How CBT Can Help Insomnia in Seniors

Insomnia is a common sleep disorder that affects up to 50% of seniors. Cognitive behavioral therapy for insomnia (CBT-I) is a form of talk therapy (or psychotherapy) that can help address insomnia in seniors. With the support of a therapist, seniors can identify thoughts, feelings, and behaviors that interfere with their sleep. Multiple research studies show that CBT-I is highly effective for older adults experiencing insomnia.

Key takeaways

• Cognitive behavioral therapy (CBT) is the most effective, first-line treatment for chronic insomnia in older adults because it helps them change the thoughts, feelings, and behaviors that disrupt sleep.
• Seniors can benefit from personalized CBT-I strategies to improve sleep quality and daytime functioning without medication side effects.
• Treating insomnia with CBT-I can also support better mental health in older adults by reducing symptoms of depression, anxiety, pain, and other conditions.

Why insomnia and other sleep struggles increase with age

Many older adults may notice changes in sleep patterns as they age. Data indicates that about 50% of older adults have sleep complaints, compared to roughly 15-20% of the general population. Also, older women may experience insomnia more often than older men, possibly due to hormonal changes.

In addition to insomnia, older people may experience other sleep disorders, including:

• Circadian rhythm disorder 
• Restless legs syndrome
• Periodic limb movement disorder
• Sleep apnea (obstructive, central, or mixed)
• REM-behavior disorder 

While sleep patterns are bound to change as you age, poor sleep is not a “normal” part of aging. Physiological factors, such as having multiple medical conditions, or changes in hormones and lifestyle, can lead to recurring sleep disruptions like insomnia in older adults. Seniors report waking up more often at night and earlier in the morning due to factors such as frequent urination, anxiety, and pain or discomfort from chronic illnesses. While daytime naps can help the elderly catch up on lost sleep, excessive or irregular napping may disrupt nighttime sleep and worsen insomnia symptoms. 

How cognitive behavioral therapy works for sleep problems

CBT helps you identify and change negative thinking patterns to address mental health conditions. CBT can work for several conditions, including depression, anxiety, substance abuse, eating disorders, and sleep problems.

Cognitive behavioral therapy isn’t the only treatment for insomnia for seniors. Sleeping pills may also be prescribed to help you get to and stay asleep. Some seniors may explore natural remedies like magnesium, melatonin, or light therapy to improve sleep. However, for chronic insomnia, CBT-I is typically recommended as the first-line treatment to address symptoms. Evidence shows that CBT-I is more effective than medication.

CBT-I for older adults with insomnia

Cognitive behavioral therapy for insomnia (CBT-I) is a specific form of CBT designed to treat the sleep disorder. It’s a multi-component treatment that targets a person’s challenges with initiating and/or maintaining sleep. Treatment is delivered over six to eight sessions, each 30 to 90 minutes. 

CBT-I consists of two main components: sleep restriction therapy and stimulus control therapy . There are also two supportive components: sleep hygiene and cognitive therapy .

Here’s a breakdown of each component:

• Sleep restriction therapy (SRT): Temporarily limits the time you spend in bed at night and gradually increases it to improve sleep efficiency (the ratio of time spent asleep to time spent in bed). 
• Stimulus control (SCT): A technique that retrains your brain and body to associate your bed with being asleep. 
• Sleep hygiene (SH): Habits that promote better sleep, such as having a consistent sleep schedule, creating a bedtime routine, and keeping naps short. 
• Cognitive therapy (CT): Helps you identify and change unhelpful thinking patterns that interfere with your sleep.

The overall goal of CBT for insomnia in the elderly is to improve sleep quality and duration by restructuring thoughts, feelings, or behaviors that contribute to poor sleep.

CBT-I modifications for seniors

Therapists can modify CBT-I for seniors to make it easier for them to achieve treatment goals. 

Modifications can include:

• Offering virtual or telephone sessions instead of in-person office visits.
• Adapting therapy for people managing medical conditions that may be contributing to their insomnia.
• Creating individualized strategies to overcome barriers affecting better sleep, such as frequent urination at night or chronic pain.
• Focusing on one component at a time, such as sleep restriction or sleep hygiene.

Benefits of CBT-I for the elderly

Cognitive behavioral therapy for chronic insomnia in seniors offers many benefits, including:

• Improved sleep efficiency 
• Reduced time to fall asleep
• Increased total sleep time
• No side effects
• Improved daytime functioning
• Better management of co-occurring conditions, such as depression, pain, and post-traumatic stress disorder (PTSD)

How chronic insomnia can affect mental health in older adults

If older adults don’t seek CBT for their insomnia or another sleep disorder, over time, sleep disruptions can impact their mental health and well-being. 

Current research reveals that insomnia doesn’t just often occur alongside several mental health conditions, it actually increases the risk of developing depression, anxiety, and even suicide.

Further research warns that sleep disturbances can also worsen the mental health outcomes, causing them to become more severe, preventing full recovery, and making conditions harder to treat.

Treating chronic insomnia in older adults can often address several other conditions at the same time. While CBT-I targets thoughts, behaviors, and feelings associated with insomnia, a systematic review reports that it also reduces symptoms of depression, anxiety, and chronic pain.  

Treating insomnia and other sleep disorders in seniors

If you believe you’re experiencing insomnia or are a caregiver for someone showing symptoms of poor sleep, the first step towards getting help is reaching out to a primary care provider. They can help rule out any underlying physical or mental health conditions.

If your provider suspects that you have chronic insomnia, they can refer you to a licensed mental health professional, such as a therapist, to start CBT-I — the best treatment for insomnia in older adults. You can also use a directory, such as the Association for Behavioral and Cognitive Therapies (ABCT)’s Find-a-Therapist service, to find a CBT-I therapist. Sailor Health offers a list of older, experienced providers accepting Medicare, including therapists who specialize in sleep issues. 

Once you find a CBT-I therapist, you can work together to create a personalized treatment plan and start taking the steps towards better sleep.

How Sailor Health can help

CBT-I is the most effective treatment for addressing insomnia in older adults. Talk therapy helps you identify the behaviors, thoughts, and feelings that cause sleep problems and incorporates several therapeutic techniques to improve your sleep, ultimately improving your overall health and well-being.  

Sailor Health can connect you with licensed therapists to help you navigate these challenges. If you’re an older adult or a caregiver of one who’s facing mental health struggles and needs a therapist, we offer teletherapy via phone, computer, or even landline. We’re here to support your mental health, and most of our Medicare patients have a $0 copay. Get started today.

References 

1. Brewster, G. S., Riegel, B., & Gehrman, P. R. (2017). Insomnia in the older adult. Sleep Medicine Clinics, 13(1), 13–19. https://doi.org/10.1016/j.jsmc.2017.09.002 
2. Tatineny, P., Shafi, F., Gohar, A., & Bhat, A. (2020, October 1). Sleep in the elderly. https://pmc.ncbi.nlm.nih.gov/articles/PMC7723148/ 
3. Insomnia | Office on Women’s Health. (n.d.). OASH | Office on Women’s Health. https://womenshealth.gov/a-z-topics/insomnia 
4. Neubauer, D. N. (1999, May 1). Sleep problems in the elderly. AAFP. https://www.aafp.org/pubs/afp/issues/1999/0501/p2551.html
5. Aging changes in sleep: MedlinePlus Medical Encyclopedia. (n.d.). https://medlineplus.gov/ency/article/004018.htm 
6. Insomnia - Symptoms and causes. (n.d.). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/insomnia/symptoms-causes/syc-20355167 
7. What is Cognitive Behavioral Therapy? (2017). American Psychological Association. https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral 
8. Insomnia - Diagnosis and treatment - Mayo Clinic. (n.d.). https://www.mayoclinic.org/diseases-conditions/insomnia/diagnosis-treatment/drc-20355173 
9. Mitchell, M. D., Gehrman, P., Perlis, M., & Umscheid, C. A. (2012). Comparative effectiveness of cognitive behavioral therapy for insomnia: a systematic review. BMC Family Practice, 13(1), 40. https://doi.org/10.1186/1471-2296-13-40 
10. Walker, J., Muench, A., Perlis, M., & Vargas, I. (2022). Cognitive Behavioral Therapy for Insomnia (CBT-I): A primer. Clinical Psychology and Special Education, 11(2), 123–137.  https://doi.org/10.17759/cpse.2022110208 
11. Allan, G. M., Lindblad, A. J., & Varughese, J. (2017, August 1). Trouble sleeping: spend less time in bed? https://pmc.ncbi.nlm.nih.gov/articles/PMC5555328/ 
12. Meltzer, L. J., Crabtree, V. M., & American Psychological Association. (2015). H A N D O U t 2 3 Stimulus control. In Pediatric Sleep Problems: A Clinician’s Guide to Behavioral Interventions. https://www.apa.org/pubs/books/supplemental/pediatric-sleep-problems/Stimulus_Control.pdf 
13. Solodar, J. (2025, January 31). Sleep hygiene: Simple practices for better rest. Harvard Health. https://www.health.harvard.edu/staying-healthy/sleep-hygiene-simple-practices-for-better-rest 
14. Ritterband, L. M., Shaffer, K. M., Thorndike, F. P., Chow, P. I., Gonder-Frederick, L., Ingersoll, K. S., Cohn, W. F., Frederick, C., MacDonnell, K., Glazer, J. V., Mattos, M. K., Hilgart, M. M., Quigg, M. S., Bashir, M., & Morin, C. M. (2025). A randomized controlled trial of a digital cognitive behavioral therapy for insomnia for older adults. Npj Digital Medicine, 8(1), 458. https://doi.org/10.1038/s41746-025-01847-0 
15. Rossman, J. (2019). Cognitive-Behavioral therapy for Insomnia: An effective and underutilized treatment for insomnia. American Journal of Lifestyle Medicine, 13(6), 544–547. https://doi.org/10.1177/1559827619867677
16. Fernandez-Mendoza, J., & Vgontzas, A. N. (2013). Insomnia and its Impact on Physical and Mental Health. Current Psychiatry Reports, 15(12), 418. https://doi.org/10.1007/s11920-013-0418-8 
17. Fornaro, M., Caiazza, C., De Simone, G., Rossano, F., & De Bartolomeis, A. (2024). Insomnia and related mental health conditions: essential neurobiological underpinnings towards reduced polypharmacy utilization rates. Sleep Medicine, 113, 198–214.  https://www.sciencedirect.com/science/article/abs/pii/S1389945723004513 
18. Alimoradi, Z., Jafari, E., Broström, A., Ohayon, M. M., Lin, C., Griffiths, M. D., Blom, K., Jernelöv, S., Kaldo, V., & Pakpour, A. H. (2022). Effects of cognitive behavioral therapy for insomnia (CBT-I) on quality of life: A systematic review and meta-analysis. Sleep Medicine Reviews, 64, 101646. https://doi.org/10.1016/j.smrv.2022.101646 ‍
19. Find a CBT therapist | Association for Behavioral and Cognitive Therapies. (n.d.). https://services.abct.org/i4a/memberDirectory/index.cfm?directory_id=3&pageID=3282/