Table 1.

Key components of standard cognitive behavioural therapy for insomnia

Treatment strategy	Main approach
Assessment	Sleep diaries are used as a key feature of assessment and treatment to establish the pattern of sleep on a nightly basis. In addition, actigraphy may be used. Actigraphy is the measurement of movement via a small accelerometer device worn on the wrist that can be used to estimate sleep via periods of inactivity, in conjunction with sleep diaries.
Formulation	Formulation focuses on developing a shared understanding of the factors that led to the development and persistence of the sleep disturbance.
Psychoeducation	Psychoeducation includes learning key information regarding the process of sleep and the impact of poor sleep.
Sleep hygiene education	Sleep hygiene is a specific psychoeducational intervention. It focuses on addressing a number of environmental and behavioural factors that may influence sleep quality and quantity.
Stimulus control	The aim of stimulus control is to strengthen the association between the bed and good quality sleep. This is achieved by limiting the time in bed not sleeping. Therefore the bed is used only for sleeping and sexual activity. One is instructed to only go to bed when feeling sleepy (after following a wind-down routine to prepare the mind and body for sleep), if not able to sleep within approximately 15 minutes one should get out of bed, engage in relaxing activities in a different room and only return to bed when feeling sleepy. Stimulus control identifies the need for regular bed and rise times.
Sleep restriction	Sleep restriction aims to reduce sleep onset latency and waking after sleep onset by increasing the sleep drive and overcoming compensatory strategies that disrupt the association between bed and sleep. This is achieved by limiting the time in bed to the average total sleep time and then delaying the bed time. As sleep efficiency increases patients extend the sleep period in small 15-minute increments to increase overall sleep quantity.
Relaxation	Relaxation techniques (including progressive muscle relaxation and breathing exercises) are utilized to reduce physiological and emotional arousal in order to facilitate sleep.
Cognitive strategies	Cognitive restructuring and behavioural experiments may be used to test out specific beliefs related to sleeplessness. In addition, cognitive strategies might be used to reduce the impact of worry on sleep.