Cognitive Behavioral Therapy for Insomnia (CBT-I)

Cognitive behavioral therapy for insomnia (CBT-I) is recognized as the first-line treatment for chronic insomnia. Unlike sedatives, CBT-I targets the underlying psychological and behavioral factors that maintain sleep difficulties through five core components: stimulus control (re-associating the bed with sleep), sleep restriction/compression (limiting time in bed to increase sleep drive), cognitive restructuring (addressing anxiety and misconceptions about sleep), sleep hygiene education, and relaxation training. The primary goal is to improve sleep efficiency and consolidate rest into a single, continuous block. Because standard CBT-I techniques like sleep restriction involve intentional sleep deprivation — which can trigger manic or hypomanic episodes — the protocol is carefully modified for individuals with bipolar disorder (CBT-I-BD). Key adaptations include: 

• Modified sleep restriction: Time in bed is typically never restricted to less than 6.5 hours to minimize the risk of mood destabilization.
• Social rhythm integration: Drawing from interpersonal and social rhythm therapy (IPSRT), the protocol places a heavier emphasis on regularizing daily routines (consistent mealtimes and social interactions) alongside sleep-wake times.
• Proactive safety planning: Therapists and patients develop a “safety plan” to monitor for early signs of mania that might emerge as sleep patterns change.
• Circadian focus: There is an increased focus on light exposure and wind-down routines to stabilize the body’s internal clock.