Third, CBT-I therapists can teach us sleep hygiene and offer recommendations to follow in between appointments. Sleep hygiene may involve establishing an association between bed and actual sleep. When we look at our beds, many of us see the place we lounge, read, snack, watch TV, or work on our laptops. Instead, CBT-I suggests that at bedtime, if we only get into bed to sleep, and only when we are already sleepy, falling asleep is more likely to occur. If ten minutes pass and sleep hasn’t come, we can go to another room and read or relax until we are again sleepy, then lie down in bed once more. At first, this sequence may need to be repeated several times through the night, building what is called “sleep pressure”. In order for the change in thought patterns to occur, we need to prove them to ourselves through changes in our behavior, such as not allowing ourselves to nap or go to bed early. Using agreed-upon regular waking and sleeping times, the CBT-I therapist will help us navigate the changes we commit to practicing. Gradually, increased sleep pressure will help us be ready and able to drift off to sleep the first time we get into bed at night.

Finally, as treatment progresses and sleep quality improves, CBT-I can help identify ways to maintain sleep gains, prevent relapses of insomnia, and establish a plan to reverse any sign of relapse. This makes CBT-I a longer-term commitment offering a longer-term result. Because CBT-I inevitably changes our sleep thought and behavior patterns, as our new patterns become lifestyle habits, insomnia can become a thing of the past.

The Basics of Cognitive Behavioral Therapy for Insomnia (CBT-I)


If you’re reading this, it is likely that you are searching for ways to improve your sleep. Perhaps you prefer not to take sleep medication due to the potential for side effects. If you long for a night of restorative sleep, Cognitive Behavioral Therapy for Insomnia (CBT-I) can help. CBT-I has become the gold standard for non-drug treatment of insomnia, and here are the reasons why:

First, CBT-I treats insomnia by changing the way we behave and think about sleep. No pill can do that, and the process of working with a qualified sleep therapist requires effort and commitment. In order to emerge at the end of therapy with consistently improved sleep, you will need perseverance as unhelpful beliefs about sleep are identified and dismantled, and new behaviors adopted. In other words, you may feel worse initially before it gets much, much better.

Second, insomnia is more than simple absence of good sleep at night. Insomnia is self-perpetuating, whether we have trouble falling asleep or staying asleep. Often with good intention, we think and behave in ways that keep the cycle of insomnia turning. For example, worrying about not sleeping, assuming we are doomed to another night of tossing and turning, or allowing ourselves to sleep during the daytime are some ways we unwittingly feed the insomnia cycle. This is why talking with a sleep therapist can help us become aware of which misperceptions we may harbor, or which of our coping behaviors are making insomnia chronic. The therapist will consider our other diagnoses, since cancer, mood disorders and other conditions may heavily factor into our sleep beliefs and behaviors. How to best treat insomnia in cancer patients is, of course, what the CHOICE Study is investigating.