CBTI consists of several components that are tailored to the
patient's individual presentation. Stimulus control, developed by
Richard Bootzin, is a set of instructions that address conditioned
arousal. These instructions strengthen the bed as a cue for sleep and
weaken it as a cue for wakefulness. Sleep consolidation training is a
procedure developed by Arthur Spielman. It was originally designed to
eliminate prolonged middle-of-the-night awakenings but it can also
help with problem falling asleep at the beginning of the night.
This step-wise procedure aims to first improve sleep quality and
later worry about its quantity. Initially the time spent in bed is
restricted to the amount of sleep that is currently feasible. In
subsequent steps the time spent in bed is gradually increased.
A third component of CBTI consists of strategies for reducing sleep
interfering thoughts and worries, managing stress, calming an active
mind that won’t shut off when trying to sleep and relaxing. The key is
shifting from “trying hard to sleep” to “allowing sleep to happen.”
CBTI takes into account people’s biological clocks and aims to align
bed time and rise time with an individual’s internal clock. This may
sometimes involve properly timed exposure to bright light.