Table 1.

Cognitive-Behavioral Interventions for Insomnia^*

Intervention	General description	Specific techniques
Sleep hygiene education	Recommendations promoting behaviors that help sleep, discouraging behaviors that interfere with sleep	Don’t try to sleep Avoid stimulants (caffeine, nicotine) Limit alcohol intake Maintain a regular sleep schedule 7 nights a week Avoid naps Get regular exercise, at least 6 hours before sleep Keep the bedroom dark and quiet
Stimulus control	Based on operant and classical conditioning principles: Non-sleep activities and the bedroom environment can serve as stimuli that interfere with sleep. Treatment prescribes behaviors that strengthen associations between the environment and sleep.	Go to bed only when sleepy. Use the bed and bedroom for sleep only. Do not read, watch television, talk on the phone, worry, or plan activities in the bedroom. If unable to fall asleep within 10-20 minutes, leave the bed and the bedroom. Return only when felling sleepy again. Set the alarm and wake up at a regular time every day. Do not snooze. Do not nap during the day.
Sleep restriction therapy	Based on experimental evidence that sleep is regulated by circadian and homeostatic processes. Treatment increases homeostatic sleep drive by reducing time in bed, and maintaining a consistent wake time in the morning to reinforce circadian rhythms.	Restrict time awake in bed using by setting strict bedtime and rising schedules limited to the average number of hours of actual sleep reported in one night. Increase time in bed by advancing bedtime by 15-30 minutes when the time spent asleep is >85% of time in bed. Keep a fixed wake-up time, regardless of actual sleep duration. If after 10 days, sleep efficiency is lower that 85%, further restrict bedtime by 15-30 minutes.
Relaxation training	Muscular tension and cognitive arousal are incompatible with sleep. Relaxation decreases waking arousal, and facilitates sleep at night.	Specific techniques may include: Progressive muscle relaxation Guided imagery Paced breathing
Cognitive therapy	Identify, challenge, and replace dysfunctional beliefs and attitudes regarding sleep and sleep loss. These beliefs increase arousal and tension, which impede sleep and further reinforce the dysfunctional beliefs.	Challenge unhelpful beliefs and fears about sleep, e.g.: ○ Overestimation of numbers of hours of sleep necessary to be rested. ○ Apprehensive expectation that sleep cannot be controlled. ○ Fear of missing opportunities for sleep. Thought journaling to reduce rumination Design behavioral ―experiments‖ to test beliefs about sleep
Cognitive Behavioral Treatment of Insomnia (CBT-I)	Multi-modal treatment combining elements of above techniques	Sleep education Stimulus control techniques Sleep restriction techniques Cognitive therapy techniques May include relaxation training
Brief Behavioral Treatment of Insomnia35	Core techniques from Stimulus Control, Sleep Restriction therapies	Limit time in bed to actual sleep time + 30 minutes Establish regular wake time every day, regardless of prior night’s sleep duration Do not go to bed until sleepy Do not stay in bed if awake

^*See^59-61 for further details of each therapy.