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.

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.

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. We’ll discuss how this works in session.

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 wide awake the second your head hits the pillow.

CBT-I targets those two mechanisms directly.

What We Actually Do

Rebuild your sleep drive. We use a sleep journal to find out how much you’re actually sleeping, how much you are awake, and how long you’re in bed. Then we may adjust your time in bed to match. This is the part that’s not always easy to hear, but 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. The bed is for sleeping. If you’re awake and frustrated, you get up. We rebuild the link between lying down and going to sleep, 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. There is usually a gap between what you are worried will happen because of a tough night of sleep and what actually happens. Research shows that a rough night of sleep impacts mood more than productivity. Of course, if there are safety issues, like falling asleep behind the wheel, etc., we will directly address those. That is usually a different issue.

Turn down the arousal. Practical, trainable ways to calm down a nervous system that’s been running hot for months, or even years.

And yes, we clean up the sleep habits too. Good sleep hygiene is still good! Just not the only focal point.

When Insomnia Is Traveling With Something Else

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.

For example, I worked with a client who came to me with her high-level professional job in jeopardy, and her marriage was struggling due to what she thought was primarily depression. After digging around a little, she revealed her sleep patterns . . . we immediately started working through her sleep symptoms and habits and built a plan to address a few things: her partner complained of her snoring, so she got a sleep study and a CPAP (see the next section regarding sleep apnea). Once that was managed, we moved through the CBT-i protocol. With her psychiatrist’s help, she weaned off her meds and found that the depression did not return. Depression is often a symptom of sleep apnea and/or chronic insomnia, not the cause. Treating the depression was treating the symptom, not the cause.

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 sleep apnea, and it needs a sleep study. 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 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. Getting sleep apnea treated first is the approach.

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. I will want to collaborate with your prescriber so that we are working in sync with one another to help you.

CBT-i works regardless of whether you are on sleep meds or not, so my objective is not to get you to stop the meds.

What Treatment Looks Like

Four to eight sessions in most cases. A sleep journal between sessions, which takes about two minutes a day and is genuinely non-negotiable, because the whole protocol is calibrated off your real numbers.

The first two weeks of sleep restriction can be tough, though some adapt to it more easily than others. Being tired IS the mechanism working, and it’s brief. Again, if you are sleepy, where you are nodding off in class, at work, or behind the wheel, that is different, and we will address that. But feeling tired is the sleep pressure building–that is what will help you fall asleep later.

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 could be 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.

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Frequently Asked Questions

A: Usually four to eight sessions. It is one of the shorter evidence-based protocols in mental health, and it is designed to end. You are learning a skill set, not entering open-ended therapy.
A: Yes. The research supports CBT-I delivered by video, telephone, and web-based formats. Nothing in the protocol requires being in the same room. All of my sessions are virtual and available anywhere in Texas.
A: Temporarily, we compress the time you spend in bed to match the time you are actually sleeping. It is the hardest part and the most effective part. It is calculated from your own sleep diary, it is not a punishment, and the window widens back out as your sleep consolidates. Most people find the first two weeks difficult and then feel the shift.
A: No, and that is not my call to make. Medication decisions belong to you and your prescriber. CBT-I is often what makes a taper possible, because it gives you a way to sleep once the medication is gone, but the sequence should be coordinated with the person who prescribed it.
A: Then you need a sleep study, not just a therapist. I screen for apnea, restless legs, and circadian rhythm problems, and I will tell you plainly if I think that is what I am seeing. Many people have insomnia alongside apnea, and CBT-I still helps in those cases, but you should know which problem you are solving.
A: I completed a 19-hour training in CBT-I with Colleen Carney, PhD, and Meg Danforth, PhD, two of the field's leading CBT-I trainers. Dr. Carney co-authored the American Academy of Sleep Medicine's clinical practice guideline on behavioral treatments for insomnia.
A: Sessions are $200 for 45 minutes. I am an out-of-network provider and provide superbills for potential insurance reimbursement.