What do professional guidelines say about insomnia? Explore CBT-I and support

Sleep medicine: understand the whole picture

A doctor will usually ask about bedtimes and waking times, how long the problem has lasted, daytime alertness, health and current medicines. A sleep diary can help you describe the experience more clearly.

Loud snoring, pauses in breathing during sleep or difficulty staying awake in the day may prompt assessment for other sleep disorders. Different causes need different care.

Reference: US NIH: insomnia assessment and sleep diaries

Psychological treatment: an introduction to CBT-I

Cognitive behavioural therapy for insomnia, or CBT-I, is a structured approach focused on sleep. The American Academy of Sleep Medicine strongly recommends multicomponent CBT-I for chronic insomnia in adults.

It helps you understand sleep, work through sleep-related worries and gradually change behaviours that keep insomnia going. Treatment usually takes place over several sessions, with practice and adjustments tailored to you.

Reference: American Academy of Sleep Medicine: guidelines for treating chronic insomnia in adults

What does CBT-I involve?

A professional tailors treatment to your situation. It may include:

• Understanding sleep rhythms and establishing a more consistent sleep–wake schedule.
• Rebuilding the association between bed and sleep.
• Working with recurring thoughts such as “I know I'll sleep badly again tonight”.
• Learning relaxation methods and adjusting time in bed where appropriate.

Reference: US NIH: treatments for insomnia

Healthy daily habits are one starting point

Reducing evening caffeine and making the bedroom comfortable can be part of everyday care. For chronic insomnia, professional guidelines caution that sleep-hygiene advice alone is usually not a complete treatment.

Methods that adjust or restrict time in bed should be assessed and guided by a trained professional. Do not drastically cut your sleep on your own.

Reference: American Academy of Sleep Medicine: guidelines for treating chronic insomnia in adults

Questions to take to your first appointment

You can start with your family doctor and ask whether a sleep or mental-health assessment would help.

• What in my sleep diary needs further attention?
• Would CBT-I suit me, and where can I find an appropriate service?
• Could my medicines, shift work or other physical symptoms be affecting sleep?
• If I have already tried changing my habits, what could the next step be?

Reference: US NIH: insomnia assessment and sleep diaries