Insomnia Counseling and CBT-I
You’ve tried the tea. You’ve tried the app. You put the phone in the other room, bought the weighted blanket, cut the coffee off at noon. And you’re still lying there at 3 a.m. doing math on how many hours you have left.
Chronic insomnia is not a willpower problem and it’s not a discipline problem. It’s a self-perpetuating cycle, and it responds to a specific treatment. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a structured, short-term protocol, usually four to eight sessions, and it’s the first-line treatment for chronic insomnia in adults. Not medication. First.
Why Sleep Hygiene Didn’t Work
Because it was never supposed to work on its own.
This is the part that frustrates people, and they’re right to be frustrated. Sleep hygiene is what you get handed at a fifteen-minute doctor’s visit: dark room, cool room, no screens, consistent bedtime. Those are reasonable habits. They are also, on their own, not a treatment for chronic insomnia. The American Academy of Sleep Medicine says so explicitly in its clinical practice guideline: sleep hygiene should not be used as a stand-alone therapy for chronic insomnia in adults.
So if you’ve been following the advice and getting nowhere, that isn’t a personal failure. You were given the garnish and told it was the meal.
What’s Actually Keeping You Awake
Something set your insomnia off. A newborn, a divorce, a bad stretch at work, grief, a health scare. That trigger is usually long gone. What’s keeping the insomnia alive now is everything reasonable you started doing in response to it.
You went to bed earlier to catch up. You slept in on Saturday. You started lying down at 9:30 to give yourself a head start. Each of those makes complete sense. Each of them also quietly weakens the biological pressure that makes you sleepy, and stretches the hours you spend in bed awake.
Meanwhile your bed has been doing something it was never meant to do. It has been the place where you lie in the dark, tense, tracking the clock, bracing for another bad night. Do that enough times and the bed stops being a cue for sleep and starts being a cue for vigilance. Your body learns it. That’s why you can nod off on the couch at 10 and be electrically awake the second your head hits the pillow.
CBT-I targets those two mechanisms directly. That’s the whole game.
What We Actually Do
Rebuild your sleep drive. We use a sleep diary to find out how much you’re actually sleeping, not how long you’re in bed. Then we compress your time in bed to match. This is the part nobody likes hearing and it’s the part that works. It is temporary, it is calculated, and we widen the window back out as your sleep consolidates.
Break the bed-and-wakefulness association. Stimulus control is a small set of rules that sound almost too simple. Bed is for sleep. If you’re awake and frustrated, you get up. We rebuild the link between lying down and going out, which is a learned response and can be re-learned.
Deal with the thinking. The 3 a.m. arithmetic. The dread that starts at 8 p.m. The belief that tomorrow is already ruined. Those thoughts generate the arousal that keeps you awake, so we work on them directly, and we test them against what your own sleep diary actually shows. Usually there’s a gap between the catastrophe you’re predicting and what happens.
Turn down the arousal. Practical, trainable ways to come down from a nervous system that’s been running hot for months.
And yes, we clean up the habits too. But last, and as support. Not as the treatment.
When Insomnia Is Traveling With Something Else
It usually is. Insomnia rides alongside depression, anxiety, chronic pain, and trauma more often than it shows up alone.
For a long time the assumption was that you treat the depression and the sleep sorts itself out. The evidence went the other way. Insomnia is now understood as a disorder in its own right, and treating it directly tends to improve the condition sitting next to it. If you’re depressed and not sleeping, the sleep is not a symptom to wait out. It’s a lever.
That’s part of why I’m comfortable working with people whose insomnia is tangled up with something else.
When It Isn’t Insomnia
Part of my job is telling you when this isn’t a therapy problem.
If you snore, if you wake up gasping, if you’re exhausted after eight hours that looked fine on paper, that may be obstructive sleep apnea and it needs a sleep study, not a therapist. If your legs crawl at night, that may be restless legs syndrome. If you’re not an insomniac so much as a night owl trapped in a 7 a.m. world, that’s a circadian rhythm problem and it’s treated differently.
I don’t diagnose or treat any of those. I screen for them, I’ll tell you plainly what I’m seeing, and I’ll tell you who to go see. CBT-I still works for many people who have sleep apnea alongside insomnia. But you deserve to know which problem you’re actually solving before you spend eight weeks solving the wrong one.
What About My Sleep Medication?
A lot of people come to CBT-I because they want off a medication they never planned to be on for three years.
I can’t advise you on medication, and I won’t. That’s between you and your prescriber. What I can tell you is that CBT-I is what makes a taper survivable, because it gives you something to sleep with once the pill is gone. The order matters. Build the skills first, coordinate the taper with the person who wrote the prescription, and don’t do it on your own in the middle of a hard month.
What Treatment Looks Like
Four to eight sessions in most cases. A sleep diary between sessions, which takes about two minutes a day and is genuinely non-negotiable, because the whole protocol is calibrated off your real numbers rather than your impression of them.
The first two weeks of sleep restriction are hard. I’m not going to pretend otherwise. You will be tired. That’s the mechanism working, and it’s short.
Sessions are virtual, by HIPAA-compliant video, and available to anyone in Texas. CBT-I holds up well remotely; the research supports delivery by video, telephone, and web-based formats. Nothing about this protocol requires being in a room. Learn more about online therapy in Texas.
My Training in CBT-I
I completed a 19-hour training in Cognitive Behavioral Therapy for Insomnia with Colleen Carney, PhD, director of the Sleep and Depression Laboratory at Toronto Metropolitan University, and Meg Danforth, PhD, former director of the Duke Behavioral Sleep Medicine Clinic. Dr. Carney is a co-author of the American Academy of Sleep Medicine guideline cited above. The training covered the full protocol along with the harder cases: insomnia alongside depression, anxiety, trauma, and chronic pain, co-occurring sleep apnea, circadian rhythm disorders, and case formulation when the standard approach stalls.
What I bring to it is 25 years of clinical experience and specialized training in a proven protocol, delivered by the people who trained the trainers.
Getting Started
If you’ve been sleeping badly for three months or more, and it’s costing you something during the day, that’s chronic insomnia, and it’s treatable. Faster than most people expect.
The first session is a conversation, not a commitment. We’ll figure out what’s actually driving it and whether CBT-I is the right tool. Learn more about what to expect, or see rates and insurance.