By Dr. Sarah Parsons

You have tried a cooler bedroom, less caffeine, and putting your phone away. You are tired all day, but when bedtime arrives, sleep still feels out of reach.

If this sounds familiar, you may be frustrated by another suggestion to “practice better sleep habits.”

Sleep habits matter. Persistent insomnia may also need a structured treatment approach. One option is cognitive behavioral therapy for insomnia, or CBT-I.

What is CBT-I?

CBT-I is a treatment that addresses thoughts and behaviors that can keep insomnia going. It is generally recommended as the first treatment for chronic insomnia and often takes place over approximately six to eight weeks.

The name can sound technical, but the work is practical. A clinician helps you understand your sleep pattern and develop a plan suited to it.

Why can sleep become such a struggle?

After repeated difficult nights, bedtime can become something you dread.

You may watch the clock, calculate how little sleep you will get, or worry about how you will function tomorrow. You might spend extra hours in bed hoping to catch up.

During an evaluation, I want to understand this pattern without making you feel blamed for it. Many responses to poor sleep are understandable attempts to get some relief.

Treatment involves more than a bedtime routine

CBT-I may include working on worry about sleep, relaxation skills, a consistent sleep schedule, and strategies that strengthen the connection between bed and sleep. It may also involve carefully adjusting the amount of time spent in bed, with changes made as sleep becomes more consolidated.

That last component is sometimes called sleep restriction. The term can sound alarming, and it deserves a proper explanation. I recommend developing that part of the plan with a qualified clinician rather than choosing an aggressive sleep schedule on your own.

Start by understanding the sleep problem

When someone tells me they cannot sleep, I want to know what that means for them.

Is falling asleep the problem? Are there repeated awakenings? Is the alarm arriving before there has been enough opportunity to sleep?

I also ask about snoring, breathing concerns, restless legs, work schedules, medications, mood symptoms, and daytime sleepiness. Those details help determine whether additional evaluation is needed.

A brief sleep diary can be useful. Approximate bedtimes, wake times, awakenings, and naps are enough to start the conversation.

What if you already take sleep medication?

You can still ask whether CBT-I would be appropriate. Medication decisions should be reviewed with your prescriber, including whether to continue treatment or consider a gradual change. Do not abruptly stop a prescribed sleep medication on your own.

I want patients to leave with a plan they understand, including what to practice, what difficulties to report, and when we will reassess.

If sleep has become a nightly struggle, tell your clinician. You deserve more than another list of tips—and you do not have to figure it out alone.

Dr. Sarah Parsons is a psychiatrist at Mental Health 2 You in Louisville, Kentucky. This article provides general education and does not replace an individual medical evaluation.