Cognitive Behavioral Therapy for Insomnia (CBTI)

CBTI consists of several components that are tailored to the patient's individual presentation. Stimulus control, developed by Richard Bootzin, is a set of instructions that address conditioned arousal. These instructions strengthen the bed as a cue for sleep and weaken it as a cue for wakefulness. Sleep consolidation training is a procedure developed by Arthur Spielman. It was originally designed to eliminate prolonged middle-of-the-night awakenings but it can also help with problem falling asleep at the beginning of the night.

This step-wise procedure aims to first improve sleep quality and later worry about its quantity. Initially the time spent in bed is restricted to the amount of sleep that is currently feasible. In subsequent steps the time spent in bed is gradually increased.

A third component of CBTI consists of strategies for reducing sleep interfering thoughts and worries, managing stress, calming an active mind that won’t shut off when trying to sleep and relaxing. The key is shifting from “trying hard to sleep” to “allowing sleep to happen.”

CBTI takes into account people’s biological clocks and aims to align bed time and rise time with an individual’s internal clock. This may sometimes involve properly timed exposure to bright light.