components to get your sleep back.

Here’s an example of a CBTi program’s schedule. Keep in mind that yours may differ.

Most CBTi resources recommend that you follow a structured approach toward learning and applying CBTi to improve your sleep. The resources recommended by Sleepwell typically offer a program that takes 6 weeks to complete. Improvement in sleep quality and duration is often experienced within the first one to two weeks of starting the program. Sleep continues to improve as you work through the rest of the program. And the best part is that sleep often continues to get better after you have finished the program. The more you put into your CBTi program the more your sleep will benefit from it.

Most people with long-lasting periods of insomnia should use CBTi. It is effective for teens and adults of all ages with or without other health issues. CBTi is effective for people who are taking sleeping pills and can help to reduce the need for them. 

Research shows CBTi is effective in many people with other conditions. For example, in those who have:

• Depression
• Anxiety
• PTSD
• Psychosis
• Pain
• Multiple sclerosis
• Fibromyalgia
• Cancer

CBTi is also effective in people who are:

• Cancer survivors
• Pregnant
• Menopausal
• Postmenopausal
• Taking sleeping pills
• Not taking sleeping pills
• Hearing impaired

Time-in-bed restriction (aka Sleep restriction, Bedtime restriction) therapy is not recommended for people with specific health conditions, including bipolar disorder and epilepsy.

Access the research behind CBTi

Known as the time-in-bed components of CBTi, Control (stimulus control) and Sleep Drive (time-in-bed restriction) are the most effective components for getting your sleep back.

Control

By following a few rules, Control breaks the habit of lying in bed and feeling frustrated because you can’t sleep. The sleep rules are:

1. Don’t go to bed before your set bedtime, even if you are feeling tired.
2. Leave your bed and sleeping area if not asleep 20 minutes after turning off the lights.
3. Return to bed only when sleepy.
4. Repeat rules 2 and 3 after going back to bed or when waking during the night and lying in bed for another 20 minutes.
5. In the morning, don’t stay in bed past your rise time.

Sleep Drive

With Sleep Drive, you make a sleep prescription that you adjust each week. Your sleep prescription includes a bedtime and a rise time, and a few rules to follow based on your sleep numbers. These sleep numbers are your time in bed, time in bed awake, and time in bed asleep. You use these numbers to calculate your sleep efficiency (the ratio between your time in bed asleep and your total time in bed). Your sleep efficiency is high when you spend most of your time sleeping between the time you get into bed and the time you rise the next morning to start your day. On the other hand, sleep efficiency is low if you spend a lot of time awake while in your bed. The target sleep efficiency is 85% to 95%.

Learn more about sleep numbers here.