Can Talk Therapy Help You Have Better Sleep?

You’ll also adopt a new sleep schedule. Instead of going to bed earlier in an attempt to get more sleep, you may be asked to stay up later until you feel sleepy and/or to get out of bed if you’re not sleeping. The goal is to “squeeze the wakefulness” out of your sleep routine, accustom your brain and body to solid “consolidated” sleep, and help your mind link your bed with sleeping, not tossing and turning, Arnedt says. That could mean several weeks of short sleep — as little as five or six hours per night, he says — because you’ll also be instructed to get up at the same time every morning. This helps reset your body clock. “Oftentimes you have to go through some challenges. It’s not magic,” he says. Working with a therapist can help you cope. Once you’re sleeping soundly, you’ll add back more sleep time, by going to bed earlier, until you arrive at the best sleep number for you. (Most people need seven to eight and a half hours per night, but the normal range is six to 10 hours, he says.)   

Conventional sleep hygiene — like having a quiet, dark, comfortable bedroom and cutting off caffeine early in the day — is covered, but “it’s a small part of CBT-I,” Drerup says. “It’s not effective on its own against insomnia. … Yes, if I’m drinking a pot of coffee at 5 p.m., it’s probably not good for my sleep. But when people make those changes they can still be frustrated that they can’t sleep.” In fact, if you’ve tried sleep hygiene tips and they haven’t worked, it’s a great time to try CBT-I, she says.

Should you try it?

If you have chronic insomnia, defined as trouble falling asleep or staying asleep three or more nights per week for three months or longer, it’s worth talking with your primary care physician about CBT-I. Same goes if you’ve been taking sleep medication for insomnia and haven’t given CBT-I a try, the experts say. But first, get evaluated for other serious sleep disorders, like obstructive sleep apnea, they add. “There could be multiple reasons you’re having trouble falling asleep,” Arnedt says. Some private insurers cover it, he and Drerup note — but many don’t, so be sure to check whether yours does.

Ask your primary care physician for a referral to a trained CBT-I practitioner, or look for one on the member directory of the Society of Behavioral Sleep Medicine. Sessions don’t have to happen in person. CBT-I via telemedicine video calls were just as effective as in-person appointments in Arnedt’s 2020 study. And audio-only telephone CBT-I was effective in a 2021 University of Washington study of people with insomnia and osteoarthritis. That’s great news if you’re not computer savvy or don’t have a great internet connection. “One of the biggest takeaway messages of our study [is that] this powerful intervention strategy can be effective when delivered over the phone,” says lead study author Susan McCurry, research professor emeritus at the University of Washington.

You can also start with online CBT-I, like the Cleveland Clinic’s Go! to Sleep program. It doesn’t include individual, one-to-one care from a therapist, Drerup notes. “Web programs not guided by a therapist are effective, but not as effective as working one-on-one,” she says. “It’s a really great place for someone who hasn’t been on sleep medications and who’s self-directed. You have the motivation to engage in the program.”

One-to-one sessions are better, she says, if you want to taper off sleep medications during CBT-I or have other health conditions that contribute to sleep problems, such as pain or depression. “It can be hard getting up in the morning if you have depression,” she says. “A computer CBT-I program will say you need a consistent wake time, but it doesn’t problem-solve around it with you.” 

​Sari Harrar is a contributing editor to AARP publications who specializes in health and science.​​​

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