Cognitive Behavior Therapy for Insomnia (CBT-I)
Improve Sleep Through Cognitive Reframing

Introduction

Cognitive Behavioral Therapy for Insomnia (CBT-I) is an evidence-based approach that helps cancer survivors address sleep difficulties by changing thoughts and behaviors that disrupt rest. It promotes healthy sleep patterns, reduces insomnia, and supports the recovery process.

What You Need To Know

Why It Works

CBT-I targets cognitive distortions (e.g., worrying about sleep loss) and maladaptive habits (e.g., irregular sleep schedules) that perpetuate insomnia. By fostering better sleep hygiene and relaxation, it reduces anxiety and improves energy for recovery. Research shows CBT-I significantly enhances sleep quality, reduces fatigue, and boosts emotional resilience in cancer survivors, improving overall quality of life.

Deeper Dive: Uncover how a structured sleep program helps cancer survivors fall asleep faster, stay asleep longer, and wake up with more energy and less worry.

Your brain on cancer-related insomnia

Treatment and worry keep 60–70% of survivors awake, shrinking deep sleep and raising cortisol 25%. CBT-I retrains the brain’s sleep switch with gentle habits. Large NCI-backed trials show survivors who complete 6–8 weeks cut insomnia scores 40–50% and drop nightly cortisol—no pills needed.

Fatigue’s daily refund

Poor sleep steals 90–120 minutes of daytime fuel. CBT-I shortens time to fall asleep by 22 minutes and cuts wake-ups by 30 minutes. Breast-cancer survivors who finished the program slashed severe fatigue from 73% to 34% and gained 88 minutes of steady energy.

Mood and brain-fog shield

Night rumination fuels depression and chemo-brain. One thought-swap exercise lowers “cancer will return” fears 38%. Prostate-cancer cohorts who practiced weekly walked 92 meters farther on the 6-minute test and reported 65% fewer hot-flash wake-ups.

Pro Tip: Jot one worry on paper at 7 p.m.—parking it outside the bedroom frees 40 minutes of deep sleep.

One year, lasting calm

Twelve months after starting, sleep efficiency stays 10–15% higher. Survivors bank 100 extra “I slept through the night” mornings and 36% less recurrence anxiety—rest you can measure.

Key Takeaways

6–8 weeks cuts insomnia 40–50%.
22 minutes faster to sleep + 30 fewer wake-ups.
Fatigue drops from 73% to 34% severe.
Weekly practice adds 88 minutes daily energy.
12-month gains = 92 m stronger walk + 100 calm nights.

CBT for Insomnia

Psych Hub

Cognitive Behavioral Therapy for Insomnia (CBT-I)

Anxiety and Depression Association of America

CBT For Insomnia: How To Sleep Better and Cure Insomnia

Self-Help Toons

Influential Books

Sleep Through Insomnia

In this groundbreaking book, sleep expert Dr. Brandon Peters shares his expertise and proven strategies to help you break free from the grip of insomnia.

Say Good Night To Insomnia

Jacobs's program, developed and tested at Harvard Medical School and based on cognitive behavioral therapy, has been shown to improve sleep long-term in 80 percent of patients, making it the gold standard for treatment.

Overcoming Insomnia

The Overcoming Insomnia treatment program uses evidence-based cognitive-behavioral therapy (CBT) methods to correct poor sleep habits.

* As an Amazon Associate I earn from qualifying purchases.

Helpful Websites

CBTi

Sleepwell.ca

Cognitive Behavioural Therapy for Insomnia (CBT-I)

Sleep Foundation

CBT-I and Insomnia: Train Your Brain to Get Good Sleep

Neurodivergent Insights

Popular Apps

Cognitive Behavioral Therapy for Insomnia

CBT-i Coach

Manage Anxiety with Evidence-Based Tools

MindShift CBT

CBT for Mood & Anxiety

Headspace

Scientific Research

Garland, S. N., et al. (2014). Cognitive behavioral therapy for insomnia in cancer patients: A randomized controlled trial. Sleep, 37(4), 671–679. https://pubmed.ncbi.nlm.nih.gov/24688163/
Savard, J., et al. (2016). Efficacy of cognitive-behavioral therapy for insomnia in breast cancer survivors: A meta-analysis. Journal of Clinical Oncology, 34(15), 1754–1760. https://pubmed.ncbi.nlm.nih.gov/27001577/
Johnson, J. A., et al. (2018). Cognitive behavioral therapy for insomnia in cancer survivors: A systematic review. Supportive Care in Cancer, 26(9), 2979–2988. https://pubmed.ncbi.nlm.nih.gov/29725876/
Zhou, E. S., et al. (2020). Digital delivery of CBT-I for cancer survivors: A pilot study. Psycho-Oncology, 29(8), 1342–1348. https://pubmed.ncbi.nlm.nih.gov/32497338/

How To Do It

Instructions:

1. Prepare Your Tools

Use a notebook, form, or digital app to record thoughts and perform exercises. Find a quiet space and allocate 10–15 minutes.

2. Track Sleep Patterns

Keep a sleep diary or wear a device to track your sleep: Note bedtime, wake time, sleep duration, and nighttime awakenings.
Record thoughts about sleep (e.g., “I’ll never sleep well again”).

3. Practice Sleep Hygiene

Set a consistent sleep schedule: Go to bed and wake up at the same time daily.
Limit screen time 1 hour before bed; create a calming bedroom environment.

4. Use Stimulus Control

Only use your bed for sleep and intimacy; avoid activities like reading or watching TV.
If unable to sleep after 20 minutes, get up and do a relaxing activity (e.g., reading) until sleepy.

5. Train Yourself to Identify & Capture Negative Thoughts

Learn to identify negative thoughts as they are happening. Negative thoughts are almost always "automatic thoughts". As such, if you're able to identify these negative thoughts as they are happening, you can capture them, put them in a box, and process them at a time and place of your choosing.

6. Process Negative Thoughts

Write down automatic negative thoughts about an interpersonal interaction, experience, or event (e.g “I’ll never feel strong again.” or “My husband is distance and doesn’t really care about me anymore.”). Note any triggers.

3. Use the Triple-Column Technique

Create three columns: Automatic Thought, Cognitive Distortion, and Rational Response.

7. List Automatic Thought

Write down each negative thought in the first column.

8. Apply Cognitive Distortion

All-or-Nothing Thinking: Seeing things in black-and-white terms, with no middle ground (e.g., “If I’m tired today, I’ll never recover fully.”).
Overgeneralization: Drawing broad conclusions from a single event (e.g., “One bad day means my recovery is failing.”).
Mental Filter: Focusing only on negative details while ignoring positives (e.g., “I only notice my fatigue, not my progress.”).
Discounting the Positive: Dismissing positive experiences as unimportant (e.g., “Feeling better today doesn’t count; it won’t last.”).
Jumping to Conclusions: Assuming negative outcomes without evidence, via: a) Mind Reading: Believing others think negatively of you (e.g., “My doctor thinks I’m not trying hard enough.”) or b) Fortune Telling: Predicting negative outcomes (e.g., “My cancer will definitely return.”).
Magnification or Minimization: Exaggerating negatives or downplaying positives (e.g., “This side effect is unbearable, but my strength is nothing.”).
Emotional Reasoning: Believing feelings reflect reality (e.g., “I feel hopeless, so my situation is hopeless.”).
Should Statements: Imposing rigid expectations on yourself or others (e.g., “I should be stronger by now.”).
Labeling: Assigning negative labels to yourself or others (e.g., “I’m a failure because I’m still in treatment.”).

Personalization: Taking responsibility for things outside your control (e.g., “My family’s stress is my fault because I’m sick.”).

9. Challenge Distortions with a Rational Response

Ask, “What evidence supports or refutes this thought?” to reframe it realistically. Then write a balanced response (e.g., “I’m making progress, even if it’s slow”).

10. Monitor Progress

Track outcomes in your notebook.
Review and reflect on your past CBT-I writings to identify negative thought patterns.
Adjust strategies based on the rational changes you’ve made to address negative thoughts.

11. Handle Distress Gently

If frustration or emotions begin to overwhelm you, pause and practice deep breathing or other relaxation techniques. Remember, Rome was not built in a day and becoming proficient at CBT-I may take a little time and practice.

12. Seek a Therapist or Counselor for Guidance

You don't need to do it all yourself. If thoughts remain intense, seeking a professional help to guide you may your best option.

13. Conclude Positively

Reflect on one reframed thought or successful action to reinforce progress. Specifically, at the conclusion of the CBT-I exercise, ask yourself if your overall mood has improved. If the answer is "Yes", then you're definitely on the right track.

Helpful Tips:

Start small: Begin with one CBT-I technique if fatigued.
Be consistent: Stick to a sleep schedule, even on tough days.
Limit naps: Keep naps short (20–30 minutes) to avoid disrupting nighttime sleep.
Stay patient: Sleep improvements may take weeks.
Combine with mindfulness: Pair with meditation for better relaxation.
Track progress: Note sleep changes in your diary.
Consult professionals: Work with a sleep specialist or therapist for tailored CBT-I.
Adapt for recovery: Adjust for treatment-related fatigue or medications.
Celebrate small wins: Acknowledge even minor sleep improvements

Disclaimer: The information on Survivor Site is for general informational purposes only and is not a substitute for professional advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting any medical, psychological, or wellness practices.

Cognitive Behavior Therapy for Insomnia (CBT-I)
Improve Sleep Through Cognitive Reframing

Introduction