What is Insomnia?
Insomnia is a sleep condition that can make it hard to fall asleep, stay asleep, or cause you to wake up too early and not be able to get back to sleep. In addition to difficulty sleeping at night, people with insomnia experience difficulties with mood, concentration and energy levels during the day. Insomnia is common, and affects around 10% of the population at any given time. Although insomnia is a distressing condition to live with, the good news is that effective treatment options exist.
CBTi is an evidence-based therapy developed specifically for people with Insomnia and related sleep problems. CBTi is based on Cognitive and Behavioural principles and as such is different to other types of Cognitive Behavioural Therapy (CBT), such as CBT for depression. CBTi is recommended as the first-line treatment of both shortand long-term insomnia in adults.
Yes! The effectiveness of CBTi is supported by numerous scientific studies, and around 80% of people who have had CBTi through our service report an improvement in their condition. Importantly, people report long term benefits from the treatment.
Although medications have a role to play in treating insomnia, difficulties with sleep often return once the medication is stopped. In contrast, CBTi targets the underlying causes of insomnia, and provides you with your own set of skills for managing your sleep. It is a good treatment choice if you have had long-term sleeping problems, are worried about becoming dependent on sleep medications, or have found medication ineffective or limited by undesirable side effects.
You will be invited to join a course within a small group format, who will meet over 5 sessions, usually on a weekly basis. Each session will last up to 90 minutes.
You will be guided through a structured program of techniques based on Cognitive & Behavioural principles:
Session 1, helps you to understand how we sleep, and how this process is affected in insomnia. We also discuss how CBTi works, and introduce the sleep diary.
In session 2, we explore habits and behaviours that interfere with sleep, and introduce two key techniques: ‘anchoring your day’ and ‘stimulus control’.
In session 3, we discuss strategies for rescheduling sleep, and also relaxation techniques.
Session 4 covers approaches to dealing with anxiety around sleep, and winding down before bed.
In session 5, you will learn some further relaxation techniques, and we help you to put together everything you have learnt over the programme.
The cognitive part of CBT-I teaches you to recognize and change beliefs that affect your ability to sleep. This type of therapy can help you control or eliminate negative thoughts and worries that keep you awake.
The behavioural part of CBT-I helps you develop good sleep habits and undo behaviours that keep you from sleeping well.
You will be asked to complete various tasks between sessions, including filling out a sleep diary for the duration of the group sessions, and beyond. This is important as it helps to tailor the programme to your individual sleep needs. Remember that to be effective, CBTi requires you to put into daily practice the techniques that you learn from each session. Although it is normal to find that some of the techniques are challenging, daunting or counterintuitive at first, we are here to guide you through them. The more motivated you are, the more you are likely to benefit from the programme.
In order to improve your sleep you will need to change some ideas and behaviours which may have been building up for years or even decades. So it will take some time to change those ideas and behaviours and for those changes to take effect. It can take several weeks or even a few months for the techniques to work, but once they start working, they will lead to long term improvements in your sleep.
Yes. The therapist will provide you with information on how to do this, and you will have the support of our team to help you with this. Normally, a plan is made at the beginning of the CBTi programme for gradually reducing and stopping the medication, as you develop the cognitive and behavioural skills for managing insomnia.
The sessions are not ‘group therapy’. You are not obliged to share any personal information, however we think it is a good opportunity to meet and chat with other people who may be experiencing similar problems.
If for some reason you miss a week, you may be able to join a different group to make up the session you have missed. Please inform us as soon as possible if you can’t attend the group sessions you have been offered.
The group therapist will guide you through the strategies and give you instructions on how to fill out the sleep diary. If you have any questions or comments, you are welcome to ask them during the session.
Generally, patients are referred to us by their GP or another specialist. You will first be assessed by a member of the RLHIM Behavioural Sleep Medicine team to confirm the diagnosis of insomnia, and make sure there are no other sleep or medical disorders underlying your sleep difficulties. If CBTi is likely to be of benefit, you will then be put on the waiting list for CBTi.
Can I still do CBTi? Yes! There are no contraindications for completing CBT. However, please make sure your therapist is aware if you have any other physical or mental health conditions, as some modifications may need to be made to your treatment plan.
Yes! There are many different types of insomnia. It may sometimes feel that you are alone in your symptoms but we can assure you that CBTi is very successful for all types of Insomnia.
Please bring a notepad, pen and calculator (a smart phone with calculator function is fine).
Due to the current limitations on meeting as a group, we are providing virtual groups via the Zoom digital platform. You will be invited to join a group via an email link. The therapist will run the session live and interactively, so you will still be able to ask questions. Please ensure you are in a quiet environment where you are unlikely to be disturbed. We will email you all the handouts and resources necessary for the group each week. Please have a notepad and pen handy to take notes. We will email you a copy of the sleep diary, as an Excel spreadsheet document. If for some reason you are unable to open this or the formulae do not work on your device, you will need to have a calculator.
If possible, we recommend you join using Zoom on a computer or tablet, as the screen on a mobile phone is small and may make it difficult to see some of the slides.
If you are unable to attend your appointment, please let us know at least 48 hours beforehand so we can offer it to someone else.
Following your treatment, you will be referred back to your GP.
The RLHIM is a teaching hospital and from time-to-time other healthcare professionals may observe in outpatient clinics as part of a training course. We will always ask your permission for students to sit in during your consultation.
You do not have to have students present if you would prefer not to.
Patient Services
The Royal London Hospital for Integrated Medicine
60 Great Ormond Street
London WC1N 3HR
Tel: 020 3448 2000
Fax: 020 3448 2004
Switchboard: 020 3456 7890
Email: uclh.enquiry.rlhim.patients@nhs.net (not for referrals)
Website: www.uclh.nhs.uk
The Royal London Hospital for Integrated Medicine (RLHIM) is part of University College London Hospitals NHS Foundation Trust and accepts GP referrals via NHS e-Referrals (formerly Choose and Book).
Patients can also be referred by their NHS hospital consultant. NHS Choices provides information and an opportunity to provide feedback about our service.
Page last updated: 05 June 2024
Review due: 31 July 2025