CBT for Insomnia: Why It Didn’t Work for Me (And Might Not Work for You)
CBT for insomnia—also called CBT-I—is considered the gold standard for treating chronic sleep issues. It’s the method doctors recommend first, and the approach sleep therapists are typically trained in. It’s also the most evidence-based approach out there for insomnia, and often paired with the promise that it is more effective than sleeping pills without the side effects.
It seems like common sense to get someone trained in CBT-I if you have insomnia. But, here’s the thing - it didn’t work for me. If you’re reading this, I’m guessing:
It didn’t work for you either
You like to explore all angles and perspectives before making an informed decision
You possess a healthy dose of skepticism and are curious about alternatives
If you fall into category a) and it didn’t work for you, first and foremost, please know that there is nothing wrong with you. Even though there is robust research behind the efficacy of cbt-i, it’s not a moral failing if you were not one of the successful data points. I hope that detailing why it did not work for me provides some reprieve - in learning that you’re not the only one and that other legitimate, evidence-based approaches work too.
As for the skeptics and conscientious decision-makers, I hope this provides insight, and a nuanced first-hand account of CBT for insomnia. I will break down what it is all about, how it works, why it doesn’t work for everyone, and what I use instead to support my clients with insomnia - as a sleep coach, licensed therapist, and former insomniac.
What Is CBT for Insomnia, Really?
Cognitive behavioural therapy for insomnia (CBT-I). is a structured protocol that aims to retrain your brain and body to sleep. As the term suggests, it works primarily by targeting unhelpful cognitions (thoughts), and behavior to support insomnia recovery. A lot of times with insomnia, people are engaging in behaviors that they think are helping (like engaging in sleep efforts) but are actually making things worse. What’s worse, there’s also the onslaught of mental monsters that can often follow an insomniac, becoming increasingly louder at night.
CBT-I addresses these using specific interventions tailored to insomnia. Here’s a breakdown of the main components.
Sleep Restriction
This involves narrowing the window of time that you spend in bed. Many insomniacs will try to force themselves to go to bed early to ‘catch up on sleep’, only to find themselves tossing and turning in agony all night. So, their ‘sleep window’ i.e. the time spent trying to sleep is spread out over a wide window of time.
I like to think of this concept as getting a river to flow back into its natural rhythm after a flood. When a river floods beyond its natural banks, it loses its force and becomes stagnant. The landscape around that needs its flow to survive becomes disorganized, sometimes even leading to rot.
With sleep restriction, the purpose is the same - narrowing and channeling the flow back to its natural path. If you have erratic sleep patterns, or are spending too long in bed, you lose sleep drive, which is basically the same as hunger for sleep. The longer you stay awake, the higher your sleep drive becomes, but it needs a steady rhythm for it to be consistent.
It may seem harsh to try to limit your sleep window when you’re barely sleeping as it is, but the idea is that it serves as a reset, so that you increase your sleep efficiency, which means you’re spending more time in bed actually sleeping instead of staring at the ceiling.
Stimulus Control
Most insomniacs (my former self included), learn to fear their bed. It may sound absurd, and in hindsight it even seems comical, but the fear is real. If you’ve had countless nights spent in your bed awake, you start to associate the negative experiences with your bed itself. What was once a restful oasis becomes a stress chamber. At my worst, as the hours passed towards bedtime, even the thought of going back into my bedroom sent me into dread.
This kind of association isn’t random — it’s classical conditioning, and it's been studied for over a century. Remember Pavlov’s dogs? He rang a bell every time he fed them, and eventually, they started salivating at the sound of the bell alone. The brain can make similar associations with the bed: if you’re frequently lying awake there, feeling anxious and restless, your body starts to associate the bed with stress instead of sleep.
Stimulus control aims to undo that pattern by using the bed only for sleep and intimacy. According to CBT-I, if your brain has learned to link the bed with frustration, you can teach it a new association by only using the bed when you’re actually sleepy (Sleep Foundation, n.d.). That means no lying there for hours, no scrolling, no mental wrestling matches. Just sleep, sex, or getting up and trying again later.
The goal is to re-teach your brain: bed = sleep, not bed = stress.
Cognitive Restructuring
Insomnia is objectively a challenging experience, but when anxiety spirals get the better of you, it adds insult to injury. So much of recovering is about changing the way you think about sleep. In cognitive restructuring, the main approach to this is recognizing negative thoughts, and then challenging them.
When in the throes of the struggle, it can feel helpless - like the catastrophizing is an accurate reflection of reality. Cognitive restructuring is aimed at challenging these thoughts. If you have insomnia, you’re probably familiar with your survival brain telling you some of the following:
You will have insomnia forever and are a lost cause
If you don’t sleep properly tonight you will make a dire error and be a colossal failure at your job, putting yourself at risk of getting fired
You will be such an emotional wreck tomorrow that you’ll disappoint or upset loved ones, possibly beyond repair
You will develop a chronic, serious health issue as a result of the insomnia
You get the idea. The thoughts above sound a lot like my survival brain’s chorus on repeat when I was at my worst. It was convinced that all these worries were plausible.
In cognitive restructuring, you practice challenging these thoughts by replacing them with a more grounded take. Here is an example from a CBT-I handout by Dr. Gregg Jacobs:
Initial thought: “I woke up in the middle of the night or early morning and feel wide awake. This means I will not be able to fall back to sleep.” (Jacobs, n.d., p. 9)
Replacement thought: “It is normal to initially feel alert if I awaken at the beginning or end of a dream; drowsiness will soon follow. If I awaken after about five and a half hours of sleep, I obtained my core sleep. If I do not fall back to sleep, I will be okay.” (Jacobs, n.d., p. 10)
Relaxation Training
With insomnia, it’s not just the brain that can go berserk out of fear, but also the body. Relaxation training in CBT-I is designed to address this piece by helping to calm the nervous system.
Relaxation training in CBT-I is designed to help calm the body and mind before sleep.
When the nervous system is in a state of hyperarousal (or fight or flight), the physiological sensations that accompany it - a racing heart, rapid breathing, muscle tension and even body jerks - can also set off alarm bells in the mind. So, it becomes a vicious cycle -> you’re already worried about sleep, then your body is in a heightened, stressful state, further heightening the worry.
Relaxation training in CBT-I employs different techniques to help calm the nervous system, including: progressive muscle relaxation, deep breathing, guided imagery or visualizations, and meditation or mindfulness practices.
These practices aren’t necessarily intended to put you to sleep directly. Instead, they’re meant to create the internal conditions that allow sleep to come more easily.
Sleep Hygiene
If you’ve ever googled “how to sleep better,” chances are sleep hygiene was the first thing you found. It was for me, too — a long list of rules and tips:
Go to bed and wake up at the same time every day.
Keep your bedroom cool, dark, and quiet.
Limit caffeine and don’t drink it past 12 pm.
Put your phone away before bed.
In CBT-I, sleep hygiene is about the environmental and behavioural factors that set the stage for sleep. The idea is simple: if you're tripping over obvious barriers that are working against you, like scrolling Instagram under fluorescent lights at midnight, even the best sleep support won’t help much.
While sleep hygiene isn’t considered a standalone treatment for chronic insomnia, it is meant to control for factors that could be hindering sleep. As I get to later on in this post, it can also backfire for some folks.
How CBT for Insomnia Works
CBT-I isn’t a grab bag of random sleep strategies — it’s a structured, heavily researched step-by-step approach designed to change the habits and thought patterns that keep insomnia going. So, what’s the issue? Well, it typically involves a lot of sleep tracking, rules, and effort - which can all add fuel to the fear fire.
The process usually starts with sleep restriction and stimulus control — the behavioral foundation of CBT-I. For sleep restriction, you’re given a limited sleep window, often based on your average sleep time. So, you need to track your sleep time for a week first. For stimulus control, because the bed is only for sleep and sex, you have to get out of your bed if you can’t sleep for 10-20 minutes, then go back to bed once you feel tired again.
The goal is to build up sleep pressure and make your time in bed more efficient.
For some people, this works. But for others (my past self included), being told to sleep less when you're already sleep-deprived is anxiety-inducing. It’s one of the more intense parts of the protocol, and for many folks, especially those with trauma or obsessive tendencies, it can backfire — ramping up stress before there’s a chance for progress.
As for stimulus control, it is meant to retrain your brain to associate your bed with sleep again. Having to get out of bed after 10-20 minutes can feel like an unreasonable demand. In theory, this is about rebuilding the bed=sleep connection. For me, my obsessive-prone brain got stressed trying to check if I’m tired enough to go back to bed, only to spend 20 minutes laying down wired because I knew if I didn’t fall asleep by then I’d have to jump out of bed again. Sometimes you need to heal the fear itself, not just behave differently around it.
Once stimulus control and sleep restriction are established, CBT-I introduces other components like sleep hygiene and relaxation techniques. While they are not the biggest core pieces of the CBT-I model, they are meant to support the process by optimizing your environment and helping your body unwind. While there is nothing wrong with ensuring a comfy sleep environment and practicing mindfulness - in fact, I would encourage that. The issue is that both relaxation techniques and sleep hygiene can sneakily become sleep efforts. Once we’re putting a lot of effort into trying to get to sleep, it creates more pressure, and in turn, worsens sleep.
Cognitive restructuring tends to come a little later. This is where you challenge the catastrophic thoughts around sleep — like “If I don’t sleep tonight, everything will fall apart.” For many people, this can be helpful. But in my case, those thoughts weren’t just cognitive distortions — they were wired into my nervous system. Even if rationally I could level that everything will indeed not fall apart if I don’t sleep, it didn’t feel that way inside. I needed more than this to work through the deep-seated fears.
So yes, CBT-I is structured, and it’s evidence-based. But that doesn’t mean it’s universally accessible, or even appropriate, for everyone. Understanding how it works is important — but so is asking whether or not it fits for you.
Can CBT for Insomnia Make You Feel Worse at First?
Yes — and you’re not alone if it does.
One of the lesser-talked-about realities of CBT-I is that the initial phases can be rough. This is most commonly due to sleep restriction, which limits your time in bed to build up sleep pressure. This, compounded with the new rules you are meant to follow, can be overwhelming to the nervous system.
Research backs this up. One randomized controlled trial (the gold standard for research) found that sleep restriction can lead to increased fatigue and sleepiness early on, especially during the first one to three weeks of treatment (Cheng et al., 2020).
For folks with trauma histories, nervous system sensitivity, or obsessive tendencies, this phase can be more than just uncomfortable — it can be destabilizing. That’s part of why I take a gentler, more personalized approach with the people I support. My nervous system is wired similarly, even after a lot of healing work. This made the rules, rigidity, and tracking more triggering than therapeutic for me.
What the Research Says About CBT-I
Even though I’ve shared my personal challenges with CBT-I — and many of the clients who come to work with me have had similar experiences — I think it’s important to acknowledge the research. There’s a substantial body of evidence showing that CBT-I can be effective, especially in the short to medium term.
Let’s start with one of the most often-cited long-term studies.
A follow-up by Jernelöv et al. (2022) found that around 66% of participants no longer met the criteria for insomnia ten years after treatment. Sounds impressive, right? But when I looked closer, I noticed the dropout rate was pretty high — about 34%. So if you include the full sample (not just the folks who stayed in the study), only about 43% were still insomnia-free at the ten-year mark. That's less conclusive than it initially sounds.
Honestly, the more compelling evidence comes from meta-analyses — studies that pool data from many clinical trials. These tend to show that CBT-I works well for most people over 3 to 12 months, with improvements in how long it takes to fall asleep, how much time you spend awake at night, and overall sleep quality (Trauer et al., 2015; van Straten et al., 2018). The results don’t last forever, but they’re meaningful.
And if you’re wondering how CBT-I compares to sleeping pills — it tends to come out ahead in the long run. While meds might offer quicker relief at first, the benefits of CBT-I tend to stick longer and come without the same side-effect risks.
That’s why major health organizations — including the American College of Physicians — recommend CBT-I as the first-line treatment for chronic insomnia.
But as you’ve probably guessed by now… “first-line treatment” doesn’t mean “right fit for everyone.” That’s where nuance really matters.
Understanding the research helps contextualize why CBT-I is widely recommended. However, it's also important to recognize that "gold standard" doesn't mean "one-size-fits-all." While the data supports CBT-I's effectiveness, individual experiences can vary, and it's crucial to consider personal needs and circumstances when choosing a treatment approach.
Who Is CBT-I For — And Who Might Struggle With It?
CBT-I can work for a lot of people. If you're someone who is not averse to collecting data with a sleep diary, tracking, and following a strict protocol including sleep restriction, it could be a good fit for you.
At the same time, if the idea of CBT-i is already sending you into anxiety, it might be worth it to listen to that. The people who come to see me have often tried CBT but found it didn’t address the deeper seated fears feeding the insomnia, or it even made them worse. I find CBT-I can fall short for people with obsessive tendencies, perfectionism, trauma histories, chronic hyperarousal, or neurodivergence.
If your nervous system is already in a state of high alert, then interventions like: restricting sleep, forcing bedtime rules, and sleep hygiene protocols can backfire. Why? Because the protocols can create more pressure to sleep, and we know that sleep doesn’t happen when there is added pressure. That is the paradox of insomnia - the harder you try, often the worse it gets. While CBT-I also targets the distorted thoughts that come with insomnia, the approach doesn’t always land for folks who already might struggle with emotion regulation. For them (and for former me), the intense emotional charge that comes with anxious thoughts like ‘ what if I never sleep again’ are often not remedied with a logic-based approach.
For me, one of the deeper issues of CBT-I is that it can unintentionally feel performance-based for some folks. So, if you’re not sleeping better, it can feel like you’re not following the protocol well enough. This can easily invite self-criticism and self-doubt, especially for those who experience shame or self-esteem issues independent of insomnia. As I’ll explain with the approach I use, some of the rules are either unnecessary or can make insomnia worse in my opinion. Without this knowledge, I fear that those folks who don’t respond well to CBT-I may then turn to self-blame when really, they just need a different approach (like I did).
How I Support People with Insomnia Using an ACT-based Approach
Fortunately, there is another option. I struggled with insomnia for several years before I discovered ACT - Acceptance & Commitment Therapy. By this point I had tried somatic therapy (very helpful for trauma but not for sleep), neurofeedback, CBT, and hypnotherapy, It was during one sleepless night whilst on a Google deep-dive that I came across ACT. It voiced what I had intuitively felt was true for my insomnia recovery, but had never seen expressed elsewhere. All my previous failed attempts also made perfect sense when seen in the light of an acceptance and commitment therapy lens.
Rather than try to find solutions or follow rigid rules, I needed to change my relationship with sleep by learning how to befriend wakefulness (a term coined by sleep expert Daniel Erichsen) rather than fear it. This was such a simple but revelatory light bulb moment that set me on a path of fearless sleep longterm. The paradoxical wisdom of needing detach from the outcome to truly heal my insomnia was the medicine I needed.
There’s now growing evidence that Acceptance and Commitment Therapy (ACT) can be a powerful alternative for treating insomnia — especially for people who find traditional CBT-I too rigid or too focused on control. ACT shifts the focus towards learning how to accept the uncertainty and let go of control, so your body can naturally do what it alrerady knows how to do - sleep.
While it bears some similarities to CBT-I with its focus on behavioural changes, psychoeducation, mindfulness techniques and working through distressing thoughts, there are some key differences. ACT tends to be a lot more flexible - the behavioral changes are often more about putting less effort into sleep, rather than more. This means, you can recover while watching tv in bed in the middle of the night, like I did (this brought me great solace). And, you won’t need to keep a sleep diary. There’s also a greater emphasis on learning how to be with distressing emotions than CBT-I offers, which I find so key for working through those deeper insomnia fears.
Research on ACT for insomnia is still nascent, but the studies so far are promising. In a recent randomized control trial it was shown to significantly reduce insomnia severity and improve sleep-related quality of life (Kanstrup et al., 2021). It also performed as well as CBT-I in treating insomnia in a recent study, offering a more flexible and values-driven approach for those who don’t resonate with strict behavioral protocols (Høghøj et al., 2023).
It’s important to note there are some limitations to the research. Many of the ACT studies so far have had small sample sizes or varied delivery methods, so we’re still learning what exactly makes this approach most effective. That said, I wish I had found this model sooner, and that’s part of why it’s so important for me to get the word out.
In my work with client who have insomnia, I draw primarily from this ACT approach. I support you to work at the pace of your nervous system so you can push yourself to work through the fears when it makes sense and also be gentle with yourself at the same time. I empower my clients with psychoeducation that simplifies the healing process, because the recipe for recovery isn’t that complicated (even if it feels tough sometimes). As both a therapist and coach, I also support clients to learn how to hold space for their emotions, rather than avoid them.
If you made it this far, and it’s resonating for you, feel free to contact me about working together. If you want to get more of a flavour for how I work with folks, you can also sign up for my free 5-day email course below if you haven’t already done so.
More on Insomnia
References
American College of Physicians. (2016). ACP recommends cognitive behavioral therapy as initial treatment for insomnia. https://www.acponline.org/acp-newsroom/acp-recommends-cognitive-behavioral-therapy-as-initial-treatment-for-insomnia
Cheng, P., Kalmbach, D. A., Fellman-Couture, C., Arnedt, J. T., Cuamatzi-Castelan, A., & Drake, C. L. (2020). Risk of excessive sleepiness in sleep restriction therapy and cognitive behavioral therapy for insomnia: A randomized controlled trial. Journal of Clinical Sleep Medicine, 16(2), 193–198. https://doi.org/10.5664/jcsm.8168
Høghøj, A., Lukac, C., Brok, J. S., Winther, T. S., Espie, C. A., & O'Toole, M. S. (2023). Acceptance and commitment therapy versus cognitive behavioral therapy for insomnia: A randomized controlled trial. Sleep Health, 9(5), 519–526. https://pubmed.ncbi.nlm.nih.gov/37431325/
Jernelöv, S., Lekander, M., Blom, K., Ruck, C., Lindefors, N., & Kaldo, V. (2022). Long-term effects of Internet-based cognitive behavioral therapy for insomnia: A 10-year follow-up. Cognitive Behaviour Therapy, 51(1), 43–58. https://doi.org/10.1080/16506073.2021.2009019
Kanstrup, M., Østergaard, T., Kristiansen, E., & Lau, M. (2021). Online acceptance and commitment therapy for insomnia: A randomized controlled trial. Internet Interventions, 25, 100415. https://pubmed.ncbi.nlm.nih.gov/34643664/
Sleep Foundation. (n.d.). CBT-I: Cognitive behavioral therapy for insomnia. https://www.sleepfoundation.org/insomnia/treatment/cognitive-behavioral-therapy-insomnia
Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M. W., & Cunnington, D. (2015). Cognitive behavioral therapy for chronic insomnia: A systematic review and meta-analysis. Annals of Internal Medicine, 163(3), 191–204. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445830/
van Straten, A., van der Zweerde, T., Kleiboer, A., Cuijpers, P., Morin, C. M., & Lancee, J. (2018). Long-term effects of cognitive behavioral therapy for insomnia: A meta-analysis. Sleep Medicine Reviews, 38, 19–27. https://pubmed.ncbi.nlm.nih.gov/31491656/