What to expect from CBT-I

What Results Can You Expect?

Cognitive-behavioral therapy for insomnia (CBT-I) is a brief but powerful program for insomnia. Unlike sleeping pills, CBT-I has no side effects and transforms sleep quality in the long run. In fact, many people report that they notice even more improvements as time goes on.

A course of CBT-I at Shuni is five weeks. At completion, our clients typically report that they experienced a transformation. Some specific changes you can expect include:

  1. Significant improvements in sleep quality. These include the ability to fall asleep easily, the ability to sleep through the night, and experiencing more satisfying sleep.
  2. A better relationship with sleep. Instead of fighting, you can trust your body's ability to sleep and feel a deep appreciation for how sleep nourishes and supports you.
  3. Most importantly, improvements to daily life. With better energy and mood, you find that you can show up better at work, in relationships, and in your life.

Expect to Track Your Sleep Experience

Starting the week before your first session with your CBT-I coach, you'll record your sleep in a subjective sleep diary.

If you usually track your sleep with a wearable sleep tracker, you may be asked to stop during the CBT-I program. Regardless, even if you are using a wearable, you'll need to log your sleep diary manually as well. Understanding the nuances in your subjective experience is key to learning to sleep better.

Expect Both Structure and Flexibility

CBT-I is a "semi-structured" program, meaning there are core components that everyone can expect to cover but it is also not one-size-fits-all.

Self-guided resources such as apps and workbooks focus on teaching core components -- and many people can see big improvements from just this.

However, we also know from peer-reviewed research that face-to-face, individualized sessions are most effective for most people. Your coach will work with you to build a strategy, based on sleep science, that is unique to you.

Expect to Cover 4 Core Components

When you complete the Shuni program, you can expect to become familiar with the four core components of CBT-I.

  1. Stimulus control: if you've struggled with sleep for a while, your brain has probably created some automatic associations between the bedroom and insomnia. In CBT-I, you'll learn techniques to break these associations: for example, getting out of bed when you can't sleep and going to bed when you feel sleepy.
  2. Time-in-bed restriction is a technique used to consolidate and deepen sleep. You start by temporarily scheduling less time in bed (the exact schedule depends on many factors, but it is common to begin at ~6 hours). When sleep efficiency improves, you can gradually expand your sleep schedule while staying efficient.
  3. Cognitive reframing & worry management. Sometimes specific unhelpful beliefs about sleep are making it more difficult. Other times, worries about life are getting in the way. During your sessions, your coach will help you manage these thoughts using techniques such as cognitive reframing.
  4. Mindfulness & relaxation. Restful sleep requires a profound letting go, which can be difficult if that feels unfamiliar. Mindfulness involves learning to be aware of your mental and physical experiences and developing the ability to shift into relaxation.

Other Commonly-Covered Topics

In addition to answering your questions about sleep science, dreaming, and more, here are some of the most commonly covered topics during CBT-I.

  • Medication tapering. When you feel comfortable, you might decide to stop using sleep medications. Learning the skills of natural sleep will build confidence in your ability to sleep without pills. A tapering protocol, which involves gradually reducing your dosage, reduces withdrawal effects such as “rebound insomnia.” For some people, it makes sense to do both the tapering protocol and the time-in-bed restriction protocol simultaneously. For others, it makes sense to start tapering after you’ve been successful with time-in-bed restriction.
  • Circadian rhythm entrainment. Aligning your internal clock with external cues such as light exposure, activities, melatonin, and food can make your sleep more predictable and better quality. Before you even begin CBT-I, the easiest thing you can do to start strengthening your circadian rhythm is to get some sunshine, ideally around the same time each morning.
  • Understanding your insomnia history. Sometimes, it can help demystify sleep to explore how and why your insomnia appeared. How might you learn from that experience and perhaps even become stronger in the future?