CBT-I: The Insomnia Reset
Shelby Harris, PsyD, one of roughly 160 clinicians worldwide board-certified in Behavioral Sleep Medicine, teaches CBT-I (cognitive behavioral therapy for insomnia), the AASM/ACP guideline first-line treatment for chronic insomnia, with stronger long-term evidence than sleep medication: stimulus control, sleep restriction, a fixed wake time every day, and cutting caffeine/alcohol as a sleep aid.
Use the bed for sleep and sex only. If you're not asleep within about 20 minutes, get up and return only when sleepy Every night
Rebuilds the mental association between bed and sleep, rather than bed and wakeful frustration.
Set a fixed, initially-tightened time-in-bed window based on your actual average sleep time from a 1-2 week diary, then widen it gradually as sleep efficiency improves Reassess weekly against your sleep diary
Consolidating time in bed to match actual sleep time increases sleep drive and sleep efficiency, then the window expands once efficiency is high.
Get up at the same time every day regardless of how the night went, including weekends Daily, no exceptions
This is the single most load-bearing rule in CBT-I; it anchors your circadian signal and stabilizes sleep drive night to night.
Stop caffeine by early afternoon and stop using alcohol as a way to fall asleep Daily habit
Both fragment sleep architecture even when they seem to help you fall asleep faster; this is a standard CBT-I psychoeducation component.
CBT-I works by rebuilding the association between bed and sleep (stimulus control) and consolidating fragmented sleep into a tighter, more efficient window before gradually expanding it (sleep restriction).
View sources
How to Treat Insomnia, Part 1: CBT-I (Sleep Talking with Dr. Shelby)
Shelby Harris, PsyD
Shelby Harris, PsyD - Contributor Profile
Not medical advice. This page is for education only and is not a substitute for professional medical care. Consult a qualified clinician before changing your health routine.
Independent curation. YourProtocol is an independent platform. This protocol is based on the publicly available work of Shelby Harris, PsyD, CBSM, DBSM and is not created, reviewed, endorsed by, or affiliated with Shelby Harris, PsyD, CBSM, DBSM or Albert Einstein College of Medicine.
Is this for you
- Anyone with chronic insomnia (trouble falling or staying asleep, 3+ nights/week for 3+ months)
- People who want the guideline first-line treatment before or alongside sleep medication
- Complements, does not replace, chronotype-timing content already on this site
Cautions
- Informational only, not a substitute for evaluation, especially if insomnia is new, severe, or accompanied by suicidal ideation
- Sleep restriction can cause short-term daytime sleepiness; use caution around driving during the adjustment window
- If you are having thoughts of harming yourself, contact the 988 Suicide & Crisis Lifeline (call or text 988) or your local emergency services immediately
- Educational only, not medical advice