Chronic back pain often prevents good sleep, and poor sleep can worsen back pain. The best way to break this cycle is to treat the root cause of your back pain, but you can also encourage better sleep by adjusting your thought patterns and behavior. This idea is known as cognitive behavioral therapy for insomnia (CBT-I).

Medical literature has shown cognitive behavioral therapy to be effective for treating insomnia.
Psychological Approaches for Insomnia

Read on to learn how cognitive behavioral therapy for insomnia works, why it is beneficial, and what steps you can take to get better sleep.


How cognitive behavioral therapy for insomnia works

Certain thoughts and behaviors may be causing or worsening your insomnia. The goal of cognitive behavioral therapy is to eliminate these thoughts and behaviors and develop better sleep habits.

See Addressing Pain and Medical Problems Disrupting Sleep

Commonly used methods include:1

  • Sleep restriction. Limit yourself to sleep only within a certain time frame (between 11 pm and 7 am, for example), which may mean keeping yourself from sleeping in too late, taking an afternoon nap, or nodding off after dinner. Over time your body and mind may adjust, and your sleep improve.
  • Stimulus control. Minimize bedroom distractions and break negative associations with bedtime. Some examples of stimulus control include placing your cell phone out of reach, leaving your room if you can’t fall asleep after 30 minutes, and not checking the clock.
  • Cognitive restructuring. Gain an awareness of your negative, worrisome thoughts about sleep, and replace them with more realistic and positive thoughts. Shift your anxious mindset to a relaxed one.

See Practicing Good Sleep Hygiene

Cognitive behavioral therapy for insomnia involves meeting with a medical professional, such as a psychologist, to learn practical strategies for improving your sleep. Meetings may occur over several weeks and months—whatever you two determine is best.

The benefits of cognitive behavioral therapy for insomnia

There are several advantages to treating insomnia with cognitive behavioral therapy:

  • Cognitive behavioral therapy is drug-free. Even though prescription sleep medications can offer effective short-term help for falling asleep and staying asleep, they carry a risk of negative side effects, such as abuse and dependence. Cognitive behavioral therapy, however, does not carry the risks involved with taking drugs.
  • Cognitive behavioral therapy is long-lasting. Because cognitive behavioral therapy involves building habits of mind and body, its effects don’t wear off. You acquire strategies that you can apply over the course of a lifetime; they are not a prescription that runs out after a definite amount of time.
  • Cognitive behavioral therapy is effective. Evidence indicates that cognitive behavioral therapy can lead to better long-term outcomes than prescription sleep medications, such as benzodiazepines and non-benzodiazepines.2 Of course, cognitive behavioral therapy will not enable good sleep for every individual, as outcomes vary across unique health situations.

While cognitive behavioral therapy has been shown to have good long-term outcomes, it has not been proven to be more effective in the short-term than other insomnia treatments. The therapy often requires a time commitment of several weeks or months, and daytime sleepiness may occur in the process.

How to get started with cognitive behavioral therapy for insomnia

Here are a couple ways you can get started with cognitive behavioral therapy for insomnia:

  • Make an appointment with a medical professional. Check if you live near a specialist certified by the American Board of Sleep Medicine. If you don’t, try reading reviews of psychologists in your area to see if they have experience working with insomnia patients. Or ask your doctor for recommendations.
  • Try cognitive behavioral therapy on the Internet. Test out online cognitive behavioral therapy programs, such as SHUTi, to learn sleep strategies. Or download a phone app, such as Sleepio, which can help you learn cognitive and behavioral techniques to improve your sleep. Experimenting with cognitive behavioral therapy on the Internet can be a convenient, low-risk way to see if you like it.

While it won’t solve the underlying cause of your pain, cognitive behavioral therapy for insomnia can be a safe and effective way to improve your long-term sleep health.

Learn more:

Chronic Pain and Insomnia: Breaking the Cycle

Video: 11 Unconventional Sleep Tips: How to Get to Sleep and Stay Asleep


  1. Mitchell MD, Gehrman P, Perlis M, Umscheid CA. Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC Family Practice. 2012;13:40.
  2. Morin, Charles M, et. al. Chronic insomnia. The Lancelet. 2012; 379:9821, 1129-1141.