Quick answer: CBT-I (cognitive behavioural therapy for insomnia) is a short, structured programme, typically 4 to 8 sessions, that retrains your sleep using sleep restriction, stimulus control and work on unhelpful thoughts about sleep. US guidelines recommend it as the first treatment for chronic insomnia, before sleeping pills. Free routes include the VA's Insomnia Coach app, Sleepio on the NHS in Scotland and parts of England, and your GP or family doctor.
In this guide
Who CBT-I is for — and when to see a clinician first
CBT-I is for adults whose sleep problem has become a pattern: trouble falling asleep, staying asleep or waking too early, even with enough time in bed. The American Academy of Sleep Medicine calls insomnia chronic when it happens at least three nights a week for at least three months; the NHS calls insomnia lasting three months or more long-term.
See a GP, family doctor or primary-care clinician before starting if any of these apply:
- Signs of sleep apnoea: loud snoring, breathing that stops and starts, or gasping and choking in your sleep, according to the NHS. Insomnia programmes won't fix this. Our guide to blood tests when you're always tired explains why sleep apnoea is often missed.
- An urge to move your legs with uncomfortable sensations that are worse at night when resting, which can be restless legs syndrome.
- Low mood or anxiety. The NHS lists stress, anxiety and depression among the causes of insomnia. If you're not sure which you're dealing with, read burnout or depression: how to tell what help you need.
- Pregnancy or other health conditions. NICE says people at higher risk of other sleep disorders, such as in pregnancy or with other conditions, should have a medical assessment before a digital programme.
- Shift work, or a job where drowsiness is dangerous. The VA says its Insomnia Coach app isn't for shift workers, and the American Academy of Sleep Medicine notes that sleep restriction may not suit drivers or machinery operators, people prone to mania, or people with poorly controlled seizures.
If you're thinking about suicide or feel unsafe, call or text 988 in the US or 9-8-8 in Canada, call Samaritans on 116 123 in the UK, or call 911 or 999 in an emergency.
What happens in CBT for insomnia?
CBT-I changes the habits and thoughts that keep insomnia going. The American Academy of Sleep Medicine's 2021 guideline describes it as a combination of:
- Sleep restriction. Time in bed is first limited to roughly the time you actually sleep, worked out from a sleep diary, then adjusted as your sleep becomes more efficient. It builds sleep drive so sleep becomes deeper and less broken.
- Stimulus control. Go to bed only when sleepy, get up if you can't sleep, use the bed only for sleep and sex, get up at the same time every morning, and avoid daytime naps.
- Cognitive work. Spotting and testing unhelpful beliefs about sleep, such as dread about the next day, that keep you alert at night.
- Sleep hygiene and relaxation. Advice on caffeine, alcohol, light and noise, plus relaxation techniques. These are one part of CBT-I, not the whole treatment.
A sleep diary runs through the whole course, and treatment typically takes 4 to 8 sessions. Improvement isn't immediate, and the early weeks of sleep restriction can feel harder before they feel better.
Why is CBT-I recommended before sleeping pills?
Because the major guidelines say so. In 2016 the American College of Physicians made a strong recommendation that all adults with chronic insomnia receive CBT-I as the first treatment, with medicines considered afterwards through shared decision-making if CBT-I alone hasn't worked. The American Academy of Sleep Medicine's 2021 guideline also strongly recommends multicomponent CBT-I, and suggests that clinicians don't use sleep hygiene on its own as a treatment.
In the UK, the NHS says GPs now rarely prescribe sleeping pills for insomnia, and then usually only for a few days or weeks. NICE's guidance on Sleepio, a digital CBT-I programme, says best practice for insomnia that isn't likely to settle soon is face-to-face CBT-I, but that availability is limited. It found Sleepio reduced insomnia symptoms compared with sleep hygiene advice and sleeping pills, and recommended it in primary care for people who would otherwise be offered those. There's no direct comparison yet between Sleepio and face-to-face CBT-I.
Where can you get CBT-I free in the US, Canada and UK?
United States
The VA's Insomnia Coach app is free, based on CBT-I and designed for veterans, service members and others with insomnia. It runs a five-week training plan with a sleep diary, and it says it doesn't replace professional care. It was also listed in the Canadian and UK App Stores when we checked in October 2026. The VA's companion app, CBT-i Coach, is free and public but is designed to be used alongside CBT-I with a provider, not on its own.
For therapist-led CBT-I, ask your primary-care clinician for a referral, and check whether your insurance covers a behavioural sleep medicine provider before paying yourself. The Society of Behavioral Sleep Medicine lists members in the US, in Canada and by telemedicine. Without insurance, federally funded health centres offer care on a sliding scale.
Canada
We couldn't find a national free CBT-I programme. Free self-help is available from Sleepwell, a not-for-profit site from Dalhousie University researchers with guides to each CBT-I step, a sleep diary and a guide to stopping sleeping pills. For a clinician, a researcher-run Canada-wide map of CBT-I providers lists practitioners by province; check fees and whether your workplace benefits cover them. Your family doctor or a walk-in clinic is free and can check for other causes first.
United Kingdom
Sleepio is free to anyone living in Scotland, with a short weekly session over six weeks. In England, the government says it's up to each integrated care board whether to offer CBT-I or Sleepio, so availability varies: for example, it's free if you're registered with a GP in Berkshire, Buckinghamshire, Oxfordshire, Farnham, North East Hampshire or Surrey Heath. NICE's assessment used a price to the NHS of £45 per person.
NHS Talking Therapies mainly treats anxiety and depression, and the government says its low-intensity therapy may include advice on sleep hygiene. Some local services go further: TALKWORKS in Devon runs a free sleep workshop by self-referral. See our guide to referring yourself to NHS Talking Therapies, and ask your GP what's available locally.
Paid online therapy is another route if you want a therapist quickly; our guide to online therapy or your GP first covers when that makes sense. Check that any therapist offers CBT-I specifically, not general talking therapy.
Compare your options
| Option | Cost | Format | Best for |
|---|---|---|---|
| Insomnia Coach app (VA) | Free | Self-guided, five-week plan | Starting now, anywhere, without a referral |
| Sleepio (NHS) | Free in Scotland and some English areas | Digital programme, six weekly sessions | UK adults where it's commissioned |
| Sleepwell (Canada) | Free website | Self-help guides and sleep diary | Learning the CBT-I steps yourself |
| Therapist-led CBT-I | Insurance, benefits or self-pay | Typically 4–8 sessions, in person or video | Complex insomnia, other health conditions, coming off sleeping pills |
| GP, family doctor or primary-care clinician | Free (UK, Canada); insurance or sliding scale (US) | Appointment | Snoring, restless legs, low mood, pregnancy, medicines |
Programme availability checked and can change.
What to do next
- Check the "clinician first" list above. Snoring with gasping, restless legs, low mood or pregnancy mean an appointment comes first.
- Start a sleep diary for a week or two: bedtime, time to fall asleep, wake-ups and get-up time. Every CBT-I route uses one.
- Pick a free route: Insomnia Coach anywhere, Sleepio if your area offers it, Sleepwell in Canada.
- Give it the full course. Sleep restriction can feel harder before it helps; take care with driving if you're sleepy.
- If nothing has changed after the programme, go back to your doctor and ask about therapist-led CBT-I.
The mental-health support finder asks how much this is affecting you and suggests self-help, therapy, your doctor or crisis support, with free routes first.
Find my supportCommon questions
Can I do CBT-I on my own?
Yes, many people use self-guided programmes. The VA's Insomnia Coach app is free and runs a five-week training plan, and Sleepio is free on the NHS in Scotland. The American Academy of Sleep Medicine found too little evidence to favour one delivery method. See a clinician first if you might have sleep apnoea or another sleep disorder.
Is sleep hygiene the same as CBT-I?
No. Sleep hygiene is general advice about caffeine, alcohol, light, noise and routine. It's often included in CBT-I, but on its own the American Academy of Sleep Medicine suggests clinicians don't use it as a treatment for chronic insomnia. CBT-I adds sleep restriction, stimulus control and work on unhelpful thoughts about sleep.
Will CBT-I make me more tired at first?
It can. Sleep restriction deliberately limits your time in bed, so you may feel sleepier for a while before sleep consolidates, and improvement isn't immediate. The American Academy of Sleep Medicine says it may not suit people who drive or operate machinery for work, or who have bipolar disorder or poorly controlled seizures.
Can I try CBT-I if I already take sleeping pills?
Yes. The American College of Physicians recommends CBT-I as the first treatment for all adults with chronic insomnia, and medicines are then a shared decision with your clinician. Don't stop or change a prescribed sleeping pill on your own; ask your doctor or pharmacist how to reduce it safely alongside CBT-I.
Related guides
Sources
- Qaseem A, et al. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 2016.
- Edinger JD, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 2021.
- American Academy of Sleep Medicine. Insomnia Awareness Night — chronic insomnia symptoms and treatment. June 2025.
- NHS. Insomnia.
- NICE. Sleepio to treat insomnia and insomnia symptoms (HTG624, first published May 2022 as MTG70).
- NHS. Sleep apnoea.
- NHS. Restless legs syndrome.
- US Department of Veterans Affairs. Insomnia Coach — who it's for and who should check with a provider first.
- Insomnia Coach (VA National Center for PTSD). App Store listing — price and five-week training plan. Accessed 20 October 2026.
- VA National Center for PTSD. CBT-i Coach — free app for use alongside CBT-I with a provider.
- Society of Behavioral Sleep Medicine. Provider directories (US, Canada, telemedicine).
- Health Resources and Services Administration. Find a health center.
- Sleep and Depression Laboratory, Toronto Metropolitan University. Canada-wide list of CBT-I providers. November 2025.
- Sleepwell (Dalhousie University, not-for-profit). CBT-I self-help resources and sleep diary.
- NHS Grampian. Sleepio and Daylight — free to anyone living in Scotland.
- NHS Thames Valley integrated care board. Sleep — free Sleepio access for registered patients. Accessed 20 October 2026.
- UK Parliament. Written question 101541 on access to digital CBT for insomnia, answered 8 January 2026.
- TALKWORKS (Devon Partnership NHS Trust). Sleep difficulties — workshops and self-referral.
- 988 Suicide & Crisis Lifeline (US).
- 9-8-8 Suicide Crisis Helpline (Canada).
- Samaritans. Contact a Samaritan.
General information, not medical advice — see our medical disclaimer. Written to the WhereToStart editorial policy. Next scheduled review: .