About this website
This website provides a guide to the principles and practice of Cognitive Behavioral Therapy for Insomnia (CBT-I). It is maintained by Nelson Binggeli, PhD, a psychologist at The Corvallis Clinic, in Corvallis, Oregon. Please note that this website is intended primarily for use by individuals who have consulted with me in person and who are currently working with me in ongoing psychotherapy. Outside of this context, the information here should be regarded as educational, and use of this website does not imply the formation of a professional relationship. Nothing found on this website is intended to be a substitute for professional psychological, psychiatric or medical advice, diagnosis, or treatment.
What is CBT-I?
Cognitive Behavioral Therapy for Insomnia (CBT-I) is a short-term psychotherapy that involves making behavioral changes that harness the natural forces that make normal sleep possible. It is well-supported by scientific research and has a high rate of success.
CBT-I is widely regarded as the preferred treatment for chronic insomnia. For example, the American College of Physicians has recommended that “all patients receive CBT-I as the initial treatment for chronic insomnia disorder.” The American Academy of Sleep Medicine concurs with this recommendation, and has stated that “Medications for chronic insomnia disorder should be considered mainly in patients who are unable to participate in CBT-I, who still have symptoms despite participation in such treatments, or, in select cases, as a temporary adjunct to CBT-I.” Unlike medication, CBT-I treats the causes of insomnia (and not just the symptoms), and it results in knowledge and skills that will help you for the rest of your life.
CBT-I consists of multiple components that are tailored to the specific factors that are maintaining your insomnia and that will help improve your sleep. I have organized these into 10 strategies which are further described on the rest of this website.
(1) Circadian rhythm: Regulate your circadian rhythm
(2) Sleep drive: Build enough sleep drive to sleep
(3) Positive associations: Re-associate your sleep environment with sleep
(4) Effortless sleep: Refrain from engaging in sleep effort
(5) Reduce tension: Reduce psychological and physical tension
(6) Sleep environment: Optimize your sleep environment
(7) Avoid substances: Avoid substances that disrupt sleep
(8) Address medications: Address use of sleep medications (if applicable)
(9) Sleep scheduling: Improve sleep efficiency using systematic sleep scheduling
(10) Modify beliefs: Modify unhelpful sleep-related beliefs
The following page contains a concise summary of the main components these ten CBT-I strategies.
Session scheduling
CBT-I typically occurs over the course of several weeks and can involve anywhere from 1 to 8 sessions. I often see patients for about 4-6 sessions. If you choose to work with me, I recommend that you schedule 2 sessions after the initial session. Ideally, there would be 1-2 weeks before our next session, and 1 week between session 2 and session 3. Follow up appointments are 45 minutes in length. If you need to cancel or reschedule your appointment, let us know as soon as possible (at 541-754-1288). We do request at least 24 hours notice so that the appointment time can be offered to another patient who may be waiting to be seen.
Sleep Diary
I typically recommend that my patients begin using a Sleep Diary (follow link to more information).
Sleep History Questionnaire
This questionnaire will help us to better understand your insomnia and identify factors that are likely to be maintaining it.
Additional recommendations
If you have not had a medical examination since your sleep problem began, I recommend that you obtain one from your primary care physician. Also, please consider signing up for the Corvallis Clinic Patient Portal in the event you may want to send me an update or a question.
Supplemental online resources
The following websites have a wealth of information about sleep, sleep disorders, and evidence-based treatments.
How Sleep Works: www.howsleepworks.com
National Sleep Foundation: www.sleepfoundation.org and www.sleep.org
Sleep Education (from the American Academy of Sleep Medicine): www.sleepeducation.org
Supplemental self-help book
If you are interested in a self-help book based on CBT-I, this is my top recommendation. It is written by two experts in the field and is clear and concise.
Carney, C. E., & Manber, R. (2013). Goodnight mind: Turn off your noisy thoughts and get a good night's sleep. New Harbinger.
Other sleep disorders
If you have another sleep disorder, such as sleep apnea, restless legs syndrome, or a circadian rhythm sleep disorder, see the Sleep Disorders section of this website.
References
Edinger, J. D., Arnedt, J. T., Bertisch, S. M., Carney, C. E., Harrington, J. J., Lichstein, K. L., Sateia, M. J., Troxel, W. M., Zhou, E. S., Kazmi, U., Heald, J. L., & Martin, J. L. (2021). Behavioral and psychological treatments for chronic insomnia disorder in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine (JCSM): Official publication of the American Academy of Sleep Medicine, 17(2), 255–262. https://doi.org/10.5664/jcsm.8986
Edinger, J. D., Arnedt, J. T., Bertisch, S. M., Carney, C. E., Harrington, J. J., Lichstein, K. L., Sateia, M. J., Troxel, W. M., Zhou, E. S., Kazmi, U., Heald, J. L., & Martin, J. L. (2021). Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. Journal of Clinical Sleep Medicine (JCSM): Official publication of the American Academy of Sleep Medicine, 17(2), 263–298. https://doi.org/10.5664/jcsm.8988
Qaseem, A., Kansagara, D., Forciea, M. A., Cooke, M., & Denberg, T. D. (2016). Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 165, 2, 125-133. http://annals.org/aim/fullarticle/2518955/management-chronic-insomnia-disorder-adults-clinical-practice-guideline-from-american
Sateia, M. J., Buysse, D. J., Krystal, A. D., Neubauer, D. N., & Heald, J. L. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 13, 2, 307–349. https://aasm.org/resources/pdf/pharmacologictreatmentofinsomnia.pdf
Table of contents
To aid in navigation of this website, I have created a Table of Contents.