What to try instead
The two behavioural pieces that do most of the work in CBT-I, the first-line treatment for chronic insomnia. Not ours.
Stimulus control
- Bed is for sleep and sex. No reading, scrolling, working or worrying in it.
- Get up at the same time every day, weekends included, however the night went.
- Awake and annoyed for more than about twenty minutes? Get out of bed. Somewhere dim and dull. Come back when you're sleepy.
- No napping while you're doing this.
Sleep restriction
- For a week, note roughly how long you actually sleep.
- Cut your time in bed to about that average. Never below five and a half hours. Same wake time every day.
- It gets worse before it gets better. The first few nights are harder, and that pressure is the point.
- Once you're asleep for most of your time in bed, add fifteen minutes. Hold. Repeat.
Don't do sleep restriction alone if you have bipolar disorder, a seizure disorder, untreated sleep apnoea, or a job where being sleepy is dangerous. Do it with a clinician.
Going further
A full CBT-I course — clinician, book, or an app that isn't this one — does more than either piece alone, and it holds after it ends.
- NHS — sleep advice
- American Academy of Sleep Medicine — Sleep Education
- A full CBT-I therapist manual, free (US Dept of Veterans Affairs)
- Sleep Foundation — CBT-I overview
Where this came from
- Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD. Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2016;165(2):125-133.
- Trauer JM, Qian MY, Doyle JS, Rajaratnam SM, Cunnington D. Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Ann Intern Med. 2015;163(3):191-204.
- Morin CM, Bootzin RR, Buysse DJ, Edinger JD, Espie CA, Lichstein KL. Psychological and behavioral treatment of insomnia: update of the recent evidence (1998-2004). Sleep. 2006;29(11):1398-1414.
- Spielman AJ, Saskin P, Thorpy MJ. Treatment of chronic insomnia by restriction of time in bed. Sleep. 1987;10(1):45-56.