CBT for Insomnia (CBT-I): What It Is, How It Works and How to Get It in the UK

What is CBT for insomnia?

CBT for insomnia is a form of cognitive behavioural therapy built specifically for sleep. It doesn’t try to knock you out. Instead it retrains your body clock and your bed so they work together again, and it tackles the worry about sleep that keeps the problem going. It usually takes 4 to 8 weekly sessions.

Insomnia that lasts 3 months or longer is called long-term (chronic) insomnia, and that’s who CBT-I is mainly for. It’s different from general CBT for anxiety or low mood, although some therapists combine the two. Our insomnia guide covers symptoms, types and causes; this page is about the treatment itself.

CBT-I works on the things that keep insomnia going long after whatever started it (stress, illness, a new baby, a bereavement) has passed:

• spending long hours in bed awake, so bed becomes linked with being awake
• an irregular body clock from lie-ins, naps and early nights to “catch up”
• racing thoughts and worry about not sleeping, which make you more alert at night (see tired but wired and anxiety at night)

Does CBT for insomnia work?

Yes. CBT for insomnia has the strongest evidence of any insomnia treatment, which is why NICE and European sleep experts recommend it first. In trials, people fall asleep faster, spend less time awake in the night and feel their insomnia is less severe, and unlike sleeping pills the benefits tend to last after the course ends.

Total sleep time often changes less than people expect, especially early on. What usually improves first is how quickly you drop off, how long you lie awake, and how much the nights worry you.

How CBT-I works: the five parts

Most CBT-I courses combine at least three of these five parts, with a daily sleep diary running through all of them.

The fifth part is sleep hygiene education: caffeine, alcohol, light and a comfortable bedroom. On its own it isn’t enough for long-term insomnia, but it supports the rest. Our sleep hygiene habits guide covers it. For relaxation, try progressive muscle relaxation or 4-7-8 breathing, and for the thought work, how to stop overthinking.

What is sleep restriction therapy?

Sleep restriction therapy is the most powerful part of CBT-I. You work out from a sleep diary how long you actually sleep, then limit your time in bed to roughly that (usually not less than 5 to 6 hours), with a fixed getting-up time. As your sleep becomes more solid, you add 15 minutes or so a week.

It’s harder than it sounds. In the first couple of weeks most people feel more tired and sleepy in the day before things settle. That’s expected, and it’s why it works best with support from a therapist, nurse or structured programme.

Our sleep calculator helps you plan a bedtime back from a fixed wake time.

What happens in a CBT-I course

Courses vary, but most follow a similar shape over about six weeks. This is a typical outline, not a plan to follow without support.

Many people notice less time lying awake by weeks 2 to 4, but give it the full course. If you track your sleep with a watch or app, our sleep trackers guide explains why a paper diary is often better during CBT-I.

How to get CBT for insomnia in the UK

You can get CBT for insomnia through your GP, through NHS Talking Therapies in some parts of England, through the Sleepio app (free across Scotland and in some areas of England), or privately from an accredited CBT therapist. What’s on offer depends on where you live, so ask your GP what’s available locally.

• Your GP: they can assess your sleep, check for other causes and refer you for CBT, in person or online.
• NHS Talking Therapies (England): you can refer yourself if you’re 18 or over (16 or 17 in some areas). It’s set up for anxiety and depression, but some local services also run CBT-I or sleep courses. Check your local service’s website.
• Sleepio: a digital CBT-I course that NICE recommends for insomnia in primary care. Free to adults in Scotland; in England only where the local NHS pays for it. See our Sleepio guide for how to sign up.
• Wales and Northern Ireland: ask your GP what CBT-I or digital options are available.
• Privately: look for a therapist on the BABCP register who has training in CBT-I. Ask how many sessions they plan and whether they use sleep restriction.

Can you do CBT for insomnia yourself?

Yes, many people improve with a structured self-help course, a book or an app, and digital CBT-I has good trial evidence. The key is to follow a complete programme with a sleep diary rather than picking out single tips, and to get support if sleep restriction leaves you too sleepy to function safely.

• A book: Colin Espie’s Overcoming Insomnia and Sleep Problems is on the Reading Well Books on Prescription list in England, so many libraries keep a copy.
• An app or online course: Sleepio where it’s free, or a CBT-I programme your GP or local service recommends.
• Start with the basics: the same wake time every day, including weekends; only go to bed when sleepy; if you’ve been awake for what feels like 20 minutes, get up and do something calm in dim light until you feel sleepy; no naps; keep a sleep diary.

If you wake in the small hours, our middle insomnia and how to stay asleep guides explain how these steps apply to night waking.

CBT-I vs sleeping pills

CBT-I treats the pattern behind insomnia; sleeping pills only cover a few nights. The NHS says GPs now rarely prescribe sleeping pills, and then only for a few days or weeks at most, because they can have serious side effects and you can become dependent on them.

NICE says a newer medicine, daridorexant, can be considered for long-term insomnia only if CBT-I hasn’t worked, isn’t available or isn’t suitable. More in our zopiclone and over-the-counter sleeping tablets guides. Don’t stop a prescribed sleeping tablet suddenly: ask your GP or pharmacist how to come off it.

Who should see a GP first

iSee your GP before starting CBT-I on your own if any of these apply, because another cause may need treating first or alongside it:

• loud snoring, choking or gasping in your sleep, or being very sleepy in the day: signs of sleep apnoea
• an urge to move your legs in the evening or at night: restless legs
• low mood, loss of interest, or anxiety most days
• pain, breathlessness, needing to pee at night, menopause symptoms or another health condition that wakes you
• you’re pregnant, have epilepsy or bipolar disorder, or drive for work
• you take medicines that might affect sleep, or sleeping tablets you want to come off

Older adults often sleep more lightly and wake earlier, which isn’t always insomnia: see sleep as you get older. Midlife women can find help in perimenopause and sleep; NICE also says CBT should be considered for menopause-related sleep problems.

Where an evening routine fits

Supplements and CBD aren’t a treatment for insomnia, and CBT-I courses usually suggest changing one thing at a time. Once you have a fixed wake time and a wind-down hour, some people like a regular evening ritual, such as a warm drink or a few minutes of quiet, at the same time each night. Our bedtime routine for adults shows how to build one, and natural sleep aids UK sets out what the evidence does and doesn’t show.