How it works
CBT-I has a handful of parts. Here is what each one asks of you, in the order most people take them. You don’t need all of them, and you can stop at any step.
Keep the diary for one to two weeks
Each morning, within an hour or so of getting up, answer a few questions about the night that just ended. A rough guess is fine for every answer, and there’s no need to watch the clock at night to get it right. To save, you need only the time you got into bed and the time you got up. If you miss a morning, you can add it for up to two days afterward.
Optional questions ask about the day before, like naps, caffeine, alcohol, and screens. They sit beside your nights so you can look at them together. They never change the numbers or the window.
Read your nights in numbers
- Time in bed runs from when you got into bed to when you got out of it for the day.
- Total sleep starts when you fell asleep, which is the time you tried to sleep plus how long it took. It ends at your final waking, and time awake in the night is taken out.
- Sleep efficiency is total sleep divided by time in bed.
Time in bed before you tried to sleep, and after your final waking, doesn’t count as sleep. That is why total sleep is often shorter than your time in bed.
A night missing something the math needs is saved as Partial. It shows what’s missing, and it stays out of your averages and your sleep window until you add it. A night whose times add up to more than 18 hours in bed is held back the same way, since that usually means an AM and a PM got swapped.
Follow the rules for the bed
These are the stimulus control rules, first described by Richard Bootzin in 1972. They work best kept every night, the hard nights most of all.
- Go to bed only when you’re sleepy.
- Use the bed only for sleep and sex.
- If you can’t sleep, get up, and go back when you’re sleepy.
- Get up at the same time every day.
- Avoid napping during the day. If you’re too sleepy to drive or work safely, a short nap early in the afternoon is the safer choice.
Decide whether the sleep window is right for you
The sleep window limits your time in bed for a while, which is why it starts with a page called “Before you start.” This is what it says.
Limiting your time in bed can make you very sleepy during the day, especially in the first weeks. Talk with a health care provider first if you have bipolar disorder, a seizure disorder, sleep apnea, sleepwalking or other unusual behavior during sleep, a history of falls, or another health problem, if you take medicine that makes you drowsy, if you’re pregnant, or if you drive or use machinery for work. Don’t drive or do anything risky when you feel drowsy.
Stop the window and talk with a health care provider if you nod off during the day without meaning to, have a seizure or a fall, or notice your mood running unusually high, your thoughts racing, or that you need much less sleep than usual. If you already doze off easily during the day, see a doctor before you start.
Sleep compression is the gentler choice. It brings your time in bed down a little each week instead of all at once. You can also skip the window and keep using the diary and the rules.
Set the window, then check it once a week
Once the diary has 7 complete nights, the calculator works out a starting window from your average sleep. You choose one wake time for all seven days, weekends included, and your bedtime is that wake time minus the window. Go to bed no earlier than that, and only when you’re sleepy.
The sleep window check looks at your efficiency for the week, which is the share of your time in bed you spent asleep, and suggests a change.
- 90% or higher. Bedtime 15 minutes earlier.
- 85 to 89%. No change.
- Under 85%. Bedtime 15 minutes later, never less than 5 hours and 30 minutes in bed.
A week with fewer than 5 complete nights gets no suggestion, because a few nights can swing the average a lot. If you spent most nights in bed outside your window, the check says so and keeps the window where it is, since the numbers then show something other than the window. You always decide. Neither the app nor the calculator moves the window on its own.
The window keeps growing until efficiency stays under 85% at the longer length, or until you feel rested during the day. Then you can keep it where it is.
These thresholds are the ones taught in most treatment manuals. Clinicians sometimes adjust them, for example moving bedtime earlier at 85% for older adults. If you work with one, follow their plan.
Quiet a busy mind
Many people with insomnia are tired in body and wide awake in thought. CBT-I has a few ways in. Worry time, early in the evening, gives the day’s concerns a place to land before bed. A wind-down routine fills the last 30 to 60 minutes with something calm and the same each night. Slow breathing, progressive muscle relaxation, and a body scan ease the tension many people carry into bed. The app walks through each one, and the Learn article explains the ideas.
Know when to get other help
Some sleep problems aren’t insomnia. Loud snoring, gasping, or pauses in breathing, an urge to move your legs at night, acting out dreams, or falling asleep while driving all deserve a doctor’s look. So does trouble that started with a new medicine or a change in your health.