Why I Moved Away from Traditional CBT for Insomnia

When I first began working with insomnia, I used traditional cognitive behavioural therapy for insomnia (CBT-I). And to be clear, it helped. Many of my clients slept better and experienced real improvements. It remains the recommended first-line treatment for chronic insomnia and has helped countless people around the world.

But over time, I found myself asking some difficult questions.

The people sitting in front of me were already working incredibly hard to sleep. They had routines, rules, rituals, supplements, and long lists of things they were trying every night. Although CBT-I often brought structure to that effort, I sometimes wondered whether we were unintentionally adding to the pressure. Sleep hygiene became another checklist. Stimulus control became another rule to follow. Sleep restriction became another challenge to overcome.

The more I listened to my clients, the more I noticed that many weren't simply struggling with poor sleep. They were struggling with the struggle itself. They feared being awake. They judged every difficult thought. They monitored every sensation. Their nights had become a performance that they desperately wanted to get right.

I also began to question the underlying goal of therapy. Much of CBT-I focuses on reducing symptoms by helping people sleep more and worry less. But anxiety, difficult thoughts, and restless nights are all part of being human. What if recovery wasn't about eliminating these experiences? What if it was about changing our relationship with them?

One observation stood out above all others. Anxiety almost always overrode sleep drive. No matter how tired someone was, if their mind was full of urgency, pressure, or fear, sleep became much harder to access. It became increasingly clear to me that helping people feel safer around wakefulness might be just as important as helping them feel sleepier.

This isn't to say that CBT-I is wrong. It clearly helps many people. But for me, it didn't fully explain the role of pressure, fear, and the ongoing battle people were having with sleep itself.

Gradually, my focus began to shift. Instead of asking, "How do we control sleep?" I became more interested in asking, "What happens when we stop trying so hard to control it?" I wanted to help people learn how to be with wakefulness differently, to respond to difficult thoughts and feelings with greater openness, and to rediscover that the bed could once again become a place of safety rather than struggle.

Eventually, that search led me to Acceptance and Commitment Therapy. Looking back, it was a turning point in my work. Rather than teaching people how to fight harder for sleep, it taught me how to help them step out of the struggle that was keeping sleep away in the first place.