When sleep tips aren't enough: asking for CBT-I
If your sleep has been poor for months, ask your clinician about cognitive behavioral therapy for insomnia (CBT-I). The American College of Physicians recommends that all adults with chronic insomnia disorder receive it as the initial treatment, a strong recommendation. [1] The American Academy of Sleep Medicine also recommends it, and suggests clinicians not rely on sleep hygiene tips alone. [2]
What is CBT-I?
The NHLBI describes CBT-I as a 6- to 8-week treatment plan to help you learn how to fall asleep faster and stay asleep longer, and says it can be done by a doctor, nurse or therapist, in person, by telephone or online. [3] It has several parts. Cognitive therapy helps you feel less nervous about not being able to sleep. Relaxation or meditation therapy teaches you how to relax and fall asleep faster. Sleep education teaches sleep habits. [3] Sleep restriction therapy gives you a specific amount of time to spend in bed, which can be increased as you sleep better. [3] Stimulus control therapy helps you link bed with sleep, which involves going to bed only when sleepy, getting out of bed if you cannot sleep, and using the bed only for sleep and sexual activity. [3]
What do the guidelines say?
The American College of Physicians (ACP) 2016 guideline is based on a systematic review of randomized trials. Its first recommendation is that all adult patients receive CBT-I as the initial treatment for chronic insomnia disorder, graded as a strong recommendation with moderate-quality evidence. [1] The American Academy of Sleep Medicine (AASM) 2021 behavioral guideline recommends multicomponent CBT-I for chronic insomnia disorder in adults, also a strong recommendation, meaning clinicians should follow it under most circumstances. [2]
Are there shorter or single-part options?
The AASM also suggests multicomponent brief therapies for insomnia, and suggests stimulus control, sleep restriction therapy and relaxation therapy each as single-component therapies; all of these are conditional recommendations, meaning the clinician uses judgment and weighs your preferences. [2] The strongest wording in that guideline is reserved for multicomponent CBT-I. [2]
Why aren't sleep tips enough for chronic insomnia?
The same AASM guideline suggests clinicians not use sleep hygiene as a single-component therapy for chronic insomnia disorder, a conditional recommendation. [2] That does not make good habits useless. It means that for insomnia that has lasted, habits alone are not what the guidelines point to. Our 7-Day Midlife Sleep Reset is a starting point, and CBT-I is the next step if it is not enough.
How is insomnia defined, and how do I know if I qualify?
The National Institute on Aging describes insomnia as trouble falling asleep or staying asleep at least three nights a week, and chronic insomnia as lasting more than three months and not fully explained by another medical cause. [4] Your clinician makes the diagnosis, which is part of the point of asking: the Office on Women's Health says to talk to your provider about sleep problems because it could be something serious, and that many women develop sleep apnea or insomnia. [5]
Does CBT-I work in menopause?
The National Institute on Aging says that if bedtime changes don't help as much as you'd like, you may want to consider CBT-I, which it says has been shown to improve sleep in women with menopausal symptoms. [6] It adds that your therapy should be guided by a trained professional with experience working with women during the menopausal transition, and that your doctor may be able to recommend a therapist in your area. [6]
What about sleep medicines and melatonin?
The ACP's second recommendation is a shared decision-making discussion of the benefits, harms and costs of short-term medicines, to decide whether to add them for adults in whom CBT-I alone was unsuccessful (a weak recommendation, low-quality evidence). [1] The National Institute on Aging says sleep medicines may help in the short term but carry risks and should not be used long term. [4] On melatonin, see what the evidence says.
How to ask for CBT-I
Say how long it has gone on and how many nights a week. [4] Bring a sleep diary of a couple of weeks: bedtime, night waking, wake time. [4] Ask: "Can I be referred for cognitive behavioral therapy for insomnia, in person or online?" [3] Ask whether the therapist has experience with women in the menopausal transition. [6] Ask whether sleep apnea or night sweats should be checked first. [5]
When to talk to your clinician
Ask when your sleep problem has gone on for weeks or months, when it affects your days, or when habit changes haven't helped. [4][6] Insomnia is not the only possibility, and your clinician can also consider sleep apnea, night sweats and urinary symptoms, all of which the Office on Women's Health links to midlife sleep trouble. [5]
Sources
- Qaseem et al., Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians, Ann Intern Med 2016. PMID 27136449. Retrieved 2026-10-18.
- Edinger et al., Behavioral and psychological treatments for chronic insomnia disorder in adults: an AASM clinical practice guideline, J Clin Sleep Med 2021. PMID 33164742. Retrieved 2026-10-18.
- National Heart, Lung, and Blood Institute, Insomnia: Treatment. Last updated March 24, 2022. Retrieved 2026-10-18.
- National Institute on Aging, Sleep and Older Adults. Content reviewed February 6, 2025. Retrieved 2026-10-18.
- Office on Women's Health, Menopause symptoms and relief. Page last updated May 30, 2025. Retrieved 2026-10-18.
- National Institute on Aging, Sleep Problems and Menopause: What Can I Do? Content reviewed September 30, 2021. Retrieved 2026-10-18.
Every statement above was checked against the linked source on October 18, 2026. This article is education, not individual medical advice. Related: Why you wake at 3 a.m. after 45, Melatonin for sleep, the 7-Day Midlife Sleep Reset.