CBT-I: For Whom Does It Really Work?

CBT-I is often called the gold standard for insomnia. Many people ask me, does CBT-I work for insomnia? And the honest answer is: it depends.

Some of the most common words I hear in my practice are:

“I tried it… and my sleep actually got worse.”

Often, when clients say this, there’s something heavier underneath:

“There must be something seriously wrong with me. Maybe I’m broken. Otherwise CBT-I would have worked.”

That feeling of failure is painful, but it doesn’t mean you’re broken. It usually means we need to understand your sleep system a little more deeply before structure alone can help.

Over the years, I’ve learned that CBT-I does work — just not always, and not for everyone.

Sleep Doesn’t Happen at Night

One of the first things I tell clients is this:

Sleep doesn’t happen at night. It’s a 24-hour process.

What happens during the day, the afternoon, and especially the evening shapes what happens when your head hits the pillow. Habits, routines, and even small choices add up to create your sleep pattern.

This becomes very clear when we look at clients like Rose.

Rose: When CBT-I Works Beautifully

Rose came to me in her mid-20s. She didn’t reach out specifically for sleep — she came because her entire life felt out of control.

Her sleep habits reflected that chaos. She went to bed at different times each night. On weekends, she slept for long stretches to “catch up.” Evenings were spent scrolling her phone for hours. There was no concept of winding down, no awareness of what her body or mind actually needed.

She exercised occasionally, ate poorly in the evenings, and snacked out of boredom. If she felt bored, she lay in bed — even when she wasn’t tired. Structure and consistency weren’t part of her personality at that stage of life, and it affected everything.

In Rose’s case, insomnia wasn’t driven by fear of sleep. It was behavioral.

Once we brought rhythm into her days — consistent wake times, intentional evenings, less time in bed, and more awareness of cues — sleep followed.

And something interesting happened: as her sleep improved, her entire life felt steadier. Her energy improved. Her focus improved. Her confidence improved. Sleep wasn’t the only thing that changed — but it was the foundation.

Rose is the kind of client CBT-I was designed for.

What CBT-I Actually Is

At its core, CBT-I is a structured, skills-based approach. It focuses on changing sleep-related behaviors, creating consistency, reducing time spent awake in bed, and strengthening the association between bed and sleep.

For many people, this structure is grounding. It brings clarity. It gives the brain new rules to follow.

But here’s where things get complicated.

“I Tried CBT-I and My Sleep Got Worse”

I hear this more often than people expect. And when you understand how CBT-I works, it makes sense.

CBT-I is rule-based:

• Don’t do this.

• Don’t do that.

• If you’re awake for 20 minutes, get out of bed.

• No napping — no exceptions.

  
  

One of the core components is sleep restriction — intentionally limiting time in bed so the body becomes exhausted enough to consolidate sleep.

I had another client, Esther, who experienced this differently. As part of sleep restriction, she was “allowed” to go to sleep at 2:45 a.m. and had to wake up at 6:00 a.m.

She told me it was one of the hardest things she had ever done.

For some people, that level of rigidity works. For others, it can feel unbearable.

When CBT-I Can Backfire

CBT-I tends to struggle when insomnia is driven less by behavior and more by anxiety. An anxious nervous system doesn’t respond well to pressure.

Rules can quickly feel threatening. Structure can feel like surveillance. Sleep becomes something you have to get right.

I once worked with a schoolteacher who refused to go out with friends in the evening — not because she didn’t want to, but because she was terrified of being home “too late” for her prescribed bedtime.

Sleep began to shrink her life instead of supporting it. When the system is already hyper-alert, adding more rules keeps the body in a state of vigilance — the opposite of what sleep requires.

This Is Not a Failure

If CBT-I didn’t work for you, it doesn’t mean you failed. It often means your system needed safety before structure.

For some people, sleep improves when pressure is removed, not added. When the nervous system learns it doesn’t have to perform. When the body feels supported instead of controlled.

CBT-I is one tool — not a moral test, and not the only path to healing sleep.

So… When Does CBT-I Work Best?

Over the years, I’ve noticed CBT-I works best when insomnia is primarily behavioral — when sleep has become messy, inconsistent, or crowded out by habits that never allow the system to settle.

It often struggles when insomnia is driven by anxiety, when the nervous system is already on high alert, or when sleep feels fragile, pressured, or closely monitored. In those cases, more rules can make sleep feel harder, not easier.

A Final Thought & Invitation

If you’re struggling with sleep, the most important question may not be what technique to use — but what your system needs right now.

More discipline?

Or more safety?

Structure?

Or permission to soften?

Sleep isn’t stubborn. It’s responsive.

If you’re reading this and you’ve either tried CBT-I and it hasn’t worked, or you’re not sure what your sleep struggle is, let’s chat and figure it out together. Book a complimentary call here: https://calendly.com/chevymermelstein/30min

If you missed a previous blog, this might be helpful: The Truth About Sleep Restriction Therapy