lady awake in bed


Cognitive behavioural therapy for insomnia is offered by:

Dr. Alan G. Ruth

BSc, MA, PhD (Psych), MBA, DipCBT, CSPP

APS Certified in Sleep Psychology Practice
Accredited Clinician (CBT for Insomnia)

About CBT-I

Many leading professional medical organisations in Europe and the United States recommend cognitive behavioural therapy for insomnia (CBT-I) as the first-line treatment for patients with chronic insomnia. These organisations include the American Academy of Sleep Medicine, the European Sleep Research Society, the British Association for Psychopharmacology and the American College of Physicians.

Indeed, the evidence favouring CBT-I over sleeping pills, for improved sleep, is so powerful, and the safety risks associated with it so limited or non-existent (unlike sleeping pills) that in 2016, the American College of Physicians made a landmark decision. Following an evaluation of the efficacy and safety of CBT-I compared to standard sleeping pills, their conclusion was published in the prestigious journal Annals of Internal Medicine. The conclusion was that CBT-I must be used as the first-line treatment for all individuals with chronic insomnia, not sleeping pills.

An article published in the British Journal of General Practice in 2019 made the following key points about the treatment of insomnia in primary care:

“Practice guidelines recommend that chronic insomnia be treated first with cognitive behavioural therapy for insomnia (CBT-I), and that hypnotic medication be considered only when CBT-I is unsuccessful.”

“Insomnia is the most prevalent sleep disorder, affecting 10–15% of the adult population and 19–44% of primary care patients worldwide.”

“For patients seeking professional help for insomnia, GPs are, by far, the health professionals most likely to be consulted.”

“Compared with pharmacotherapy, CBT-I has been shown to be superior in reducing symptoms of insomnia and in maintaining sleep improvements for years.”

“Non-pharmacological approaches are often preferred by patients, as they are considered to be better at improving daytime functioning and less likely to produce adverse side effects.”

“Despite abundant evidence for the efficacy of CBT-I, the approach is under-utilised. GPs are often aware of the need to reduce hypnotic prescribing but have limited knowledge about, and access to, CBT-I.”

In Ireland, the HSE (Health Service Executive) website states:

“Sleeping pills can have serious side effects and you can become dependent on them. They have also been shown to increase the risk of hip fractures and dementia.”

If you take sleeping pills for several days in a row, you may begin to depend on them to fall asleep. Also, if you stop taking them, your sleep may be worse than before you tried them. Importantly, if you have been taking sleeping pills for quite a long time, consult your doctor on how to safely stop taking them.

If you would like more information on the possible dangers posed by sleeping pills, you will find this link an excellent source of information.

CBT-I (cognitive behavioural therapy for insomnia) refers to a variety of evidence-based techniques combined into a treatment that includes behavioural and cognitive strategies. For more information on CBT-I, please visit the CBT for Insomnia section of this website.


Adjunctive Treatments to CBT-I

CBT-I is the main treatment Alan offers for insomnia. However, for some clients, it may be appropriate to offer a hybrid form of CBT-I. This could involve integrating mindfulness for insomnia, or breathing retraining, into the programme.

For example, some clients may find the cognitive therapy component of CBT-I very challenging, and it may be appropriate to replace this with mindfulness. Some other clients may have dysfunctional breathing habits that may be detrimentally affecting the quality of their sleep. With such clients, it would make sense to include relevant aspects of breathing retraining into their treatment programme.

Breathing is a crucially important behaviour that we engage in 24/7. For our overall health (and sleep quality) it’s important we breathe in a correct, healthy way. Although we normally breathe automatically, without thinking about it, we can also exercise conscious control over our breathing behaviour, to improve it, if our breathing is currently dysfunctional.

It has been estimated that an average adult takes between 20,000 and 23,000 breaths per day. That’s a lot of breathing behaviour! It makes a lot of sense to breathe correctly. The following quote is apposite.

“Improper breathing is a common cause of ill health. If I had to limit my advice on healthier living to just one tip, it would be simply to learn how to breathe correctly.”

Professor Andrew Weil
Founder & Director, Center for Integrative Medicine, University of Arizona



086 822 3933