There are five key components of CBT-i.
Aims to identify, challenge and replace dysfunctional beliefs and attitudes about sleep and insomnia. Such misconceptions may include unrealistic expectations of sleep, fear of missing out on sleep, and overestimation of the consequences of poor sleep.
Behavioural instructions aimed at strengthening the association between bed and sleep and preventing conditioning of the patient to associate bed with other stimulating activities. Such instructions include avoiding non sleep activities in the bedroom; going to bed only when sleepy; and leaving the bedroom when unable to sleep for 15–20 minutes, returning to bed only when sleepy.
Behavioural instructions to limit time in bed to match perceived sleep duration in order to increase sleep drive and further reduce time awake in bed. Time allowed in bed is initially restricted to the average time perceived as sleep per night and the adjusted to ensure sleep efficiency remains greater than 85%.
General recommendations relating to environmental factors, physiologic factors, behaviour and habits that promote sound sleep. Specific instructions include advice on control of the bedroom environment, including avoiding visual access to a clock; regular sleep scheduling and avoiding daytime naps; and limiting alcohol, caffeine and nicotine intake, especially before bed.
Any relaxation technique that the patient finds effective can be used to limit cognitive arousal and reduce muscular tension to facilitate sleep. Specific techniques that may be effective include meditation, mindfulness, progressive muscle relaxation, guided imagery and breathing techniques.
Severity of panic attacks are monitored by the patient and are a guide to progress.