Can you do CBT-I on your own? Apps, books and courses

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By Small Hours · Last reviewed

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Yes, for many people with chronic insomnia. Trials of books and of web or app-based CBT-I programs show clear gains over no treatment, and the European guideline accepts digital delivery as a first-line route. [5][1][7] Results tend to be stronger when a real person provides some support. [1][5]

What the research says

The trials say yes, with a condition. Across 11 trials of internet-delivered CBT-I (1,460 participants), insomnia severity, time to fall asleep and time awake in the night improved by amounts comparable to face-to-face treatment, and the gains mostly held at follow-up of 4 to 48 weeks; longer programs and more personal support went with larger effects. [1] A network analysis of 54 trials and 11,815 people ranked web-based CBT-I with therapist input highest, adding about 23 minutes of sleep and cutting about 31 minutes awake after falling asleep against usual care. [2] A 6-week automated program beat online education in 303 adults, with follow-up to one year, [3] and in 1,711 adults a digital program improved health, well-being and sleep-related quality of life against sleep-hygiene advice. [4] Across 20 self-help trials, sleep, sleep-related thoughts, anxiety and depression improved, dropout matched therapist-delivered CBT-I (14.5% versus 16.7%), and telephone contact added benefit. [5] In plain terms, a structured program followed on your own works, and some human contact makes it work better.

The studies behind this
  • Digital CBT-I, 11 trials (Zachariae, 2016): 1,460 participants. Insomnia severity, time to fall asleep, time awake in the night and other measures improved, with effects comparable to face-to-face CBT-I and mostly maintained at follow-up of 4 to 48 weeks. Longer programs and more personal support were linked to larger effects. [1]
  • Network meta-analysis (Hasan, 2022): 54 trials, 11,815 people. Web-based CBT-I with therapist input ranked highest. Against usual care it added about 23 minutes of sleep and cut about 31 minutes awake after falling asleep. [2]
  • Web program trial (Ritterband, 2017): 303 adults with chronic insomnia, a 6-week automated program against online education. The program group did better on insomnia severity and diary measures, with follow-up out to one year. [3]
  • Large digital CBT-I trial (Espie, 2019): 1,711 adults. Compared with a sleep-hygiene website and booklet, digital CBT-I improved functional health, well-being and sleep-related quality of life. The reduction in insomnia symptoms mediated (carried) those improvements. [4]
  • Self-help CBT-I overall (Ho, 2015): 20 trials. Sleep, sleep-related thoughts, anxiety and depression symptoms improved. Dropout was 14.5% versus 16.7% with therapist-delivered CBT-I. Telephone contact added benefit. [5]

What the guidelines say about doing it yourself

The two main guidelines do not say the same thing. The European Insomnia Guideline (2023) recommends CBT-I delivered either in person or digitally, at its top grade. [7] The American Academy of Sleep Medicine's 2021 guideline found there was not enough evidence to recommend for or against any specific delivery method, including internet and self-help formats. It notes that one-to-one treatment with a trained provider is the most studied format, and asks clinicians to discuss the options with each patient. [9] So "yes" rests on the trials below and on the European guideline, not on both guidelines agreeing.

Books versus apps versus a therapist

  • Books. In one early trial of 54 adults, six weekly booklets helped compared with a waiting list. Weekly 15-minute phone calls added a little at the end of treatment, but both groups were similar at follow-up. [6]
  • Web programs and apps. The strongest trials are of structured programs that follow the full CBT-I package, not of generic sleep-tip apps. [1][2][4]
  • A trained therapist. A sensible next step when self-help has not been enough. The authors of the 2015 meta-analysis describe self-help CBT-I as an entry level of stepped care, where more intensive help can be added later. [5]

How to judge a CBT-I app or course

Ask these questions. They come from what the trials tested, not from any ranking.

  • Does it include the full set of CBT-I parts (education, scheduling of time in bed, stimulus control, cognitive work, relaxation), or only tips? [4][1]
  • Does it use a sleep diary and adjust to your own data?
  • Does it run for several weeks rather than a single session? Longer programs did better. [1]
  • Is there human support, even by message or phone? [1][5]
  • Does it say who it is not for, and tell you to seek medical advice for other sleep disorders?

We compare the programs, therapists and public options available here in CBT-I options in Canada.

Who should not go it alone

  • People who suspect another sleep disorder such as sleep apnea, or whose insomnia sits alongside a serious medical or psychiatric condition. The European guideline recommends an overnight sleep study (polysomnography) to evaluate other sleep disorders when they are suspected. [7]
  • People predisposed to mania or hypomania, or with poorly controlled seizure disorders. The American Academy of Sleep Medicine guideline notes sleep restriction may be contraindicated, meaning unsuitable, for them. [9]
  • People in high-risk occupations such as driving or operating heavy machinery, which the same guideline also names. [9] In a small laboratory study, the early weeks of sleep restriction brought objective sleepiness and slower reaction times. [8] Talk with a doctor first, and take care while sleepy. There is more on this in why sleep restriction can make you more tired at first.

Where the evidence is thin

  • Many trials are of specific research programs. Results for one product do not automatically apply to another.
  • Trial participants who stay with an online program may differ from the people who drop out. Larger dropout was linked to smaller effects. [1]
  • Small Hours is one option alongside books, therapists and other apps. We do not have our own published trial, so the evidence above is about digital CBT-I as a category, not about our app.

If you would like to try a structured program, what makes Small Hours different sets out how it is built, and you can sign up at trysmallhours.com.

General education, not medical advice.

References

  1. Zachariae R, Lyby MS, Ritterband LM, O'Toole MS. Efficacy of internet-delivered cognitive-behavioral therapy for insomnia - a systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev. 2016;30:1-10. Source for reference 1 (opens in a new tab)
  2. Hasan F, Tu YK, Yang CM, et al. Comparative efficacy of digital cognitive behavioral therapy for insomnia: a systematic review and network meta-analysis. Sleep Med Rev. 2022;61:101567. Source for reference 2 (opens in a new tab)
  3. Ritterband LM, Thorndike FP, Ingersoll KS, et al. Effect of a web-based cognitive behavior therapy for insomnia intervention with 1-year follow-up: a randomized clinical trial. JAMA Psychiatry. 2017;74(1):68-75. Source for reference 3 (opens in a new tab)
  4. Espie CA, Emsley R, Kyle SD, et al. Effect of digital cognitive behavioral therapy for insomnia on health, psychological well-being, and sleep-related quality of life: a randomized clinical trial. JAMA Psychiatry. 2019;76(1):21-30. Source for reference 4 (opens in a new tab)
  5. Ho FY, Chung KF, Yeung WF, et al. Self-help cognitive-behavioral therapy for insomnia: a meta-analysis of randomized controlled trials. Sleep Med Rev. 2015;19:17-28. Source for reference 5 (opens in a new tab)
  6. Mimeault V, Morin CM. Self-help treatment for insomnia: bibliotherapy with and without professional guidance. J Consult Clin Psychol. 1999;67(4):511-519. Source for reference 6 (opens in a new tab)
  7. Riemann D, Espie CA, Altena E, et al. The European Insomnia Guideline: an update on the diagnosis and treatment of insomnia 2023. J Sleep Res. 2023;32(6):e14035. Source for reference 7 (opens in a new tab)
  8. Kyle SD, Miller CB, Rogers Z, Siriwardena AN, Macmahon KM, Espie CA. Sleep restriction therapy for insomnia is associated with reduced objective total sleep time, increased daytime somnolence, and objectively impaired vigilance: implications for the clinical management of insomnia disorder. Sleep. 2014;37(2):229-237. Source for reference 8 (opens in a new tab)
  9. Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021;17(2):255-262. Source for reference 9 (opens in a new tab)

This article is general education, not medical advice. It cannot diagnose anything or replace a conversation with your doctor. Read how we choose and check sources on the how we write page.

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