Baseer Maroof, LCSW · Raleigh, NC · Adults 21+

Insomnia

Can’t fall asleep, can’t stay asleep, awake at 4 a.m. doing math on how many hours are left. Here’s what’s going on, and the treatment that actually works.

In short

The basicsWhat helpsMind & body clockEvidenceCheck with a doctor

At a glance

Tap a card to open it.

What it isDSM-5-TR and ICD-11

Difficulty starting or keeping sleep, or waking too early and not getting back to sleep, with real daytime impact (tiredness, mood, focus, work). It happens even when you have a fair chance to sleep. That’s what separates it from simply not getting enough time in bed. (DSM-5-TR via AHRQ)

What worksThe first-line treatment

CBT-I: stimulus control, a structured sleep window, working with the thoughts that keep you up, and relaxation. Typically 4–8 sessions. The AASM gives it a strong recommendation; the American College of Physicians says use it first. (AASM 2021; ACP 2016)

Why it sticksThe 3P model

A trigger starts it (stress, illness, a baby). Your coping keeps it going: going to bed early, sleeping in, napping, lying awake in bed. Those habits weaken sleep pressure and teach your brain that bed is a place to be awake. (Spielman 1987)

When it might be something elseApnea, restless legs

Loud snoring, pauses in breathing, or heavy daytime sleepiness point to sleep apnea. An urge to move your legs at night that eases when you move points to restless legs. Both need a doctor, and both change the plan.

Explore

Eight short pages. Start with CBT-I if you just want to sleep.

By the numbers

~1 in 3adults report at least one insomnia symptom
6–10%meet criteria for insomnia disorder
~2×risk of later depression with insomnia (OR 2.60, 21 studies)
−19 / −26 mintime to fall asleep / time awake at night with CBT-I (20 trials)

Ohayon 2002; AHRQ 2015; Baglioni 2011; Trauer 2015.

Myths

MythGood sleep hygiene fixes insomnia.
What the evidence says

Hygiene advice (caffeine, screens, a dark room) is sensible, but on its own it isn’t an effective treatment for chronic insomnia. The AASM recommends against using it as the only treatment.

AASM 2021

MythIf I can’t sleep, I should stay in bed and rest.
What the evidence says

Lying awake in bed for long stretches trains your brain to link bed with wakefulness. Getting up when you can’t sleep, and coming back when sleepy, is one of the core CBT-I steps.

AASM BBTI fact sheet; Spielman 1987

MythSleeping pills are the real treatment; therapy is the soft option.
What the evidence says

In head-to-head comparisons, CBT-I matches medication in the short term and does better over the long run. Guidelines put CBT-I first.

Mitchell 2012; ACP 2016; Riemann 2023

MythI need to catch up on lost sleep by going to bed early.
What the evidence says

Going to bed before you’re sleepy usually means more time awake in bed. CBT-I often does the opposite at first: a shorter, fixed window that builds sleep pressure.

Spielman et al. 2011

Sources

All sources, linked15 references⌄
  1. Ohayon MM (2002). Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev 6(2):97–111. doi.org/10.1053/smrv.2002.0186
  2. Brasure M, et al. (2015). Management of Insomnia Disorder. AHRQ Comparative Effectiveness Review No. 159, Introduction (DSM-5 criteria; 6–10% meet criteria). www.ncbi.nlm.nih.gov/books/NBK343490/
  3. McNamara S, Spurling BC, Bollu PC. Chronic Insomnia. StatPearls (NCBI Bookshelf). www.ncbi.nlm.nih.gov/books/NBK526136/
  4. World Health Organization. ICD-11 for Mortality and Morbidity Statistics: 7A00 Chronic insomnia; 7A01 Short-term insomnia. icd.who.int/browse/2024-01/mms/en#323148092
  5. Edinger JD, et al. (2021). Behavioral and psychological treatments for chronic insomnia disorder in adults: an AASM clinical practice guideline. J Clin Sleep Med 17(2):255–262. pmc.ncbi.nlm.nih.gov/articles/PMC7853203/
  6. American Academy of Sleep Medicine (2021). A patient’s guide to behavioral and psychological treatments for chronic insomnia disorder in adults. aasm.org/wp-content/uploads/2021/08/Behavioral-and-Psychological-Treatments-for-Insomnia-Patient-Guide.pdf
  7. Qaseem A, et al. (2016). Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med 165(2):125–133. www.acpjournals.org/doi/10.7326/M15-2175
  8. Riemann D, et al. (2023). The European Insomnia Guideline: an update on the diagnosis and treatment of insomnia 2023. J Sleep Res 32(6):e14035. doi.org/10.1111/jsr.14035
  9. Spielman AJ, Caruso LS, Glovinsky PB (1987). A behavioral perspective on insomnia treatment. Psychiatr Clin North Am 10(4):541–553. pubmed.ncbi.nlm.nih.gov/3332317/
  10. Trauer JM, et al. (2015). Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Ann Intern Med 163(3):191–204. pubmed.ncbi.nlm.nih.gov/26054060/
  11. Mitchell MD, et al. (2012). Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC Fam Pract 13:40. pubmed.ncbi.nlm.nih.gov/22631616/
  12. Baglioni C, et al. (2011). Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord 135(1–3):10–19. pubmed.ncbi.nlm.nih.gov/21300408/
  13. Spielman AJ, Saskin P, Thorpy MJ (1987). Treatment of chronic insomnia by restriction of time in bed. Sleep 10(1):45–56. pubmed.ncbi.nlm.nih.gov/3563247/
  14. Spielman AJ, Yang C-M, Glovinsky PB (2011). Sleep restriction therapy. In Perlis M, et al. (eds), Behavioral Treatments for Sleep Disorders. Elsevier (chapter hosted by the Penn CBT-I program). www.med.upenn.edu/cbti/assets/user-content/documents/BTSD%20Spielman%20Chapter%20on%20SRT.pdf
  15. American Academy of Sleep Medicine (2025). Provider fact sheet: Brief Behavioral Treatment for Insomnia (BBTI). aasm.org/wp-content/uploads/2025/11/ProviderFS_BBTI_updated-2025_final.pdf

Related on this site

Sleep Reset toolCBTACTDBTADHDStress & BurnoutSolo DoloCheck-insClient Intake
← Back to the galaxy