Insomnia · First-line treatment
CBT-I: retraining sleep,
not sedating it.
Cognitive behavioural therapy for insomnia changes the habits and thoughts that keep insomnia going. It is the first-line treatment in American, European and Chinese guidelines, and its effects tend to last after treatment ends.
Quick answer
What is CBT-I and does it work?
CBT-I is a structured, usually 4–8 session programme combining sleep restriction (temporarily limiting time in bed to match actual sleep), stimulus control (using the bed only for sleep), cognitive therapy for worry about sleep, relaxation and sleep education. In a meta-analysis of 20 randomised trials, CBT-I cut the time to fall asleep by about 19 minutes and night-time waking by about 26 minutes, and raised sleep efficiency by about 10 percentage points. The gains appeared to last. Digital CBT-I has shown comparable effects.
−19 min
Time to fall asleep
CBT-I vs inactive control after treatment
Trauer et al., Ann Intern Med 2015
−26 min
Awake during the night
Wake after sleep onset
Trauer et al., Ann Intern Med 2015
+9.9%
Sleep efficiency
20 trials, 1,162 participants
Trauer et al., Ann Intern Med 2015
11 trials
Internet CBT-I
1,460 people; effects comparable to face-to-face
Zachariae et al., Sleep Med Rev 2016
3,755
Students in digital CBT-I trial
Insomnia improved (d = 1.11); paranoia and hallucinations also fell
OASIS, Lancet Psychiatry 2017
Strong
AASM recommendation
The only strong recommendation in the 2021 guideline
Edinger et al., JCSM 2021
Components
The five parts of CBT-I.
Sleep restriction
Time in bed is cut back to roughly the time you actually sleep, then extended as sleep consolidates. Expect to feel more tired in the first week or two. That is how it works.
Conditional, AASM
Stimulus control
Bed is for sleep (and sex) only. If you can't sleep, get up, do something calm in dim light and return when sleepy. Same wake-up time every day.
Conditional, AASM
Cognitive therapy
Works on beliefs that fuel arousal, such as 'I'll be useless tomorrow if I don't get 8 hours', and on clock-watching and trying too hard to sleep.
Part of CBT-I
Relaxation
Progressive muscle relaxation, breathing or body-scan techniques to lower physical arousal at bedtime.
Conditional, AASM
Sleep education
Caffeine, alcohol, light and timing. Useful within CBT-I, but the AASM suggests against sleep hygiene as a stand-alone treatment.
Not enough alone
Ready to start CBT-I?
Tell us how you sleep now. We'll arrange an assessment and your first sessions, by video from home or in person on a sleep wellness trip.
What to expect
A typical CBT-I course
CBT-I starts with a sleep diary, which drives every later decision. Sessions are usually weekly. The therapist reviews the diary, sets the sleep window for the next week and works on whatever is keeping you awake. Most people notice improvement within a few weeks. The first week of sleep restriction is usually the hardest.
CBT-I needs care with some conditions. Sleep restriction is usually modified or avoided for people with bipolar disorder, seizure disorders or untreated sleep apnoea, and for anyone whose job makes daytime sleepiness dangerous. Your clinician will check this first.
| Session | Focus |
|---|---|
| 1 | Assessment, sleep diary review, education on how sleep is regulated |
| 2 | Sleep restriction: set a time-in-bed window; stimulus control rules |
| 3 | Adjust the sleep window; troubleshoot; relaxation training |
| 4 | Cognitive therapy: worry, beliefs and expectations about sleep |
| 5 | Adjust the window; tapering plan for sleeping pills (if relevant, with the prescriber) |
| 6 | Relapse prevention: what to do after a bad night or a long-haul flight |
Session content varies between programmes. Digital programmes follow the same structure through an app.
Start in person, finish at home
Your first sessions can take place in China, with the course continuing in English by video. Ask how it would fit your dates.
Starting CBT-I on a trip
In person in China, continued at home
A course takes weeks, so it doesn't fit neatly into a holiday. On our sleep wellness tours, the assessment and the first one or two sessions happen in person, including setting your first sleep window. Later sessions continue by video or through a digital CBT-I programme after you return. Meta-analyses show that internet-delivered CBT-I produces effects comparable to face-to-face therapy.
Jet lag complicates the first week. We schedule the in-person start after you have had a few days to adjust, and the plan sets your sleep window by home time once you return.
Sleep and mental-health centres
Where CBT-I
can be started in China.
Shanghai Mental Health Center 上海市精神卫生中心
Sleep-disorder ward and outpatient clinic
Hangzhou Seventh People's Hospital 杭州市第七人民医院
Hangzhou Sleep Disorder Diagnosis and Treatment Center
West China Hospital, Sichuan University 四川大学华西医院
Sleep Medicine Center treating insomnia and circadian disorders
FAQ
CBT-I — answered.
- How many sessions of CBT-I do I need?
- Most programmes run 4–8 sessions over 6–8 weeks. Brief versions of 1–4 sessions also exist, and the AASM conditionally suggests them. Progress is judged from your sleep diary, not a fixed number of sessions.
- Is CBT-I better than sleeping pills?
- Guidelines put CBT-I first for chronic insomnia because the benefits tend to persist after treatment ends and it has no drug side effects. Pills act faster, and some people use both, with CBT-I helping them taper medication later.
- Does digital CBT-I work?
- Yes. A meta-analysis of 11 trials (1,460 people) found internet-delivered CBT-I improved insomnia severity, sleep efficiency and time awake, with effects comparable to face-to-face CBT-I and maintained for up to 48 weeks. The European 2023 guideline recommends CBT-I either in person or digitally.
- Why does sleep restriction make me more tired at first?
- It deliberately builds up sleep pressure, so sleep becomes deeper and less fragmented. The extra tiredness usually eases within one to two weeks, as the sleep window is widened step by step. Avoid driving if you feel drowsy.
- Can I do CBT-I in English in China?
- We arrange English-language sessions with a coordinator interpreting if needed, and continue with English-language video sessions or a digital programme after you return home.
Related guides
Insomnia treatment (hub)
What works for chronic insomnia, step by step.
Read the guideSleeping pills & new drugs
What guidelines allow, for how long — and orexin drugs now approved in China.
Read the guideAcupuncture & TCM for insomnia
What the trials show, honestly graded.
Read the guideJet lag & sleep in China
Light, timing and melatonin for long-haul flights.
Read the guideSleep wellness tours
Six slow-travel routes with sleep care built in.
Read the guideSleep apnoea & sleep studies
Polysomnography, CPAP and surgical options.
Read the guideSources
References
- Trauer JM, Qian MY, Doyle JS, et al. Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Ann Intern Med. 2015;163(3):191–204.
- Zachariae R, Lyby MS, Ritterband LM, O'Toole MS. Efficacy of internet-delivered cognitive-behavioral therapy for insomnia — a systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev. 2016;30:1–10.
- Freeman D, Sheaves B, Goodwin GM, et al. The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis. Lancet Psychiatry. 2017;4(10):749–758.
- Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an AASM clinical practice guideline. J Clin Sleep Med. 2021;17(2):255–262.
- Qaseem A, Kansagara D, Forciea MA, et al. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;165(2):125–133.
- Riemann D, Espie CA, Altena E, et al. The European Insomnia Guideline: an update on the diagnosis and treatment of insomnia 2023. J Sleep Res. 2023;32(6):e14035.
Start CBT-I
with a proper assessment.
Send a two-week sleep diary and your medication list. We'll arrange an assessment and your first CBT-I sessions, at home by video or on a sleep wellness trip.
This page is for general education only and is not medical advice. Insomnia can be a symptom of other conditions — sleep apnoea, depression, anxiety, pain, thyroid disease or medication side effects — that need their own treatment. Do not stop or change sleeping medication without talking to your doctor. Seek urgent help if you have thoughts of self-harm, or if sleepiness affects your driving.
Published 5 October 2026 · Figures checked against the cited sources by the PandaTouring Care editorial team · Editorial policy