CBT for Insomnia (CBT-I): How It Works and How It Can Help You Sleep Better

By Katharine De Santos, MA, RP, Founder and Clinical Director, Healthy Minds Psychotherapy
Published September 2026

This article is for educational purposes only and is not a substitute for professional or medical care. If you're in crisis, call or text 9-8-8 (Suicide Crisis Helpline) or call 911.

In this article:

• What is CBT for insomnia?

• Common signs of insomnia

• How insomnia affects daily life

• 4 core CBT-I strategies

• Getting support for sleep problems in Toronto and Ontario

• Frequently asked questions

Sleep shouldn't feel like a nightly battle, yet many people lie in bed exhausted and still can't switch off. If your mind starts racing the moment your head hits the pillow, you're not alone.

Sleep problems are very common. About a third to half of adults have regular trouble falling or staying asleep, and about 7% to 18% meet the criteria for insomnia disorder (Rossman, 2019). The good news is that there's an effective, well-researched treatment that doesn't rely on medication: cognitive behavioural therapy for insomnia, or CBT-I.

In this post, you'll learn what CBT-I is, how it works, and how it can help you build healthier, more reliable sleep.

What Is CBT for Insomnia (CBT-I)?

CBT for insomnia (CBT-I) is a structured, short-term form of therapy that helps you change the thoughts and habits that keep insomnia going. It's recommended as the first-line treatment for chronic insomnia in adults by the American College of Physicians (Qaseem et al., 2016).

Many people try sleep medication, and for some people it's helpful in the short term. However, some people continue to have trouble sleeping while taking it, and over time they may need higher doses or become dependent on it (Rossman, 2019). CBT-I works differently. It helps your body relearn how to sleep by reducing the stress and alertness that have become linked with bedtime and by supporting your natural sleep rhythm. Many people find their sleep keeps improving even after treatment ends (Rossman, 2019).

If you're currently taking sleep medication, don't stop or change it without talking to your doctor or pharmacist. Some medications need to be reduced gradually, and CBT-I can be done alongside your current treatment.

Common Signs of Insomnia

Insomnia looks different for everyone, but common signs include:

Trouble falling asleep. Lying awake for a long time before drifting off, often with racing thoughts or worry.

Waking during the night. Waking up several times and struggling to fall back asleep.

Waking too early. Waking well before your alarm and not being able to get back to sleep.

Unrefreshing sleep. Spending enough time in bed but still waking up tired and foggy.

Daytime effects. Low energy, irritability, mood changes, trouble concentrating or memory problems.

Worry about sleep. Dreading bedtime and feeling pressure to "make" yourself sleep.

If several of these sound familiar, effective help is available. It's also a good idea to talk to your doctor, since sleep problems can be linked to medical issues, medications or other sleep disorders. Loud snoring, gasping or pauses in breathing during sleep can be signs of sleep apnea, which needs medical assessment.

How Does Insomnia Affect Daily Life?

Insomnia affects much more than your energy level. It can affect your physical health, your mood, your relationships and your work.

Physical Effects

When insomnia goes on for a long time, your body can get stuck in a state of hyperarousal. Your nervous system stays on alert, which makes it hard to relax into sleep. This can show up as muscle tension, headaches or a racing heart at bedtime. Being short on sleep can also make you less alert during the day, so take extra care when driving or doing anything that requires focus.

Emotional and Mental Effects

Insomnia can take a real toll on your mental health. Many people start having thoughts like "I'll never fall asleep" or "I'm going to be a wreck tomorrow." These thoughts create anxiety, and that anxiety makes sleep even harder, which becomes a frustrating cycle. Over time, this can lead to irritability, trouble concentrating and feeling discouraged.

Effects on Relationships and Work

Poor sleep can shorten your patience with colleagues, partners and children. You may start skipping social plans because you're too tired. At work, you may find it harder to focus, make more mistakes or lean on caffeine to get through the day. Over time, insomnia can chip away at your confidence at home and at work.

4 Core CBT-I Strategies

These strategies are the core of CBT-I and are backed by decades of research. Some can be tried on your own, while others should be done with guidance from a clinician trained in CBT-I.

1. Stimulus Control

When you spend a lot of time lying awake in bed, your brain can start to link your bed with frustration and alertness instead of sleep. Stimulus control helps rebuild the connection between your bed and sleep.

How to try it: Use your bed only for sleep and intimacy. If you feel like you've been lying awake for about 20 minutes, get up and go to another room. Try not to watch the clock. Do something quiet and relaxing in dim light until you feel sleepy, then go back to bed. Repeat as needed. Keep the same wake-up time every day, including weekends, and try to avoid daytime naps.

2. Sleep Restriction

Sleep restriction temporarily limits your time in bed to match the amount of sleep you're actually getting. This builds up your natural sleep drive, so sleep becomes deeper and more consistent. As your sleep improves, your time in bed is gradually increased.

This is one of the most effective parts of CBT-I, but it should be done with guidance from a clinician trained in CBT-I. It can make you quite sleepy during the day at first, and it needs to be adjusted carefully for people with certain conditions, including bipolar disorder, seizure disorders, sleep apnea or pregnancy, and for people who drive or operate machinery for work. Your family doctor can help you find a CBT-I provider or sleep clinic.

3. Cognitive Restructuring

People with insomnia often have unhelpful beliefs about sleep that fuel anxiety, such as "I haven't slept in days" or "I won't be able to function tomorrow."

How to try it: When you notice these thoughts, gently question them. Ask yourself: "Is this completely true? What's a more balanced way to look at this?" For example, you could replace "I can't sleep" with "This is a hard night, but I've gotten through hard nights before."

4. Relaxation Training

Many people with insomnia feel physically and mentally wired at bedtime. Relaxation techniques help activate your body's natural relaxation response.

How to try it: Try box breathing. Breathe in for 4 seconds, hold for 4, breathe out for 4 and hold for 4. Repeat 4 to 6 times, and skip the holds if they make you feel uncomfortable. You can also try progressive muscle relaxation by gently tensing and then releasing each muscle group, from your toes up to your head. For more body-based relaxation ideas, read our post on somatic therapy for anxiety.

These strategies are a starting point. If stress, anxiety or racing thoughts are a big part of what's keeping you awake, working with a therapist can help. Learn more about our services.

Getting Support for Sleep Problems in Toronto and Ontario

Self-help strategies can be a helpful first step, but sometimes sleep problems are tied to something bigger, like ongoing stress, anxiety, depression, grief or a difficult life change. When that's the case, working on what's underneath can make a real difference to your sleep.

At Healthy Minds Psychotherapy, our Registered Psychotherapists use cognitive behavioural therapy (CBT) and other evidence-informed approaches to help with the anxiety, worry and stress that often keep people awake. We offer therapy for anxiety in person at our Harbord Street office in Toronto and virtually across Ontario. We also have an affordable therapy program with supervised student therapists who see clients at a lower fee, including sessions in Spanish and Hindi. If you're looking for full CBT-I, including sleep restriction, your family doctor can refer you to a CBT-I provider or sleep clinic.

In your first appointment, your therapist will ask about your sleep, what's been going on in your life, and the thoughts and worries that may be keeping you awake. Together, you'll create a plan for what to work on.

Book a Free 15-Minute Consultation

Frequently Asked Questions About CBT for Insomnia

Is CBT-I more effective than sleeping pills?

For chronic insomnia, CBT-I is recommended as the first-line treatment because it addresses the thoughts and habits that keep insomnia going, not just the symptoms (Qaseem et al., 2016). An estimated 70% to 80% of people improve with CBT-I, and the benefits tend to last after treatment ends (Cho, 2025). Medication can still be part of some people's treatment, so talk to your doctor about what's right for you.

How long does CBT-I take to work?

CBT-I is usually delivered over about 4 to 8 sessions. Some people notice changes within a few weeks, and many find their sleep keeps improving after treatment ends.

What's the difference between sleep hygiene and CBT-I?

Sleep hygiene includes general healthy sleep habits, like limiting caffeine and keeping your bedroom dark and cool. These habits can help, but on their own they usually aren't enough for chronic insomnia. CBT-I is a structured treatment that goes further, using strategies like stimulus control, sleep restriction and cognitive restructuring.

Can I do CBT-I on my own?

There are reputable CBT-I self-help books and apps, and some people find them helpful. For the full program, especially sleep restriction, guidance from a clinician trained in CBT-I is best, and your doctor can help you find one. If anxiety, stress or low mood are part of what's keeping you awake, a therapist can help you work on those too.

Can therapy help if stress or anxiety is keeping me awake?

Yes. Sleep problems and anxiety often feed each other. Our therapists use CBT and other evidence-informed approaches to help with racing thoughts, worry and stress, which can make it easier to wind down at night. We offer sessions virtually across Ontario and in person at our Toronto office. To get started, book a free consultation on our website.

About the Author

Katharine De Santos, MA, RP, is a Registered Psychotherapist and the Founder and Clinical Director of Healthy Minds Psychotherapy. She has more than 25 years of clinical experience supporting people through trauma, anxiety, depression, grief, fertility challenges and major life transitions.

Her approach is trauma-informed and integrates somatic therapy with talk-based work. This means paying attention to how stress and difficult experiences show up in the body, which can give clients another way to understand what they're carrying and begin working with it. Katharine is also EMDR-trained.

Katharine holds a BA in Psychology from Western University and an MA in Counseling from The George Washington University, and has completed postgraduate training through Johns Hopkins University and The Global Mental Health: Trauma and Recovery Certificate Program through Harvard Medical School.

Learn more about Katharine

Works Cited

Cho, M. (2025, September 12). Cognitive behavior therapy for insomnia and hypnotic deprescribing. Psychiatric Times. https://www.psychiatrictimes.com/view/cognitive-behavior-therapy-for-insomnia-and-hypnotic-deprescribing

Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., & Denberg, T. D. (2016). Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 165(2), 125–133. https://doi.org/10.7326/M15-2175

Rossman, J. (2019). Cognitive-behavioral therapy for insomnia: An effective and underutilized treatment for insomnia. American Journal of Lifestyle Medicine, 13(6), 544–547. https://doi.org/10.1177/1559827619867677