For chronic insomnia (three or more nights a week, for three or more months) every major guideline now recommends CBT-I as the first-line treatment, ahead of medication. The reason is simple: pills suppress the symptom, CBT-I changes the system. The effect outlasts the treatment.

The four pillars

Stimulus control — bed is for sleep and intimacy only. No phone, no work, no doom-scrolling. If you are awake for 20 minutes, get up.

Sleep restriction — paradoxically, narrowing the time you spend in bed initially deepens sleep pressure and consolidates sleep. We start at your average actual sleep time and expand as efficiency improves.

Fixed wake time — pin the morning anchor regardless of how the night went. The rest of the rhythm pulls itself around it.

Cognitive component — challenge catastrophic predictions about lost sleep. One bad night does not ruin the next day; rumination about it does.

What to do now

Take the ISI on this site. If you score in the moderate or severe band, please book a consultation. CBT-I is what I run with almost every insomnia patient and most people see meaningful change inside 3–4 weeks.