A-
practicesleep
CBT-I (Cognitive Behavioral Therapy for Insomnia)
Best evidence: A- — Strong evidence for Insomnia severity & sleep onset latency
The gold-standard, first-line behavioral treatment for chronic insomnia — the strongest sleep evidence in this database, and recommended ahead of sleep medication.
Graded outcomes
What the evidence says
A-
Insomnia severity & sleep onset latency
Strong evidence · Consistent, high-quality evidence of a meaningful effect.
- Effect size
- Hedges g = 0.64 at 3 months, sustained at 0.25–0.40 at 12 months (insomnia severity, sleep onset latency, sleep efficiency).
- Evidence base
- 30 RCTs in the long-term meta-analysis; consistently replicated across independent meta-analyses in older adults, adolescents, and digital-delivery formats.
- Population
- Effective across adults, older adults, and adolescents with chronic insomnia. Considered the gold-standard, first-line treatment by the American Psychological Association and American College of Physicians, ahead of pharmacological treatment.
- Dosage / protocol
- Typically 4–8 structured sessions (in-person, group, or digital) combining stimulus control, sleep restriction, cognitive restructuring, and sleep hygiene education.
- Contraindications & cautions
- None significant; requires behavioral adherence, which some find difficult short-term (temporary sleep restriction can increase daytime sleepiness during the adjustment period).
Citations
- 1.PubMed 31491656 — Meta-analysis
- 2.PMC10244489 — Systematic review
- 3.PubMed 35968818 — Meta-analysis
Mechanism
How it works
How CBT-I Breaks the Insomnia Cycle
CBT-I works by breaking the learned association between the bed and wakefulness (via stimulus control and temporary sleep restriction), while cognitive restructuring reduces the anxious hyperarousal about sleep itself that perpetuates insomnia — addressing the behavioral cause rather than sedating symptoms.
Citations
- 1.PMC10244489 — Systematic review
Compared with