'CBT-I is the gold-standard treatment for insomnia' — an expert shares his go-to method for helping people with sleep disturbances

According to the American Academy of Sleep Medicine, 12% of US adults are diagnosed with chronic insomnia, a disorder that makes falling asleep and staying asleep difficult.

While treatment for insomnia can include medication, more and more people are turning to CBT-I (Cognitive Behavioral Therapy for Insomnia). This form of therapy is designed to address the root factors contributing to insomnia, rather than just medicating symptoms.

But how effective is it? We spoke to Dr Aric Prather, Sleep Advisor to wellness app Headspace, and the Director of the Behavioral Sleep Medicine Research Program at the University of California at San Francisco, to find out more following the launch of Headspace's new CBT-I sleep programme Finding Your Best Sleep. Here's what he told us...

How does CBT-I for insomnia work?

"Cognitive Behavioral Therapy for Insomnia (CBT-I) is the gold-standard empirically supported treatment for insomnia, and should be the first line treatment for individuals with insomnia before embarking on pharmacologic treatment," says Dr Aric.

"Unlike hypnotic medication, CBT-I addresses the perpetuating factors that drive insomnia, and provides the patient with science-backed strategies to improve sleep by consolidating sleep and entraining their circadian rhythm.

"CBT-I also addresses the anxiety that develops with unpredictable sleep by incorporating relaxation techniques and psychological strategies like cognitive restructuring.

"The goal is to help patients better regulate their sleep, find some success in sleeping, and build confidence and resilience."

How does CBT-I differ from other forms of CBT?

"CBT-I focuses specifically on sleep and insomnia symptoms. Unlike other CBT therapies, CBT-I is heavily behavioral. We know quite a bit about what regulates our sleep biologically, so that’s where we start.

"Focusing on standardizing someone’s wake up time, implementing stimulus control to reduce cognitive arousal in bed, and tracking sleep behavior via a sleep diary followed by restricting their time in bed to increase sleep consolidation can go a long way towards increasing the predictability at nighttime and reducing anxiety prior to and during the night."

Does CBT-I also help anxiety?

"CBT-I can certainly improve anxiety symptoms. In fact, several clinical trials demonstrate that individuals randomized to CBT-I show significant reductions in anxiety symptoms compared to those randomized to control conditions.

"This isn’t surprising given that poor sleep often leaves people more “on edge” and anxious. Headspace also offers a guided program specifically for anxiety and depression, the CBT for Anxiety & Depression program, which incorporates CBT techniques specific to improving anxiety and depression symptoms.

"The course has been shown to decrease anxiety & depression symptoms, improve sleep quality and positively impact mental health and wellbeing (results currently being prepared for peer review)."

In your experience, are there certain people who’ll find CBT-I more beneficial than others?

"Some people tend to benefit more from CBT-I than others, though much more research is needed to clarify these differences.

"There is some evidence that shorter sleepers with insomnia- those sleeping less than six hours, for example- may struggle with CBT-I more than longer sleepers.

"This is likely because one of the active mechanisms for why CBT-I is effective is through time in bed restriction, which may not be as powerful in those already getting little sleep.

"In my clinical experience, CBT-I may also be less effective in individuals with complex psychiatric or medical presentations.

"In some cases there may be conditions or medications that are impacting sleep where CBT-I may not completely resolve the sleep concern."

What advice would you give people who are considering CBT-I?

"While CBT-I remains the gold standard for treating insomnia, it isn’t always accessible. Headspace’s sleep course “Finding Your Best Sleep” was created to expand low-cost access to effective sleep support.

"The course expands access to proven sleep support by offering expert-led, self-guided sessions that can be completed anytime, anywhere. Included with a Headspace membership, it offers flexibility and affordability—removing common barriers to care.

"The course has been clinically proven to improve insomnia after practicing just 10 minutes a day over the course of 18 days.

"I hope that anyone who is struggling with insomnia will consider a trial of CBT-I in any way that is accessible to them. There is little downside, and is likely to provide you with a greater sense of control over your sleep experience.

"Unlike sleep medications, CBT-I does not carry any long term risk. Moreover, the strategies learned through CBT-I can be useful well into the future and sleep changes as our lives unfold."

Based on your experience, what do you think the most common cause of insomnia is in our modern world?

"My suspicion is that stress and feelings of uncertainty are the most likely culprits of insomnia. For so many- too many- we feel like we are in a state of hypervigilance, and this results in nights of disturbed sleep.

In turn, we often lack the emotional resources to deal with the stressors the following day, leading to yet another night of poor sleep.

Thankfully, programs like CBT-I can help provide a roadmap to better regulate our sleep, and when coupled with stress management strategies, can help us cope with this stressful world."

Finally, what advice would you give someone who feels constantly sleep deprived?

"First, I would say that they are not alone. In fact at least 30% of adults, if not more, are not getting adequate sleep. The second piece of advice is to take stock of your sleep life. Is it that you are getting sleep but don’t feel refreshed?

"Is something disrupting your sleep? Are you so pressed for time that you are not giving yourself enough opportunity? The answer to these questions will lead to different solutions.

"If you are worried about your sleep, the first step could be to talk to your doctor to make sure that you don’t have a sleep disorder, like sleep apnea, disrupting your sleep.

"If not and you’re looking for a personalised approach, consider trying CBT-I through a sleep specialist, I always suggest that people explore the Society for Behavioral Sleep Medicine directory to find someone in their region."