CBT for Insomnia: Where to Find the Help You Need

Here’s a question that often comes my way: “I’d like to try cognitive behavioral therapy for insomnia [CBT-I], so where can I find a sleep therapist?”

The availability of CBT-I providers varies depending on where you live. Here’s where you’re likely to find help and where you’re not, and alternative ways to get the insomnia treatment you’re looking for.

Where to find a therapist who does CBT for insomniaHere’s a question that often comes my way: “I’d like to try cognitive behavioral therapy for insomnia [CBT-I], so where can I find a sleep therapist?”

The availability of CBT-I providers varies depending on where you live. Here’s where you’re likely to find help and where you’re not, and alternative ways to get the insomnia treatment you’re looking for.

Why CBT for Insomnia?

It’s the most effective insomnia treatment known at this time, improving sleep for 70 to 80 percent of the people who try it. CBT-I is more effective and long lasting than treatment with sleeping pills, and it’s effective for many people with chronic insomnia who also have other health problems such as depression, anxiety, or sleep apnea.

For more information on CBT-I, take a quick look at this blog post I wrote at the beginning of last year.

Where Can I Find Treatment?

It depends on where you live, say authors of a paper published last year in Behavioral Sleep Medicine. If you live in New York or California, insomnia therapy is likely close at hand. If you live in Hawaii, South Dakota, Wyoming, or New Hampshire, you’ll have no luck in finding a doctor, psychologist, or nurse practitioner trained in behavioral sleep medicine. Authors of the paper were unable to find a single provider practicing in those states.*

Here’s a chart showing the number of behavioral sleep medicine providers in the US by state:

No. of providers States
73–33 CA, NY, PA, IL, MA, TX
27–22 FL, OH, CO, MN, MI, WA
17–10 MD, NC, TN, AZ, MO, DC
9–6 CT, VA, WI, AL, OR, AR, SC, WV, IN, ME, NJ
5–3 AK, DE, GA, KS, LA, NE, RI, KY, NM, NV, OK, UT, MS
2–0 ID, ND, IA, MT, VT, HI, NH, SD, WY

 

Canada has 37 behavioral sleep medicine providers, but no other country outside the US has more than 7.

Do I Really Need a Sleep Therapist for CBT-I?

There are alternatives to working with a doctor or therapist trained in behavioral sleep medicine. But working with a professional—someone with a clear grasp of the protocol who can lead you through it step by step, motivating you to continue if the going gets rough—is probably the best way to ensure success and maximize the gains you’re going to make.

“Having somebody who’s experienced with this telling me that, if I do this, there’s a good chance everything will turn around is very inspiring,” said a man I interviewed for my book, The Savvy Insomniac, after we finished a group course in CBT-I.

Find a professional trained to administer CBT-I by clicking on this provider directory.

What If I Can’t Get Insomnia Therapy Nearby?

Your next best bet is to take an online course in CBT-I. These interactive courses have been found to be as effective as the face-to-face coaching you’d receive from a sleep therapist, the only downside being that research shows people going through an online course are more likely to drop out. Check these programs out:

  • CBT for insomnia is a 5-week course developed by sleep specialist Gregg D. Jacobs at Harvard Medical School. The cost is $49.95.
  • SHUTi sells its 6-week course, developed by Canadian sleep specialist Charles Morin, for $149. The price includes access to the site for 26 weeks. The extended access might appeal to you if (1) you’re not ready to jump right into the course, (2) something unforeseen happens during therapy and you have to start all over again, or (3) you feel you might like to continue tracking your sleep after the course ends.
  • Sleepio, developed by UK sleep specialist Colin Espie, offers a 6-week course plus a year’s access to the website and a host of supplementary materials for the hefty price of $400. What you’d gain from a whole year’s access to the website isn’t clear to me. But you may be able to access Sleepio for free by agreeing to take part in a research study.

Couldn’t I Just Read a Book?

You could. Stephanie Silberman’s book, The Insomnia Workbook: A Comprehensive Guide to Getting the Sleep You Need, leads you step by step through everything you need to know to go through CBT-I using the book as your guide. But here’s a warning: while I know it’s possible to succeed in self-administering CBT-I using only a book as a guide (I did), I hear some people complain of failure. Make sure you succeed by starting out right:

  1. Read all you can about the CBT-I protocol before starting therapy. It’s important to understand the process before you begin.
  2. For 1 to 2 weeks before you start therapy, keep a sleep diary (download a sleep diary here), recording bed and rise times and relevant habitual activities.
  3. From the data you’ve gathered, calculate your average nightly total sleep time and set your initial sleep window accordingly. (But if you sleep less than 5 hours a night, set your sleep window at 5 hours.)

Stick closely to the protocol and hang tight. Your sleep should start to improve in a couple of weeks.

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*To gather data, the authors consulted a directory of professionals certified in behavioral sleep medicine, BSM provider lists, and BSM listservs.

Find the Right Sleep Doctor for Insomnia

When people write in with lots of questions about insomnia, I’ll often recommend seeing a sleep specialist or a sleep therapist who can provide cognitive behavioral therapy for insomnia (CBT-I).

But finding sleep specialists and sleep therapists can be tricky. Here’s why you might want to consult one and how to locate the right provider.

Insomnia sufferers can get help from sleep specialists and CBT providersWhen people write in with lots of questions about insomnia, I’ll often recommend seeing a sleep specialist or a sleep therapist who can provide cognitive behavioral therapy for insomnia (CBT-I).

But finding sleep specialists and sleep therapists can be tricky. Here’s why you might want to consult one and how to locate the right provider.

Why a Sleep Specialist?

Many people turn first to a primary care provider for help with insomnia. Some PCPs may know enough about sleep disorders to diagnose your problem and give you the help you need.

But a 10-minute appointment may not be long enough for a doctor to correctly diagnose your sleep problem—let alone figure out the most appropriate treatment. Also, sometimes I hear complaints about how PCPs respond to people with insomnia. The complaints go something like this:

“He didn’t seem to have much sympathy for my situation.”

“All she wanted to do was prescribe another sleeping pill.”

In contrast, a sleep specialist

  • Will probably have more empathy for your problem. A doctor who completes a one-year fellowship in sleep medicine after a 3- or 4-year medical residency is likely to take insomnia complaints more seriously and show more compassion than doctors without this training.
  • Will spend enough time with you to make an accurate diagnosis. There’s no objective test for insomnia, so sleep doctors have to figure out what’s wrong based on clinical interviews alone. Just because you have insomnia symptoms does not mean the underlying problem is actually insomnia disorder, or that the insomnia is not occurring in conjunction with another health problem. A good sleep specialist may spend 45 or 50 minutes with you in order to arrive at an accurate diagnosis.
  • Has in-depth knowledge of (1) sleep and sleep disorders, (2) the clinic- and home-based tests used to diagnose sleep disorders (rarely used if the suspected diagnosis is insomnia), and (3) the array of treatments available—and is qualified to administer those treatments.
  • May or may not be a certified provider of CBT-I.

Find a Board-Certified Sleep Medicine Specialist

To make sure you’re going to get good care, you’ll want to consult a sleep medicine specialist who is board certified. This means that he or she has passed the certification examination administered by the American Board of Sleep Medicine.

Board-certified sleep specialists are often affiliated with sleep centers accredited by the American Academy of Sleep Medicine. Use this AASM locator tool to find an accredited sleep center (and a sleep specialist) near your home.

Help with Cognitive Behavioral Therapy for Insomnia

But say you’re reasonably certain that yours is a case of persistent insomnia uncomplicated by any other disorder. You might want to try CBT-I and be looking for someone to guide you through it. If so, your quest for help with sleep will follow a slightly different path.

There’s a branch of sleep medicine called behavioral sleep medicine. It addresses the learned behaviors and thought patterns that typically disrupt sleep, and changes that can be made to improve sleep. Providers certified in this field are the ones who can help you out.

Some sleep specialists are certified in behavioral sleep medicine as well. (The credential is written CBSM, which stands for “Certified in Behavioral Sleep Medicine.”) MDs of all stripes are eligible to undergo training and become certified. So are psychologists (PhDs and PsyD’s), nurses, and some master’s-level health care professionals.

Unfortunately, certified CBT-I providers are still somewhat scarce. They tend to cluster in urban areas—which is also where most sleep centers are located.

Find a CBT-I Provider

But help is closer now than ever before. The Society of Behavioral Sleep Medicine has published a list of behavioral sleep medicine providers. The great thing about this list is that the providers are listed alphabetically by state (rather than by providers’ names). So click on this list of CBT-I providers, find your state (or a nearby state), and set up a consult.

It’s never too late!

If you’ve consulted a sleep specialist or a CBT-I therapist, how did you locate that person and were you satisfied with the help you got?