Online across the UK, or at our Birmingham clinic
Sleep problems and CBT for insomnia
CBT for insomnia is the treatment NICE recommends first for long-term sleep problems, ahead of sleeping tablets. We deliver it one to one with our CBT-I therapist, Teresa McCougherty.
Chronic insomnia
Three nights a week, for three months
Most people sleep badly sometimes. Chronic insomnia is different. The usual threshold is difficulty falling asleep or staying asleep at least three nights a week for three months or more, together with the effect that has on your days.
By that point the problem has usually changed shape. What began as stress, illness or a period of shift work has become a pattern that sustains itself: going to bed earlier to catch up, lying awake calculating how much sleep is left, dreading bedtime, and feeling most alert at the moment you most want to be asleep.
That self-sustaining pattern is the thing CBT-I treats. It is also why sleep hygiene advice, which is aimed at the original cause, so often fails to shift it.
The evidence
NICE recommends CBT-I first
What the guidance says
NICE recommends CBT-I as the first-line treatment for chronic insomnia in adults, with medication considered where CBT-I has not worked or is not available.
Where medication fits
Sleep medication has its place, and Dr Nabavi can advise on it where it is the right answer. Medication and CBT-I are not either-or, and some people use both.
What CBT-I does
It works on the pattern that keeps poor sleep going. It takes a few weeks, and the results tend to hold.
NICE Clinical Knowledge Summaries, Insomnia.
The treatment
Two halves, and some homework
The behavioural part
Changes what you do: when you go to bed, when you get up, what you do when you cannot sleep, and how long you spend in bed compared with how long you spend asleep. Several of the most effective instructions involve spending less time in bed rather than more.
The cognitive part
Changes what you think about sleep: the arithmetic at 3am, the belief that tomorrow is already ruined, the sense that you have become someone who cannot sleep.
The homework
A sleep diary and whatever you have agreed to try that week. It is not optional. It is most of how the treatment works, and the sessions are largely there to interpret it and decide the next step.
Six to eight sessions
How many, how often
Six to eight sessions, one to one, weekly or fortnightly if that suits you better.
Around two months in total.
How long each one is
50 to 60 minutes with Teresa McCougherty, our CBT-I therapist, plus the sleep diary and the exercises you have agreed between sessions.
It has an end point
A finite course, not open-ended therapy. You are taught something and then you use it.
Wherever you are, we can treat you
CBT-I works as well over video as it does in person, because it is structured and built on discussion and record keeping rather than anything physical. It also removes the problem of getting to an appointment when you are exhausted.
It is the one treatment we offer that you can have without coming to the clinic. You can be anywhere in the UK, or sit in a room with someone in Edgbaston. It is your choice, and you can change your mind partway through.
Getting started
It depends what has already been established
If you already have a diagnosis of chronic insomnia that we are satisfied with, we can go straight to treatment.
If you do not, or if there is a chance something else is disturbing your sleep, you will see Dr Nabavi first. Sleep disorders are a particular interest of his. He will work out what is actually going on, because insomnia, sleep apnoea, a circadian rhythm problem and sleep disturbed by an untreated mood disorder look similar from the outside and need entirely different treatment.
That assessment is £400, and it also covers medication where that is the right answer.
Already diagnosed
We can begin CBT-I straight away.
Not diagnosed, or not sure
An assessment with Dr Nabavi first, at £400. Sleep medicine is one of his particular interests.
If it is not insomnia
If we think it is sleep apnoea or something else, we will say so and point you towards proper investigation rather than waste your time.
What it costs
£120 a session
A course of six to eight sessions comes to £720 to £960.
If you need an assessment with Dr Nabavi first, that is £400. We set out the full cost of your recommended course in writing before you commit to anything.
Common questions
You can start CBT-I while taking them. Many people find they need them less as the treatment progresses. Any change to the prescription is a decision for you and whoever prescribes it, not something to do on your own.
Mostly a sleep diary, plus whatever you have agreed to try that week: a fixed wake time, getting out of bed when you cannot sleep, changing the hours you spend in bed. It takes a few minutes a day.
Yes. CBT-I translates well to video because it is structured and based on discussion and record keeping rather than anything physical.
Most people see a change within two to three weeks, although sleep often gets slightly worse first while the schedule is being reset. We warn you about that at the start so it does not come as a surprise.
No. If we think that is what is going on, we will say so and point you towards proper investigation. Treating apnoea with CBT-I would waste your time.
Sleep is treatable, and this is where to start
If you have been sleeping badly for months and sleep hygiene advice has not helped, CBT-I is the treatment UK guidance recommends. Get in touch and we will tell you whether it fits.