Cognitive behavioral therapy for insomnia (CBT-I) is an effective, first-line treatment option. A doctor may prescribe sleeping pills if CBT-I does not work for a person.

A person with insomnia has difficulty getting to sleep, staying asleep, or waking up very early and not sleeping again. Insomnia also causes excessive daytime sleepiness, making it hard to function as they typically would.

Research estimates suggest that around 30 to 40% of U.S. adults report insomnia symptoms at some point in the year. Females are more likely to receive a diagnosis of insomnia than males. However, a person’s chances of having the condition increase with age. Almost 50% of older people have complaints about initiating or maintaining sleep.

CBT-I works by teaching someone how to fall asleep faster or asleep longer. A doctor, nurse, or therapist can oversee the treatment course. The therapy is good for treating long-term insomnia. Prescription medications are more likely to have adverse side effects than CBT-I.

Keep reading to learn more about the different therapy types for insomnia, including how they might work and where a person can get more support.

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Insomnia can co-occur with psychiatric or physical conditions. Some evidence suggests that insomnia may also be a risk factor for certain conditions, such as:

Sometimes insomnia may be a symptom of the co-occurring condition. Diagnosis usually requires a physical examination that can rule out conditions causing the sleeping issues.

About 1 in 5 cases of short-term insomnia can progress to chronic insomnia — which can last many years. Doctors can treat long-term insomnia by recommending sedative antidepressants and sleep-promoting behavioral techniques.

The most effective non-drug therapy for long-term insomnia is cognitive behavioral therapy for insomnia, shortened to CBT-I. It is typically a 6- to 8-week treatment course.

People appear to have long-term improvements in their sleep following CBT-I largely because they learn how to support and encourage their body’s natural sleep mechanisms.

There are several parts to this type of therapy.

Sleep consolidation

A person with insomnia may spend hours worrying about not sleeping, which can worsen matters. So this component involves limiting the amount of time a person spends in bed.

They stay up and awake for longer to fall asleep and stay asleep when they do go to bed.

Stimulus control

Spending a lot of time in bed dealing with trying to sleep can create an association in a person’s mind between their bed and anxiety.

So this component requires a person to only use their bedroom for sleeping and sex and no other activities, such as using the phone or reading.

If a person cannot get to sleep within 10 minutes, they must go to another room to do a relaxing activity until they feel sleepy.

Cognitive restructuring

People with insomnia commonly build negative thoughts around sleeping, such as dreading going to bed. This may happen because they believe they will not be able to sleep or think they will be unable to function properly the next day.

So this component involves transitioning negative thoughts into positive thoughts. This might include letting go and trusting their body’s natural ability to get to sleep.

Sleep hygiene

This component emphasizes practices that promote healthy sleep patterns, including:

  • not eating or drinking alcohol within 2 to 3 hours before bed
  • avoiding bright light exposure within the 2 hours before bed, including from devices
  • getting out in the bright daylight in the morning
  • avoiding caffeine after midday
  • getting into a relaxing evening routine

Relaxation techniques

Mindfulness meditation can help quiet the mind, calm emotions, and prepare the mind and body for sleep. Additionally, slow, deep breathing can help relax the nervous system.

If CBT is ineffective, medications to improve insomnia symptoms could be a beneficial next step. However, the person and prescribing doctor should discuss the possible benefits, harmful effects, and medication costs before starting treatment.

The treatment course may be short term, lasting for 5 weeks or less.

Medication types

Various classes of drugs are available to treat insomnia, including:

  • Benzodiazepines: These drugs can have a sedating effect, slowing down how the body and brain function. An example is Triazolam (Halcion)
  • Z-drugs: These drugs work similarly to benzodiazepines. Zopiclone (Zolpidem) is type of medication in this class of drugs.
  • Melatonin receptor agonists: These drugs alter melatonin levels, a hormone involved in the sleep/wake cycle. For example, ramelteon (Rozerem) is a melatonin receptor agonist.
  • Histamine receptor agonists: These drugs alter the levels of neurotransmitters, or chemicals, in the brain. An example is Doxepin (Silenor).
  • Orexin receptor agonists: These drugs can help promote wakefulness and impact the sleep/wake cycle. An example is Lemborexant (Dayvigo).

Antidepressants, antipsychotics, and anticonvulsants can have some benefits, but these are not approved treatment options for insomnia.

Each drug class comes with its own set of unique side effects and could interact with other drugs someone is taking. Speak with a doctor before taking any medication.

Learn more about sleep medication types.

Research shows that CBT-I and sleep medications may produce similar results.

However, a person who undergoes CBT-I:

  • is less likely to experience adverse side effects
  • has fewer relapses
  • can usually continue to experience sleep improvements long after the end of their treatment

Some people try herbal remedies, such as valerian and kava, to treat insomnia. However, uncertainty surrounds the safety and effectiveness of these natural remedies.

A 2022 study explored the effect of a range of complementary and alternative therapies on insomnia. The authors found evidence supporting the use of acupressure, yoga, and tai chi, and mixed evidence for acupuncture and L-tryptophan.

However, they did not find enough evidence to support the use of natural remedies like valerian for insomnia.

Light therapy may also help some people with insomnia. A 2016 study found that light therapy benefits people with sleep problems, especially in regulating the sleep-wake cycle and reducing insomnia symptoms.

A person who has trouble sleep may want to consider seeking the guidance and support of a doctor or CBT-I counselor.

However, they may also try practicing some of the components of CBT-I at home. For instance, a person can try the following:

  • aiming to keep a regular sleep schedule every day of the week to get their body into a rhythm, which can make it easier to fall asleep
  • getting out of bed if they are lying there awake and doing something relaxing until they feel tired
  • creating a nightly wind-down routine that involves switching off devices early and practicing relaxing activities before going to sleep
  • exercising during the day and trying to avoid drinking caffeinated beverages after lunch
  • avoiding eating and drinking alcohol too close to bedtime

A person can find a trained CBT-I counselor through the Society of Behavioral Sleep Medicine or the American Board of Sleep Medicine.

Where these services are not easily available to a person, they may want to try a digital option, such as the CBT-I Coach app.

A person with insomnia has difficulty falling asleep, staying asleep, or a combination of both. Doctors can treat long-term insomnia with CBT-I, an effective first-line therapy.

Insomnia may also be a symptom of another condition, such as depression, in which case medical professionals should treat the underlying cause.

Some medications can treat insomnia. However, they are usually meant for short-term use. Each drug class comes with its own side effects. Speak with a doctor about the available options.

Some people may also benefit from alternative therapies, such as acupressure, yoga, tai chi, or light therapy. However, there is limited scientific evidence for their effectiveness in treating insomnia.