black and white image of a person in a gray room, double exposure of her trying to sleep and her also awake and sleepless | cognitive behavioral therapy for insomnia | Dr. Orna Izakson

got insomnia? try CBT-I first

When you think about sleepless nights, the first treatments that come to mind often aren’t the best ones.

For instance, we may think that a nice glass of wine will help. Or a gummy. Or a sleepytime tea. If you’re supplement savvy, you might think of magnesium or 5HTP. Herbalists will all have go tos, including chamomile, skullcap, passionflower or lavender. If the sleep disruption lasts long enough, we may turn to over-the-counter sleep aids or prescription medications for relief.

And while most of those can help in the short term (not the alcohol!), the best treatment for chronic insomnia isn’t on that list at all. The best treament for insomnia is called cognitive-behavioral therapy for insomnia (CBT-I) and you may have never even heard of it.

what makes CBT-I the best insomnia treatment

Of course “best” is a loaded term. Isn’t that a value judgement? Yes, but there’s also science supporting that appellation.

It requires no medications, supplements or prescriptions.
It leads to better sleep over the short and longer term than supplements or drugs.
It leverages your natural sleep drive and circadian clock.
You can do it on your own, with apps or with a trained provider.
The treatment can help you in just six to eight weekly or biweekly sessions.
It is backed by significant research, affirming it as an evidence-based treatment for chronic insomnia.

This is why CBT-I is recommended as the first-line treatment for chronic insomnia by the American College of Physicians and the American Academy of Sleep Medicine.

what is cognitive behavioral therapy for insomnia?

CBT-I focuses on changing thoughts (the cogntive part) and actions (the behavioral part) to address underlying causes of insomnia.

Sleep is fundamentally an automatic function, something our bodies are wired to do without requiring any conscious attention. This is a shocking idea to those who struggle with sleep!

What happens is our big brains can override those innate signals and cycles, unmooring us from what should happen effortlessly. (In fact, effort itself is an enemy of sleep!)

This makes sense from an evolutionary perspective: If there’s a fire, or an attack, we need to be able to wake and escape. We can pull ourselves out of natural sleep rhythms pretty easily. Add unabating modern stressors — including the cycle of sleep worry — and it’s a recipe for chronic insomnia.

CBT-I was created to help us reset our innate rhythms so we can get good rest again.

the body is a dog

It’s like the story of Pavlov’s dog: The dog would salivate every time it saw food. Normal, right? Then Pavlov would ring a bell every time he put food in front of the dog. Over time, the dog learned that the bell and the food were connected. When Pavlov finally rang the bell without a bowl of food, the dog salivated from the sound alone. The association between bell and food was effectively wired into the dog’s brain.

I often tell my patients that our body is a dog. It’s trying to do what we tell it to do, and to learn how it’s supposed to behave in the future. When we struggle with insomnia, we’re telling our dog-body that sleep is hard, that beds are places of discomfort and frustration, and that we can’t trust our natural sensations of sleepiness. That’s the bell our big brains create with insomnia.

CBT-I is about retraining those conditioned responses. It helps us relearn that sleep can be automatic, that safety and rest are available in our beds. The therapy leverages our big brain to help us stay out of our big brain so we can sleep. Like a dog.

And just so you know, this treatment was developed by the U.S. Department of Veterans Affairs for their sleepless former soldiers. It’s been very well vetted by research. If it works for folks who have some of the most complicated medical and mental-health issues, you know it can help people with a variety of challenges

accessing CBT-I

At your first appointment, you and your provider will review your sleep history and concerns, discuss how sleep works in general, and set goals that make sense for you. Together, you will develop a plan and set of practices that can help you get back to sleeping well.

Depending on what’s impairing your sleep, you will learn:

what to do if you can’t fall asleep
what to do if you wake up and can’t fall back to sleep
how to quiet a busy mind when you can’t sleep
how to think differently about sleep — so that you can sleep
how to pick bedtime and rise time to let you get the best rest

The ultimate goal is to restore the automatic nature of your sleep.

In-person therapy usually takes just six to eight sessions, meeting weekly or every other week. People often see improvement after just a couple of visits, while most use the full course to get at stubborn patterns.

After completing the series, you will have tools to help yourself if your sleep deteriorates again. You’ll also have a trusted partner who can help if you need a refresher or additional support.

There are books and free apps that can guide you through CBT-I on your own. But researchers find that the most profound and lasting effects happen when you work with a trained provider.

what about complicated cases?

In most cases, CBT-I can work alongside other medical and mental-health treatments. In the same way you can simultaneously do physical therapy and improve your food choices, you can add sleep repair to your general health-improvement regimen.

But CBT-I does include behavioral changes, which do require action on your part. Discuss your priorities and strategize with your healthcare provider to get the most of your work.

who is not a good candidate for CBT-I?

Good sleep is important for everyone. But some health conditions need to be stabilized before implementing CBT-I. Prioritize other treatments if you have:

Severe daytime sleepiness
Bipolar disorder
Epilepsy
Current substance-abuse disorder (alcohol or drugs)

how to get cognitive behavioral therapy for insomnia

If CBT-I is so great, why have so few people heard about it? There are a couple of reasons.

First, pills are simple — even if “pills” sometimes looks like a complicated regimen of staggered herbs and supplements. This DIY (or ND/herbalist-supported) approach can be useful when faced with a few sleepless nights, but it doesn’t work well as a long-term strategy. It can even become counterproductive, training our dog-bodies that sleep comes from a pill rather than being an automatic physiological process.

Second, there are too few trained CBT-I practitioners. Several years ago, one sleep specialist gave me a list of five vetted local providers. Two had moved out of state, three were not taking new patients, and none of them took insurance.

Many of my patients are already trying the complicated supplement regimens. And I didn’t have any local CBT-I referrals for them. So, in addition to my ongoing education in functional psychiatry, I decided to get trained and offer cognitive behavioral therapy for insomnia myself. As of October, 2025 I’m offering CBT-I for patients in Alaska and Oregon. I am in network with or can bill many insurances.

If you’d like to give this a try, you can make an appointment here.