The Colorado Health Institute (CHI) says a behavioral health risk surveillance system has found that more than a quarter of Colorado adults — nearly 1.2 million people — do not get seven or more hours of sleep each night, the amount recommended for good physical and mental health. It is well known that lack of sleep can affect alertness, concentration, energy level, productivity, and various aspects of physiological health and personal safety. CHI says those who reported sleeping less than seven hours a night were more likely to report mental health distress, defined as 14 or more poor mental health days in the last month, compared to their well-rested counterparts. Symptoms can include fatigue, irritableness, anxiety, and memory problems.

Sleeping pills are a frequently advertised treatment for insomnia, but they are not always the best choice. According to the Stanford University Center for Human Sleep Research, drawbacks of using drugs like Ambien, Lunesta, Sonata, and others include the following:

  • Long-term use can lead to physical and/or psychological dependence
  • If you try to withdraw from the drug, your insomnia may actually worsen
  • A study in Alzheimer’s Research & Therapy reported that long-term use can increase risk of dementia by nearly 40%
  • Sleeping pills have been linked to increased rates of cancer, heart disease, and other serious risks
  • People with short-term insomnia (difficulty sleeping three or more times a week for less than three months) in some cases find that sleeping pills contribute to having chronic insomnia (the kind that lasts three months or longer)

This doesn’t mean sleeping pills are never a viable option. Particularly if a stressful life event such as loss of a loved one, a divorce, holiday anxiety, a financial crisis, etc., causes temporary sleep problems, judicious use of sleeping pills may break a sleeplessness cycle, especially if it’s addressed early.

Sleep-Deprived Coloradans Can Consider Another Option

For many people experiencing sleep problems, there is a drug-free alternative intervention known as cognitive behavioral therapy for insomnia, or CBT-I. The nonprofit Sleep Foundation, which focuses on education, testing, and product reviews related to sleeping, says CBT-I is an effective treatment that can help people fall asleep faster, stay asleep, and feel more rested during the day.

CBT-I focuses on restructuring thoughts, feelings, and behaviors that are contributing to insomnia. A trained provider of this intervention helps identify these factors that are likely causing sleeplessness and then clarifies or reframes misconceptions in a way that is more conducive to restful sleep. The Sleep Foundation says treatment often takes from 6 to 8 sessions. Complementing the mental/conceptual “retraining,” CBT-I also incorporates changes in behaviors, such as stimulus control before bed and relaxation techniques as part of healthy pre-sleep habits. All along the patient is provided educational information to support the therapy techniques.

A Closer Look at CBT-I

Here is how the Sleep Foundation explains components on CBT-I in a little more detail:

Cognitive Restructuring. This means identifying and changing dysfunctional thoughts that can cause insomnia. One example is overcoming anxiety about falling asleep or worrying about how sleep problems will affect you, perhaps based on past experiences you have had with sleeplessness.

Stimulus Control. The goal here is to do away with habits in the bedroom that can make sleeping difficult. So no watching TV, using a cell phone, working or playing on a laptop in the bedroom. What you are doing is breaking your past association with a sleepless bedroom that you’ve come to dread — by altering your habits and making it a less sleepless place. Clients are also instructed to get out of bed when it’s difficult to fall asleep or if they lie awake for more than 10 minutes, and then go back to bed only when they are tired again.

Sleep Restriction and Compression. It sounds ironic as therapy to encourage sleep, but sleep restriction — i.e., limiting the time spend in bed — is another component. Reason being that it can increase the drive to sleep. You keep a sleep diary and gradually lengthen your sleep time as the beneficial effect takes hold. (Note: This is not recommended for people with certain medical conditions that can be made worse by losing sleep, such as bipolar disorder and seizures.) Sleep compression works somewhat in reverse, meaning total time you spend in bed is gradually reduced until it is close to the time you spend actually sleeping.

Relaxation Training. The goal here is to minimize overactive thoughts that often accompany lying awake in bed. Techniques may include focused breathing exercises, tensing and relaxing muscle groups, guided imagery, biofeedback, guided or self-hypnosis, and meditation. Movements such as yoga or tai chi may also be used.

Education and Homework. Educating clients about the importance of good sleep hygiene is also key to CBT-I. In addition to changing habits that directly facilitate better sleep, other topics covered might be the benefits of diet, exercise, and improving your sleep environment. Because CBT-I techniques require practice, homework may involve keeping a sleep diary, making it a practice to question automatic thoughts when they arise, and improving sleep hygiene practices.

How Effective Might CBT-I Be for Coloradans?

The Sleep Foundation states that when the kinds of techniques described here are used together in CBT-I, as many as 70% to 80% of patients with primary insomnia experience improvements, and the therapy has been shown to be effective in groups that are at particularly high risk of experiencing insomnia. “Benefits include less time to fall asleep, more time spent asleep, and waking up less during sleep,” the Foundation says.

The National Library of Medicine (NLM) says CBT-I has been shown to be effective “and now is considered the first-line treatment for insomnia.”  The NLM adds that the low propensity of CBT-I for side effects or harm is likely what prompted the American College of Physicians to recommend it as first-line treatment. The Foundation does note that CBT-I doesn’t always work right away, and it can take time to absorb and practice the skills learned in treatment.

Are There Any Risks with CBT-I Coloradans Should Know About?

CBT-I, to be effective, requires one to be willing to confront unhelpful thoughts and behaviors. So it may be uncomfortable at times for some patients. Talking about painful experiences, thoughts, and feelings can be challenging and may cause temporary stress and discomfort. The Sleep Foundation says working with a professional trained in CBT-I can help to minimize the risks of treatment because they are trained to offer support and tools to cope with temporary challenges or setbacks. CBT-I is often provided by a doctor, counselor, therapist, or psychiatrist trained in this form of treatment.

How Would Coloradans Pay for CBT-I?

According to research by Forbes, the average cost of psychotherapy in the U.S. ranges from $100 to $200 per session, depending on the state. But fees and billing practices can be quite variable.

Forbes notes that insurance carriers aren’t required to provide mental health benefits, but many large group plans do provide some coverage. Also, if you have health coverage through the Affordable Care Act, plans are required to include mental health benefits. Medicaid includes mental health coverage as well. You would want to refer to your specific plan’s description of services covered to determine whether it includes mental health benefits. You would also want to see whether your therapist is considered “in network” or not, which can affect what you pay. Some therapists do allow their patients to pay on a sliding scale, with or without insurance.

Medicare covers certain outpatient mental health care, such as psychotherapy. You would first want to confirm if your therapist accepts Medicare. New as of 2024, Medicare covers mental health services provided by marriage and family therapists and mental health counselors and also covers “intensive outpatient program services.” Medicare Advantage plans cover certain mental health services as well. It would be best to carefully check out your coverages, including how deductibles and copays might be involved, before seeing the therapist of your choice.

How Would Coloradans Locate Therapists Trained in CBT-I?

According to the Sleep Foundation, the number of qualified behavioral sleep medicine therapists in the U.S. is fairly limited. You can locate CBT-I providers (typically by state) and may also be able to verify their credentials through certain professional organizations, including the American Board of Sleep Medicine (, Association of Behavioral and Cognitive Therapies (, and Society of Behavioral Sleep Medicine ( The following site zeroes in on Colorado specifically:

Due to the widespread need for sleep therapy, the Sleep Foundation says there aren’t enough CBT-I professionals to meet the current demand. In response, researchers have developed new ways of offering CBT-I, such as digital, group, and self-help formats.

The Foundation says several digital CBT-I (sometimes called dCBT-I) applications have been developed in an effort to reach a greater number of patients. This approach may also reduce the cost of CBT-I. The Department of Veterans Affairs reportedly offers its own app, called CBT-I Coach, that is appropriate for non-veterans and veterans alike.

“Online resources and smartphone applications offering dCBT-I vary based on several factors,” the Foundation says, “including their purpose and the amount of involvement they require from a provider. Some resources simply offer support while people work with a trained CBT-I provider in person, while others are fully-automated and require no input from a clinician. Other resources and applications are a mix of the two, allowing people to work through a pre-set program and have regular e-mail or telephone-based feedback sessions with a professional.” The Foundation adds that improvement in insomnia symptoms from dCBT-I appear to be similar to face-to-face approaches, although only a few studies have directly compared these different approaches.

Additional Tips for Coloradans with Insomnia

The Sleep Foundation reminds anyone with sleep problems to follow the established advice to develop positive sleep habits. These tips — often referred to as good “sleep hygiene” — include the following:

  • Maintain a sleep schedule: Having a regular, predictable sleep schedule can help your body maintain a rhythm and make it easier to fall asleep. This includes weekends too, which are a common time to forget about the importance of sleep.
  • Don’t lie awake in bed: If you can’t sleep, get out of bed and find something relaxing to do until you feel tired again.
  • Create a nightly routine: Give yourself enough time to get ready for bed. Turn off your electronics early and find some relaxing activities that help you wind down before sleep.
  • Consider daytime activities: What you do during the day really counts. Even a small amount of exercise can help you sleep better. Also try to avoid eating, alcohol, and caffeine too close to bedtime.

And finally, if CBT-I alone is not successful in improving the symptoms of insomnia, speak with a doctor about the risks and benefits of using sleep meds along with CBT-I treatment.

Learn more about the Sleep Foundation at