As a psychiatric nurse practitioner, I spend a lot of time talking with clients about the importance of sleep. But I began to notice that sometimes these conversations were actually adding pressure and making sleep feel more stressful than it should be.

This is where I found that starting with therapy tools helps. These tools tend to carry fewer risks and side effects than medication, and for many people, they can make a meaningful difference on their own. One approach that I especially recommend is cognitive behavioral therapy for insomnia (CBT-I), which is a well-established, safe, and effective treatment for individuals with ongoing sleep issues.

What Is CBT-I and Why Is It Effective for Insomnia?

CBT-I works by addressing the patterns, behaviors, and thoughts that interfere with sleep. Creating an effective sleep treatment plan first starts with taking a good sleep assessment. That means asking our clients questions like:

• How often do you nap, and for how long?
• What time do you go to bed?
• How long does it take to fall asleep?
• How many times do you wake up in the night?
• How would you rate the quality of your sleep?

These questions may seem simple, but they help reveal patterns that can tell us so much about your lifestyle. We recommend tracking your sleep using these questions for at least a week. And afterwards, we can then start to take on the treatment components of CBT-I, which include sleep restriction therapy, stimulus control therapy, sleep hygiene, and cognitive therapy.

Sleep Restriction Therapy: Rebuilding Your Drive to Sleep

The goal of sleep restriction therapy is to decrease the amount of time you spend in bed not sleeping and to increase your drive for sleep. Based on your sleep data, and a set wake time that you would stick to every day, you would go to bed only at the time that you would be expected to sleep based on your recent average.

For example, let’s say you kept a sleep diary showing that, over the past week, despite being in bed for nine hours a night, you were sleeping for an average of five, and on weekdays, you had to be up for work by 7 AM. In CBT-I, you’d stick to this wake time every day regardless of your weekend plans.

Your sleep restriction practice would start with you going to bed at 2 AM every night to get your five hours in. And over the following weeks, if you were successfully filling those five hours with sleep, you would gradually increase the amount of time in bed. What this does is retrain the brain and body. Instead of associating bed with tossing, turning, and frustration, bed becomes a place where sleep reliably happens.

Stimulus Control Therapy: Associating Your Bedroom With Sleep

The purpose of stimulus control therapy is to recondition your mind to associate your bed and bedroom with sleep. If you’re struggling to sleep, it is likely that your bed has become a place where you scroll on your devices, watch TV, and let your mind wander and worry. A good sleeper associates their bed with sleeping, and there are a plenty of ways you can do this, like:

• Going to bed only when you’re feeling sleepy 
• Not using your bed for activities other than sleeping or intimacy
• Getting up at the same time every day

• Having good sleep hygiene (if you’re a student, here’s a helpful sleep hygiene blog with some great tips on how to get started!)

Cognitive Therapy: Noticing Thought Patterns

One of the most powerful parts of CBT-I is cognitive therapy. The cognitive therapy component of CBT-I can help you examine current thought patterns and expectations around sleep and how they may be contributing to insomnia by worsening anxiety and worry. Cognitive therapy can help you develop more accurate and realistic ideas about sleep, replacing catastrophizing thoughts with more adaptive and even relaxing ideas.

For example, you might find yourself fixated on negative thoughts by saying things like, “If I don’t get my eight hours of sleep, it’s terrible for my physical and mental health.” Instead, try taking a more positive approach by saying, “Even if I can’t sleep, I can still choose calming thoughts and actions that support my mental and physical health.”

It is worth acknowledging that this brief review of CBT-I doesn’t fully capture the broader context that can shape someone’s experience with sleep. Cultural factors, other mental health conditions, daily responsibilities, and life stressors can all play an important role in contributing to sleep issues, and in determining which approaches will be most helpful. Because of this,treatment is not a one-size-fits-all approach either.

If you feel like you are struggling with sleep, consider talking with your psych NP about your options. Together, you can explore approaches like CBT-I, making lifestyle adjustments, and if appropriate, taking medication as well. The goal is not to force you to get your eight hours of sleep, but to create the conditions where your sleep can return naturally.