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Chronic Insomnia / Insomnia Disorder

CBTi - Cognitive Restructuring

Cognitive restructuring therapy aims to identify, challenge and replace dysfunctional beliefs and attitudes about sleep and insomnia.

During cognitive restructuring therapy patients work with a psychologist with specialist training/experience in the management of insomnia (See Referral to a Psychologist) to discuss misconceptions about sleep and normalise sleep/wake patterns by dealing with the vicious cycle of wakefulness and anxiety that occurs when patients worry they won’t be able to perform the next day if they don’t get enough sleep and this worry keeps them awake. Misconceptions about sleep may include unrealistic expectations of sleep, fear of missing out on sleep, and overestimation of the consequences of poor sleep.1

Patients work to establish realistic expectations related to insomnia, including addressing: 2, 3, 4

  • Misconceptions about sleep need
  • Overestimations of time spent awake throughout the night
  • Misconceptions about the association between insomnia and mortality
  • Misconceptions about the need for sleep to address future problems such as stress and relapse
  • Sleep-related anxiety and maladaptive ‘sleep-protective’ behaviours (e.g. napping, extended time in bed, cancelling daytime appointments, etc.) in the maintenance of insomnia

AHI - Apnoea-Hypopnoea Index
BBTi - Brief Behavioural Therapy for Insomnia
BMI - Body Mass Index (kg/m2)
BQ - Berlin Questionnaire
CBTi - Cognitive Behavioural Therapy for Insomnia
CELL - Coblation Endoscopic Lingual Lightening
COPD - Chronic Obstructive Pulmonary Disease
CVA - Cerebrovascular Accident
CPAP - Continuous Positive Airway Pressure
CSA - Central Sleep Apnoea
DASS - Depression Anxiety Stress Scale
DBAS - Dysfunctional Beliefs and Attitudes about Sleep
DBP - Diastolic Blood Pressure
DIMS - Difficulties Initiating and/or Maintaining Sleep
DISE - Drug-Induced Sleep Endoscopy
DISS - Daytime Insomnia Symptom Scale
ENT - Ear Nose and Throat
ESS - Epworth Sleepiness Scale
FOSQ - Functional Outcomes of Sleep Questionnaire
FSH - Follicle-Stimulating Hormone
FTP - Friedman Tong Position
GP - General Practitioner
HANDI - RACGP Handbook of Non-Drug Interventions
HGNS - Hypoglossal Herve Htimulation
ISI - Insomnia Severity Index
K10 - Kessler Psychological Distress Scale
MAD - Mandibular Advancement Device
MAS - Mandibular Advancement Rplint
MBS - Medicare Benefits Schedule
MMA - Maxillomandibular Advancement Surgery
MRA - Mandibular Repositioning Appliance
ODI - Oxygenation Desaturation Index
OSA - Obstructive Sleep Apnoea
PLMD - Periodic Limb Movement Disorder
PT - Positional Therapy
PTSD - Post-Traumatic Stress Disorder
PSG - Polysomnography
QSQ - Quebec Sleep Questionnaire
REM - Rapid Eye Movement
RFTB - Radiofrequency Thermotherapy of the Tongue Base
SBP - Systolic Blood Pressure
SCI - Sleep Condition Indicator
SE - Sleep Efficiency
SF36 - Short-Form (36) Health Survey
SMILE - Submucosal Minimally Invasive Lingual Excision
SNRIs - Serotonin-Norepinephrine Reuptake Inhibitors
SOL - Sleep Onset Latency
SSRI - Selective Serotonin Reuptake Inhibitors
TFTs - Thyroid Function Tests
TIB - Time In Bed
TORS - Transoral Robotic Surgery
TST - Total Sleep Time
UPPP - Uvulopalatopharyngoplasty
WASO - Wake After Sleep Onset

Quick links


  1. www.racgp.org.au/clinical-resources/clinical-guidelines/handi/handi-interventions/mental-health/cognitive-behavioural-therapy-for-chronic-insomnia
  2. Winkelman JW. Overview of the treatment of insomnia in adults. In UpToDate, Benca R (ed). Waltham, MA: UpToDate 2020
  3. Harvey AG. A cognitive theory and therapy for chronic insomnia. Journal of Cognitive Psychotherapy: An International Quarterly 2005;19(1):41-59
  4. Smith MT, et al. Cognitive behavior therapy for chronic insomnia. Clin Cornerstone 2003;5(3):28–40