CBT-I for Insomnia, Online Across California
If you have had trouble sleeping for months or years, you have probably noticed that sleep is the one problem that gets worse the harder you work at it. You go to bed earlier. You cut caffeine. You lie there doing the arithmetic on how many hours are left. And the effort itself becomes part of what is keeping you awake.
There is a treatment designed specifically for this, and most people have never been offered it.
Why CBT-I Is the First-Line Treatment for Insomnia?
Cognitive behavioral therapy for insomnia (CBT-I) is recommended as a first-line treatment for insomnia in adults. It addresses the behavioral and cognitive patterns that perpetuate insomnia and teaches strategies that remain useful after treatment ends.
This is not sleep hygiene. Sleep hygiene—a dark room, fewer screens, or a consistent bedtime—is sensible general advice, but it is not an adequate standalone treatment for insomnia. If you have followed all of that advice and are still awake at 3 a.m., that is not a failure on your part. You were given the wrong tool.
What CBT-I actually involves
CBT-I is a structured protocol, typically delivered in four to eight sessions. It has several components, and we use the ones your sleep pattern calls for:
Sleep assessment and tracking. We start by understanding what is actually happening, using a daily sleep diary. Almost everyone is surprised by something in the first two weeks of data.
Stimulus control. Insomnia trains your brain to associate the bed with being awake and frustrated. Stimulus control helps rebuild the connection between bed and sleep, so the bed becomes a cue for sleep rather than wakefulness, frustration, or worry.
Sleep restriction. Counterintuitively, we often begin by limiting time in bed to consolidate fragmented sleep, then gradually extend it as sleep becomes more efficient. It can be one of the most demanding—and effective—parts of CBT-I, so we tailor it carefully to your sleep patterns, health, and daily life.
Cognitive work. At 2 a.m., thoughts about tomorrow, how badly you need to sleep, or whether something is wrong with you can increase pressure and alertness. We work on examining these thoughts and responding to them differently so they no longer intensify wakefulness.
Reducing arousal. Practical strategies help address the mental and physical activation that can keep a tired body awake.
Two things worth saying plainly: the first two weeks can be harder before they get easier, and I will tell you that up front rather than after you have started. And CBT-I requires you to do the between-session work. It is short, but it is not passive.
If you are on sleep medication
Many people arrive already taking something for sleep. That is common and it is not a barrier to starting CBT-I. Any changes to medication are made by your prescriber, not by me, and I am glad to coordinate with them. Please do not stop a sleep medication abruptly on your own.
Working together
I am a licensed clinical psychologist providing telehealth to adults anywhere in California. Insomnia treatment is one of the clearest examples of therapy with a defined endpoint — we know what we are doing, we know roughly how long it takes, and we will know whether it worked.
