Cognitive behavioural therapy for insomnia (CBT-i)
What is CBT-i?
Cognitive behavioural therapy for insomnia (CBT-i) is a structured treatment program for people with insomnia. It is the first-line treatment for chronic insomnia, recommended ahead of sleeping pills.
CBT-i activities include:
- Sleep restriction: Limit time in bed in order to increase sleep efficiency and allow sleep to become deeper and more consolidated (this means getting your sleep in one chunk, rather than broken up)
- Stimulus control: Break negative associations with the sleep environment and bedtime routines.
- Sleep hygiene or healthy sleep habits: Behaviours and routines that help you have quality sleep and feel fresh and alert during the day. We put stimulus control and sleep hygiene info together under behavioural strategies for improved sleep.
- Cognitive restructuring: Challenge unhelpful automatic thoughts (also called cognitive distortions) and manage racing thoughts that undermine your ability to get good sleep. Use the relaxation strategies described in our Stress Management section.
CBT-i is a highly-structured program that is provided by psychologists with special training; it includes weekly sessions over several weeks. You will have exercises to complete and review with your psychologist, techniques to learn and practice, and logs to record and track your sleep and thought patterns.
The "What is Insomnia and How to Cure it with Cognitive Behavior Therapy" video offers a detailed overview of CBT-i.
If you prefer to work on your own, bibliotherapy (self-help workbooks) and computerized CBT (online programs) can be effective.
Bibliotherapy is affordable: buy the workbook or borrow it from your local library. CBT-i titles include:
- Overcoming Insomnia A Cognitive-Behavioral Therapy Approach Workbook
- Sink into Sleep: A Step-by-Step Workbook for Reversing Insomnia
- The Insomnia Workbook: A Comprehensive Guide to Getting the Sleep You Need
- Goodnight Mind: Turn Off Your Noisy Thoughts and Get a Good Night's Sleep
- Overcoming Insomnia 2nd Edition: A self-help guide using cognitive behavioural techniques
Online CBT-i programs such as Go! to Sleep involve a one-time or monthly fee.
Using a workbook or online program can also be helpful if you are being followed by a health professional or a cognitive therapist. They will be able to review and offer recommendations based on your logs and sleep diaries (Sink into Sleep's Sleep Diary; the Centre for Clinical Interventions's Sleep Diary).
Having the workbook on your bedside table or the app on your phone is not enough(!) — you must engage in the process and complete the exercises to reap the benefits.
Students can get help with their sleep issues at Concordia by contacting Counseling and Psychological Services.
If you wish to participate in the specialized treatment program of CBT-i, you will have to go into the community. You may be able to access CBT FOR FREE by participating in a Concordia research study! Check out Concordia's PERFORM Centre's Participate in Research to learn more (scroll down to 'Insomnia').
Undergrad and international students have some coverage for psychological services through their student insurance plans. Three local centers that offer CBT-i include:
- the Insomnia Clinic at the Jewish General Hospital
- the Emotional Health CBT Clinic in NDG
- PSYMontreal: Students covered by the Concordia undergraduate student health insurance plan can get a discounted price by using the preferred rate negotiated by the CSU.
For staff and faculty, as CBT-i qualifies as a specialized service, it is not available through EAP. However, staff and faculty can also access CBT-i in the community, for example at the above-listed locations. The Concordia Health Plan (scroll down to "Psychologists and psychiatrists") or other private insurance can help pay for these services.