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Sleep Therapy: Cognitive Behavioral Therapy for Insomnia (CBT-I)

Stimulus control, sleep restriction and cognitive techniques

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Psikiyatri department. Book Appointment →

What is Sleep Therapy: Cognitive Behavioral Therapy for Insomnia (CBT-I)?

Chronic insomnia is defined by difficulty initiating or maintaining sleep with daytime impairment for at least 3 months on at least 3 nights per week.

CBT-I addresses perpetuating factors such as conditioned arousal, dysfunctional beliefs and maladaptive sleep behaviors.

Treatment can be delivered face-to-face, in groups, via telehealth or digital programs (dCBT-I) with comparable efficacy.

Sessions integrate sleep diaries, actigraphy data and education about sleep physiology and homeostasis.

Indications include primary insomnia and insomnia comorbid with depression, anxiety, chronic pain, post-traumatic stress and medical conditions.

Symptoms

Difficulty falling asleep (sleep onset insomnia), staying asleep (maintenance insomnia) or early morning awakening.
Daytime fatigue, decreased concentration, mood disturbance, irritability and reduced motivation.
Pre-sleep cognitive activity, worry about sleep and clock-watching behaviors.
Excessive time in bed, irregular sleep schedule, daytime napping or use of bed for non-sleep activities.
Reliance on hypnotic medications, alcohol or supplements with limited durable benefit.

Risk Factors

Predisposing factors: female sex, family history, anxious or perfectionist temperament.
Precipitating factors: stress, life events, illness, medication, shift work or new caregiving roles.
Perpetuating factors: extended time in bed, irregular schedule, dysfunctional beliefs, conditioned arousal.
Comorbidity with depression, anxiety, sleep apnea, restless legs, chronic pain and substance use.
Older age, menopause and pregnancy can introduce additional sleep difficulties.

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Sleep difficulty more than 3 nights per week for over 3 months with significant daytime impairment.
  • Loud snoring, witnessed apnea, leg movements or unusual sleep behaviors warrant evaluation for other sleep disorders.
  • Use of multiple hypnotics, escalating doses or rebound insomnia after discontinuation.
  • Major depression, suicidal thoughts or significant anxiety associated with insomnia.
  • Chronic medical or psychiatric conditions whose insomnia limits recovery require integrated care.

Treatment Methods

01
Stimulus control: bed used only for sleep and intimacy; leave bed if awake more than 15-20 minutes.
02
Sleep restriction: limit time in bed to actual sleep time then gradually expand based on efficiency.
03
Cognitive restructuring: identify and modify dysfunctional beliefs about sleep and consequences of poor sleep.
04
Relaxation techniques: progressive muscle relaxation, paced breathing, mindfulness and imagery.
05
Sleep hygiene, education and management of comorbidities (sleep apnea, depression, pain) optimize long-term outcomes; pharmacotherapy is used short-term and in combination when needed.

Which Department to Visit?

You can visit our Psikiyatri department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.