CBT-I: What It Is, How It Works, and Why It Sometimes Backfires for Insomnia (Plus What to Do Instead)

CBT-I: What It Is, How It Works, and Why It Sometimes Backfires for Insomnia

If you're googling insomnia related topics chances are you've stumbled upon the term "CBT-I" and how it's often called the gold standard treatment for insomnia.

So why is it that so many people (including myself) get mixed results with CBT-I? Some people find that it's helpful for them before it felt like it started to backfire?

As someone who has heavily relied on CBT-I during my own struggles with insomnia before switching over to a more sustainable method I can speak to this problem very well.

In this post we'll cover what exactly CBT-I is, how it compares to CBT, the core principles of it, how it compares to sleeping pills, and what I'd recommend instead.

What is CBT-I?

CBT-I stands for Cognitive Behavioral Therapy for Insomnia. This is a structured program designed to improve sleep by utilizing CBT based techniques by changing:

• Behaviors around sleep and wakefulness (for example: routines, what time to go to bed, etc.)

• Thoughts and beliefs around sleep ("If I don't sleep, tomorrow will be ruined")

CBT-I can also involve education that I would personally agree with: Waking at night isn't as uncommon as you'd think, "perfect sleep" isn't the goal, etc.

Where CBT-I can get really tricky quickly is that it can convince us that we need to use the right amount of control and approach sleep in the "correct" way in order to overcome insomnia.

What is the difference between CBT and CBT-I?

CBT is a broader therapeutic framework used for a wide array of mental health issues such as anxiety, depression, OCD, phobias and so on.

CBT-I is CBT treatment that's been adapted specifically for insomnia. It leans heavily on sleep-focused behavior changes including:

• Sleep restriction

• Stimulus control

• Thought journaling

If you want a more in-depth overview of what CBT-I includes, the NIH’s (National Heart, Lung, and Blood Institute) has a solid explainer here: CBT-I overview (NIH/NHLBI)

What makes this tricky is that this involves a lot of control, which is not very helpful when it comes to insomnia. Insomnia is one of the few things that typically gets worse the more we try to control our sleep.

What are the core principles of CBT-I?

1) Sleep restriction

Sleep restriction is probably th emost well known CBT-I tool. The idea is to limit the amount of time we spend in bed closer to the amount of sleep we're actually getting. So for example if you're spending 9 hours in bed but only sleeping for 5 hours, we should spend closer to 5 hours in bed.

The idea is that our brains would re-learn that the bed is for sleeping and we would increase our sleep drive.

What can feel good about it:

• It can reduce those long uncomfortable stretches in bed

• It gives us a "prescription" to make sleep happen

Where it can go wrong:

• It can make us nervous about only spending such a short amount of time in bed

• It gives us the impression that the more we regiment our sleep the better

As someone who suffered from chronic insomnia for over 7 years this was the "crutch" that I utilized the most to make sleep happen. In hindsight it made overcoming insomnia for good last quite a bit longer as it felt scary to remove this safety blanket that I came to believe I needed in order to make sleep happen.

2) Stimulus control: changing the bed-awake pattern

CBT-I aims to psychologically re-associate the bed with sleep instead of fear, frustration, any of the negative emotions we've developed around sleep. In order to help make this happen there are some typical rules:

• Only go to bed when you are sleepy

• If you're awake for 15 minutes, get up and do something else until you feel sleepy again

This can backfire because it's another way we make sleep feel like a process we have to get just right (which in itself is a driving force of insomnia). It's very common for people to get stressed out about whether or not they are going about these rules well enough.

From an ACT-I (Acceptance Commitment Therapy for Insomnia) lens, the bed isn't the enemy but rather our unhelpful relationship with wakefulness.

3) Cognitive work: challenging catastrophic sleep thoughts

CBT-I often utilizes thought journaling to challenge some unhealthy thoughts which might sound like this:

• "I'll never sleep well again."

• "I need perfect 8 hours of sleep"

I actually find this to be helpful to engage in sometimes. We don't need to do it to overcome insomnia but sometimes the persistent never ending stream of thoughts can be quite uncomfortable. Addressing them out on a paper can help calm and settle the mind.

ACT-I takes a different angle: You don't need to put in effort to remove these thoughts. Our brains are terrified so it makes sense for them to be there. We can simply acknowledge that they are there and we don't have to do anything about them.

Is CBT-I better than sleeping pills?

This is fairly difficult to answer, I don't think one is necessarily "better" than the other one. They both have their pros and cons but ultimately I wouldn't particularly recommend either of them to my clients in terms of overcoming insomnia.

Medication is simpler to implement; you simply take the dose your medical doctor prescribed to you at the right time. Yet CBT-I doesn't have any potential undesired side effects that can often come with medication.

At the end of the day neither approach really address the control aspect of insomnia, which really fuels the insomnia struggle.

In my opinion CBT-I is a step in the right direction but not for the reasons why it claims. For example, when sleep restriction "works", it's not so much due to the increased sleep drive but rather because we are using that extra time of wakefulness doing things we'd rather enjoy doing instead.

What I recommend instead: an ACT-I based approach

Perhaps you've tried out CBT-I already and you feel like it's not working out for you. This can feel fairly demoralizing considering that CBT-I has the reputation for being the "golden standard" of insomnia.

ACT-I might be better suited for you. It focuses less on solving the "How do I sleep tonight" puzzle and more on making the idea of wakefulness less and less of a threat.

We are repairing the true cause of the problem which is that we've become afraid of being awake and losing more sleep.

The more we practice ACT-I the more we rebuild trust in our body's natural ability to sleep again and the more we learn to live well even when sleep is imperfect.

Final takeaway

CBT-I is widely recommended and it can help many people—especially when it’s used as a flexible framework, not a strict performance.

But if CBT-I becomes another sleep-control strategy, it can backfire, because insomnia isn’t solved by more effort. It’s solved by more safety.

If you’ve been stuck in “fix it” mode, an ACT-I approach may be the missing piece: reduce struggle, drop safety behaviors, and teach your brain that wakefulness is not an emergency.

CBT-I is widely considered to be the gold standard and it has been helpful to a lot of people struggling with insomnia. However, it does run the risk of inviting us to try to control our sleep more and more which can eventually cause us to exacerbate our problem with insomnia.

Insomnia isn't solved by throwing more effort towards it. It's solved by re-learning to be more open to wakefulness.

References:

1. National Heart, Lung, and Blood Institute (NHLBI). (2022, March 24). Insomnia – Treatment (Cognitive behavioral therapy for insomnia, CBT-I). National Institutes of Health. Retrieved December 14, 2025, from https://www.nhlbi.nih.gov/health/insomnia/treatment