Online CBT-I Guide for Insomnia

Cognitive behavioral therapy (CBT) has been a respected form of talk therapy for decades. CBT-I takes the basics of CBT and directs those concepts toward helping those who struggle with insomnia get longer, more high-quality sleep. 

Online CBT-I (cognitive behavioral therapy for insomnia) offers even more people an opportunity to take back control of their sleeping habits. Instead of having to find time in your schedule to drive to an office, CBT-I brings the office to you — putting the same trusted principles in the palm of your hand. 

What Is CBT-I?

Cognitive behavioral therapy (CBT, for short) is just one of many different types of psychotherapy available. As a whole, CBT focuses on how many psychological problems are the result of unhelpful patterns of thinking and behavior. 

When you are able to work with a professional to learn better coping methods for counteracting these patterns, it can help you lead a more fulfilling, less stressful life.

Inside the CBT umbrella are multiple subcategories of therapy, including cognitive behavioral therapy for insomnia (CBT-I). CBT-I is a multifaceted approach to help support healthy sleeping patterns of those who have trouble falling asleep, staying asleep, or both. 

The primary focus of CBT-I is to address and support the management of any factors (behavioral, situational, etc.) that may contribute to developing chronic insomnia.

How Can CBT-I Help With Insomnia?

CBT-I is considered the “gold standard” for managing insomnia. Of all of the available treatments for insomnia, CBT-I is one of the most effective (without the same potential side effects that come with many of the sleep medications).

A CBT-I program is individualized, so no two people will get the same information used in the same way. Your CBT-I coach will get to know you and the heart of what you struggle with so they can address the things you need to improve in your sleep. They’ll help you restructure your behaviors, feelings, and thoughts so that you feel empowered to make the necessary changes that support better sleep quality. 

Here are a few ways they may help you do that:

Mental Health Assessments

Any type of therapy starts with a mental health assessment to establish a baseline of where you are emotionally before insomnia treatment. These assessments are important for finding the right evidence-based treatments for your specific needs and verifying that you’re a good candidate for CBT-I treatment.

If you haven’t been through any type of therapy before, the questions may seem invasive. However, make sure to be as honest as possible — the more your CBT-I coach knows about you, the more customized they can make your program.

Plus, insomnia can be challenging to handle on an emotional level. Mental health assessments can also help to identify those struggles and direct treatment appropriately. 

Evidence-Based Treatments

Once you’ve gone through your assessment, your CBT-I coach will work with you to use evidence-based treatments and interventions that will most effectively help improve your sleep. 

A few of the effective treatments that CBT-I coaches will employ to help support good sleep include:

• Behavioral interventions and treatments focus on how you can make changes in your routine and behavior to improve your sleep. Controlled sleep restriction, relaxation training, and stimulus control are all evidence-based ways to help establish better sleep habits. Biofeedback is an example of one of these interventions.

• Cognitive interventions and treatments that help attempt to change inaccurate and unhelpful sleep-related thoughts (known as cognitive restructuring) and break the cycle of insomnia.

Self-Help and Relaxation Techniques

In addition to evidence-based treatments, CBT-I coaches also have a wealth of self-help and relaxation techniques in their arsenal. Not only are these techniques helpful in helping you sleep better, but they are also incredibly beneficial for your overall physical and mental health and wellness.

A big part of CBT-I is education — teaching you how to take the techniques you’ve been taught and continue to apply them to your life even after therapy. When you understand more about how your thoughts and behaviors can impact your insomnia symptoms, you’re far more empowered to take control of your sleep patterns.

Can CBT Help With Other Sleep Disorders?

CBT can be a very effective form of therapy, but it can’t “fix” everything. A sleep medicine professional must manage certain sleep disorders, like those tied to physical causes (sleep apnea, circadian rhythm disorders, insomnia disorder, etc.). These sleep disorders often require prescription treatment, including CPAP machines, that aren’t available from a CBT-I program.

How Does Online CBT-I Work?

With the pandemic drastically changing how healthcare functions, there are more options than ever to have your needs managed — without even having to leave your home. Online programs using CBT-I work just the same as an in-person appointment with a qualified professional, although they may cost slightly more out-of-pocket. 

These programs are often offered using either app-based or web-based technology. You will “meet” with your CBT-I coach the same way you would if you were having in-person therapy – the goals and process are the same (minus having to drive across town).

Can CBT-I Be Paired With Other Sleep Treatments?

CBT-I is an excellent way to manage and improve your sleep, but like all forms of healthcare, it works best when used as part of a multi-faceted approach. Pairing CBT-I with other sleep first-line treatments, like updating your sleep routine and utilizing medications properly, can get you the rest you’ve always wanted. 

CBT-I and Sleep Hygiene

While sleep hygiene can be a crucial part of addressing sleep difficulties, it is not a component of CBT-I. However, the two work hand-in-hand to help provide a well-rounded approach you can use to improve your sleep for the rest of your life.

What is sleep hygiene? Here are just a few sleep hygiene tips that you can start using today:

• Make sure to keep your sleep space cool and dark. Both ambient temperature and light can play a significant role in the quality of sleep you’re able to get. Rooms that are too light, too warm, or too cold can keep you from getting the sleep you deserve.

• Do what you can to minimize the amount of noise around you when you sleep — even relatively small noises like a ticking clock. Ambient noise can keep you from falling asleep or wake you up after you’ve already fallen asleep.

• Develop a sleep routine and be consistent with it — do your best to go to sleep and wake up at the same time, even on weekends and holidays. A consistent sleep schedule can help prepare your body for sleep on a subconscious level, adding to the effectiveness of other approaches.

• Remove distractions from your bedroom, especially electronic devices (like televisions and computers). Blue light can impair your ability to reach the important deeper levels of sleep. Electronic devices can also stop you from getting the amount of sleep you need.

• Cut back on your caffeine use during the morning and stop drinking it entirely in the afternoon. Caffeine is a stimulant and can significantly impact the quality of sleep.

• Get physical activity during the day, but schedule your workouts so they’re completed at least a few hours before bedtime. Although exercise is great for both body and mind, the endorphins it releases can keep you up at night instead of helping you sleep better if you work out too close to going to bed.

CBT-I and Sleep Medications

CBT-I can also be used in tandem with sleep medications (like Ambien). However, for many people, sleeping pills are often only needed on a short-term basis while they work with a CBT-I professional to address their sleep issues. 

The “problem” with sleep medications is that they don’t address the root of the issue — they’re considered more of a band-aid. Many of them may help you fall asleep but don’t guarantee you’ll get the deep, high-quality sleep your body needs to heal and recover. 

Dealing with the underlying reasons that your sleep may be suffering is more beneficial and helps provide people with a longer-term “fix.”

Who Shouldn’t Use CBT-I?

Although CBT-I is incredibly beneficial and safe for nearly anyone, there are a few exceptions. These exceptions are generally made on a case-by-case basis. 

Those with an increased fall risk or certain diagnosable disorders may not benefit from CBT-I. If you fall into any of those categories, speak with a sleep or healthcare professional before starting therapy.

The Bottom Line

Online CBT for insomnia (CBT-I) is one of the most effective tools we have to support our body’s defenses against sleep problems. Unlike many other health conditions that have strictly physical causes, like sleep apnea or diabetes, insomnia is frequently related to emotional ones. Working with a CBT-I coach can help you work through anything that may be holding you back so that you can get back to getting your best sleep ever. 

If you’re unsure where to start, take our free sleep quiz. Sleep is crucial — don’t wait one minute longer to improve your quality of life and overall health and well-being.

Sources:

What is Cognitive Behavioral Therapy? | APA

Cognitive Behavioral Therapy for Insomnia (CBT-I): A Primer | PMC

Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review | PMC

FAQs for Cognitive Behavioral Therapy for Insomnia (CBT-I) | Center for Deployment Psychology