CBT for insomnia (CBT-I): what it is and how to access it in the UK

Chronic insomnia means difficulty falling asleep, staying asleep or waking too early, at least a few nights a week for months, with daytime consequences such as fatigue, low mood and poor concentration. It often begins with a stressful event and persists because of habits and worries about sleep, even after the original trigger has passed. Other conditions, such as sleep apnoea, restless legs, depression and medicines, need to be considered.

• Sleep diary: recording sleep patterns over a week or two to see what is happening.

• Sleep restriction or scheduling: limiting time in bed to match actual sleep, then gradually extending it as sleep consolidates.

• Stimulus control: using the bed only for sleep, getting up if awake for long and keeping a regular wake time.

• Cognitive techniques: addressing unhelpful beliefs and worries about sleep.

• Relaxation and wind-down routines.

• Sleep hygiene education as a supporting, not sole, element.

Hypnotic medicines can help in the short term but lose effect, risk dependence and cause next-day drowsiness. CBT-I changes the underlying habits and has effects that last after treatment ends. Trials show it improves sleep for most people who complete it, though the first weeks can be challenging because sleep restriction may initially increase tiredness.

People with conditions that could be worsened by sleep restriction, such as epilepsy, bipolar disorder, untreated sleep apnoea or jobs involving driving or safety-critical work, need guidance from a clinician. Therapists adapt the programme where needed. Insomnia occurring alongside depression or anxiety may be treated together.

Options include asking your GP about local NHS services, which may include talking therapies or sleep clinics, using NHS-recommended digital programmes where available, and private therapists. Look for therapists trained specifically in CBT-I and registered with a relevant professional body. Some areas allow self-referral to talking therapy services that include sleep. Waiting times vary.

Commit to the full programme, keep a sleep diary, expect an initial period of adjustment and avoid compensating by napping. Reduce caffeine and alcohol, particularly late in the day. Tell your therapist if you have mood problems. Ask what happens if progress is limited and what other options exist.

In a typical programme, you begin by keeping a sleep diary, then agree a fixed wake time and a time-in-bed window based on your recorded sleep. Over the following weeks, you adjust the window, practise getting out of bed when you cannot sleep and use a wind-down routine in the evening. Sessions also cover worries about the effects of poor sleep, which tend to fuel more wakefulness. Many people notice change within a few weeks, though full benefit builds over the course. Therapists review your diary each week and fine-tune the plan.