Can cognitive behavioral therapy (CBT) help in severe insomnia?

A young man talking to a doctor

Many people who have been diagnosed with an insomnia disorder find that cognitive behavioral therapy helps them get a better night’s sleep again. Cognitive behavioral therapy aims to change thought patterns and behaviors that may be disturbing your sleep.

Roughly 6 out of 100 people in Germany have a real sleep disorder – not just occasional trouble sleeping. You are considered to have a sleep disorder if:

  • You have trouble sleeping on at least three nights per week. In other words, if it takes a long time to fall asleep, you're awake for long periods of time during the night, or wake up far too early and can't get back to sleep.
  • These sleep problems last for more than a month.
  • They make you feel so tired during the day that it leads to stress and problems in everyday life.

If a sleep problem is severe, simple measures to change your sleeping habits are often not effective. Then doctors usually recommend cognitive behavioral therapy.

How does cognitive behavioral therapy work?

Cognitive behavioral therapy (CBT) aims to change thought patterns that may be stopping you from sleeping. This is not the same as "positive thinking." It is about changing exaggerated, unrealistic ideas about sleep. For example, if someone believes that they will always wake up at three in the morning and then not be able to go back to sleep, that negative thought may turn into a self-fulfilling prophecy.

Another typical thought that can stop you from falling asleep is: "If I don't fall asleep now, I won't make it through tomorrow." A more neutral thought might be: "This happens from time to time. But I'll fall asleep again at some point. And it's no big deal if I don't."

Being more realistic about your sleep also means not worrying too much about how much sleep you get. It is more important that your sleep is restful enough for you to feel good the next day.

When used to treat an insomnia disorder, cognitive behavioral therapy can be combined with other approaches, such as:

  • Relaxation techniques like autogenic training and progressive muscle relaxation.
  • Sleep hygiene: This involves improving your bedtime habits and ensuring you have a pleasant sleeping environment that will help you get a good night's rest.
  • Stimulus control: This aims to ensure that you mainly associate your bed with sleep.
  • Limiting sleep time: This approach aims to restrict the time you spend in bed to the time when you are actually asleep.

What can cognitive behavioral therapy do?

Research suggests that cognitive behavioral therapy can help improve severe insomnia. People who had trouble sleeping and tried this type of therapy saw an improvement in their sleep. They fell asleep a bit faster, slept a little longer and didn't wake up as often during the night.

In most of the studies, the cognitive behavioral therapy consisted of roughly one session per week over a period of four to six weeks. Many people only need a few sessions to see a positive effect, and others need several months of this treatment.

Cognitive behavioral therapy is offered in one-on-one or group sessions, both in person and in virtual formats.

Who can you go to for cognitive behavioral therapy?

Lots of people go to their family doctor first when they're having trouble sleeping. Family doctors can tell you about the different treatment options. If you're considering cognitive behavioral therapy, you can also contact a psychosocial information center or a psychotherapy practice. Psychotherapists offer initial consultations without you needing a referral or having to apply to your health insurer first.

It is very important that you feel comfortable with your therapist. For that reason, people with statutory health insurance in Germany are allowed to attend up to four trial sessions at a psychotherapy practice before deciding whether to continue. The associations of statutory health insurance physicians (Kassenärztliche Vereinigung) can help you get an appointment for trial sessions if you like.

Brasure M, Fuchs E, MacDonald R et al. Psychological and Behavioral Interventions for Managing Insomnia Disorder: An Evidence Report for a Clinical Practice Guideline by the American College of Physicians. Ann Intern Med 2016; 165(2): 113-124.

Brasure M, MacDonald R, Fuchs E et al. Management of Insomnia Disorder (AHRQ Comparative Effectiveness Reviews; Band 159). 2015.

Ye YY, Chen NK, Chen J et al. Internet-based cognitive-behavioural therapy for insomnia (ICBT-i): a meta-analysis of randomised controlled trials. BMJ Open 2016; 6(11): e010707.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Created on March 3, 2022
Next planned update: 2025

Publisher:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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