Sleep & 3AM Wakeups

You’ve probably seen “CBT-I” mentioned as the non-drug treatment for insomnia. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a structured, skills-based approach that changes habits, thoughts, and scheduling around sleep.

Insomnia becomes more common with age; roughly 20–30% of older adults live with insomnia, often for years. It’s linked with memory and concentration problems, mood changes, higher fall risk, and worse outcomes in conditions such as heart disease and chronic pain.

Major guidelines, including those supported by the American Academy of Sleep Medicine, recommend CBT-I as the first-line treatment for chronic insomnia, especially in older adults where sedative-hypnotic drugs can raise fall and confusion risk.

At the same time, CBT-I has trade-offs:

It asks you to follow a very regular schedule and temporarily cut time in bed (“sleep restriction”), which can be tiring in the short term.

It takes effort: sleep diaries, behavioral changes, and challenging long-held beliefs about sleep.

Access can be limited – there are not many clinicians trained in CBT-I, and traditional one-to-one therapy is time-intensive and expensive.

In this review, we’ll walk through four recent peer-reviewed studies (2023–2025) that help answer practical questions for adults in midlife and beyond:

What can CBT-I actually do for sleep and daytime function?

How does it seem to work in the brain?

What’s realistic to expect – and by when?

Who tends to benefit most, and where are the limits?

How can you use this evidence to decide whether CBT-I is a good fit for you?

Let’s get started.