If you have been struggling with sleep for months, you have probably heard the usual advice: cut the caffeine, put the phone away, keep the bedroom dark. Those tips have their place, but for many people with ongoing insomnia they are not enough on their own.
Cognitive behavioural therapy for insomnia, usually shortened to CBT-i, is an evidence-based treatment for insomnia. It has decades of research behind it, yet many people have never heard of it, or assume it is just a more formal version of sleep hygiene. It is not. This post explains what CBT-i is, how it works, and what to expect if you decide to try it.
What Counts as Insomnia?
Everyone has a bad night now and then. Insomnia is when poor sleep becomes a pattern. It includes one or more of the following:
- Difficulty falling asleep
- Frequent waking during the night
- Waking early and not being able to fall back asleep
When these happen on at least three nights a week for three months or more, and affect how you feel and function during the day, that is considered chronic insomnia.
Why Insomnia Keeps Going
Insomnia often starts with something real: a stressful stretch at work, a new baby, a loss, a big change. What keeps it going months later is usually different. After enough difficult nights, the brain starts to link the bed with lying awake, frustration and worry rather than rest.
People understandably try to make up for lost sleep. They go to bed earlier, sleep in, nap, or stay in bed longer hoping to catch a little more rest. Those habits make sense, but they can weaken the body's natural drive to sleep. Meanwhile, worry about sleep grows ("if I don't sleep tonight, tomorrow will be a disaster"), and that worry keeps the mind and body switched on at exactly the wrong time.
This is why insomnia can outlast whatever started it. CBT-i is designed to work on the habits and thoughts that keep the cycle going.
What CBT-i Involves
CBT-i is a structured, short-term therapy. It is tailored to each person, but it usually brings together a few core parts.
A sleep diary
Each morning you take a few minutes to note when you went to bed, roughly when you fell asleep, any waking in the night, and when you got up. Over a week or two the diary shows your real sleep pattern, which is often different from how it feels, and it guides every adjustment to your plan.
A personalized sleep window
This is the part people find most surprising. For a short time, your time in bed is matched to the amount of sleep you are actually getting, with a steady wake-up time every day. Spending less time lying awake in bed helps rebuild your sleep drive, so sleep becomes deeper and more settled. As your sleep improves, the window is gradually widened. This is sometimes called sleep restriction, although it is really about consolidating sleep rather than taking it away.
Re-linking bed with sleep
Simple guidelines help your bed become a cue for sleep again: going to bed when you feel sleepy, getting up if you can't sleep, and keeping the bed for sleep rather than for working, scrolling or worrying.
Working with sleep worries
CBT-i includes structured work on the thoughts and pressure that build up around sleep, such as clock-watching, dreading the next day, or believing you can't function without a full eight hours. The aim is not to "think positive" but to find steadier, more realistic ways of thinking about sleep that let your mind settle.
Winding down
Relaxation and calming strategies help your body and nervous system shift gears at the end of the day, so there is a buffer between a busy evening and bedtime.
What a Course of CBT-i Looks Like
Many people need around four to eight sessions, usually spaced a week or two apart. A typical course moves through four stages:
- Assessment. Your first session looks at your sleep history, your routines, and what you have already tried. You start your sleep diary.
- Setting your plan. Using your diary, you and your psychologist set your sleep window and the core guidelines.
- Adjusting week by week. Each session reviews your diary and fine-tunes the plan. As your sleep becomes more settled, your time in bed is gradually extended.
- Keeping the gains. You finish with a plan for the occasional bad night, so one rough patch doesn't turn back into insomnia.
Will I Feel More Tired at First?
Often, yes. The first week or two can feel more tiring while your sleep window is set. That is a normal, temporary part of how the approach rebuilds your sleep drive, and it is something you and your psychologist plan for together. Knowing why it happens usually makes it easier to stick with.
Common Misconceptions About CBT-i
"It's just sleep hygiene with a clinical name"
Sleep hygiene, like limiting caffeine and keeping a dark, quiet bedroom, is only a small part of CBT-i. The core of CBT-i is the sleep window, re-linking bed with sleep, and the work on sleep worries. Many people who found sleep hygiene tips unhelpful find CBT-i different because it works on what keeps insomnia going.
"My sleep has been bad for too long"
CBT-i has been studied in people with long-standing insomnia, not just mild sleep problems. How long you have struggled does not, on its own, rule it out. Your first session is a chance to talk through your history and whether CBT-i is a good fit for you.
"It will take forever"
Compared with how long many people have been struggling with sleep, CBT-i is a relatively short course of therapy. Most of the work happens at home between sessions, in small daily steps.
Working With a Psychologist vs. Going It Alone
There are CBT-i apps and workbooks, and some people find them useful. The parts that are hardest to do alone are usually setting the sleep window and adjusting it as your sleep changes. Working with a psychologist means someone reviews your sleep diary with you each session, helps you troubleshoot when things feel stuck, and adapts the plan to your life. Because sleep and mood are closely linked, a psychologist can also help with the stress, anxiety or low mood that often sit alongside insomnia.
Frequently Asked Questions
Is CBT-i covered by extended health benefits in Alberta?
Sessions with a registered psychologist are covered by many extended health plans in Alberta. Plans usually cover the provider rather than the specific type of therapy, so check your plan's coverage for registered psychologist services, including the annual maximum and any per-session limits. Flutterby Psychology provides receipts for reimbursement. For more on fees and coverage, see our guide to therapy costs in Alberta.
What is the difference between CBT-i and sleep restriction?
Sleep restriction, or setting a sleep window, is one part of CBT-i. The full program also includes re-linking bed with sleep, work on sleep worries, relaxation and sleep habits, so it addresses both the behaviour and the thinking side of insomnia.
Do I need a referral?
No referral is needed to book with Josée. If you plan to use extended health benefits, check your plan, as some have their own requirements.
Can I do CBT-i virtually?
Yes. Josée offers CBT-i in person at our Calgary and Okotoks offices, and by secure video anywhere in Alberta.
Taking the Next Step
If poor sleep has been affecting your energy, your mood or your ability to get through the day, CBT-i is worth a closer look. It takes some effort, especially in the first couple of weeks, but it gives you practical tools you can keep using.
Flutterby Psychology offers CBT-i in Calgary and Okotoks, and virtually across Alberta. Learn more about insomnia and sleep therapy, or book a free 15-minute welcome chat if you'd like to ask questions first.
Sources
- Edinger, J.D., Arnedt, J.T., Bertisch, S.M., et al. (2021). Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 17(2), 255–262.
- Trauer, J.M., Qian, M.Y., Doyle, J.S., Rajaratnam, S.M.W., and Cunnington, D. (2015). Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Annals of Internal Medicine, 163(3), 191–204.