CBTi is a structured and evidence-based therapy for insomnia. It is based on the idea that how we think about sleep affects our sleep-related behaviour and that we can improve our sleep quality and quantity by changing these thoughts and behaviours. CBTi is as effective as sleep medication in the short term and more effective in the long term.
CBTi is based on the understanding that the worries and anxieties we have about sleep and the coping behaviours we adopt are not conducive to good sleep hygiene. In our quest to return to a regular sleep pattern, we may resort to problematic solutions such as staying up late, developing rigid sleep rituals, or attempting to control every aspect of our environment. Alternatively, we may engage in counterproductive habits like napping during the day, spending hours in bed trying to force sleep, or using electronic devices to pass the time during sleepless nights. Psychologists use CBTi as a multi-component approach to target the different aspects of our maladaptive sleep behaviour and cognition.

Sleep hygiene education: This involves providing information and guidance about healthy sleep habits, such as a regular sleep schedule, avoiding caffeine and alcohol, and creating a relaxing sleep environment. The following are 3 golden rules of sleep hygiene:

Stick to a regular sleep schedule: Go to bed and wake up at the same time every day, even on weekends or vacations.
Practice healthy habits: Avoid caffeine, nicotine, and alcohol close to bedtime, avoid large meals and excessive fluid intake before bed, and relax before bed, such as taking a warm bath or reading a book.
Create a sleep-conducive environment: Make sure your bedroom is quiet, cool, and dark, and use a quality mattress and pillows.

Stimulus control therapy: With CBTi, your psychologist will help you to establish a strong association between bed and sleep and reduce the association between bed and wakefulness. This can involve limiting the time spent in bed trying to force or wait for sleep to come. It seems counterintuitive at first, but trying too long and too hard to fall asleep ‘tarnishes’ your sleep environment with feelings of frustration and anxiety. Avoiding activities unrelated to sleeping in the bedroom (e.g., online work, laundry, watching movies, using electronic devices etc.) is also better.

Sleep restriction therapy: This involves limiting the amount of time spent in bed to match the amount spent sleeping and gradually increasing the time spent in bed as sleep improves. The following steps are typically involved:

Sleep diary: Your psychologist will ask you to keep a sleep diary to record the amount of time you spend in bed, the amount of time it takes to fall asleep, the number of times you wake up during the night, and the total sleep time.

Baseline data: Based on the sleep diary, your therapist calculates your average total sleep time and sets a sleep window, which is the period you are allowed to spend in bed.

Sleep restriction: The sleep window is gradually reduced to match the average total sleep time. For example, if your average total sleep time is 5 hours, your sleep window may be initially set at 5.5 hours. The sleep window is adjusted weekly based on your progress.

Gradual increase: Once you can consistently sleep for the entire sleep window, the sleep window gradually increases by 15-30 minutes per week until you achieve a regular sleep pattern.
Overall, sleep restriction therapy aims to improve sleep efficiency, reduce the time spent in bed without sleep, and increase your sleep drive to promote a more regular sleep pattern.

Psychologists can use CBTi to help people experiencing different types of insomnia, including chronic insomnia, acute insomnia, and insomnia related to other medical or psychological conditions. Chronic insomnia is difficulty falling or staying asleep for at least three nights a week for three months or more, while acute insomnia is difficulty falling or staying asleep for less than three months. Insomnia related to other medical or psychological conditions can include sleep disturbances related to anxiety, depression, chronic pain, or other health conditions. In all types of insomnia, your psychologist will help you develop a personalised treatment plan based on the key components of CBTi.