Addressing Daytime Symptoms of Insomnia with CBT-I: An Overview and Practical Applications

OBJECTIVES: Cognitive Behavioral Therapy for Insomnia (CBT-I) is the gold standard treatment for chronic insomnia. While CBT-I is highly effective at improving sleep, standard CBT-I protocols rarely target daytime symptoms directly. The objective of this overview is to provide clinicians with a practical, evidence-informed strategies to address daytime symptoms of insomnia. METHODS: The literature was reviewed to identify evidence-informed strategies that address daytime symptoms of insomnia and can be integrated into CBT-I protocols. Strategies considered were drawn from the fields of sleep and circadian sciences, as well as health psychology. RESULTS: Daytime strategies that were identified included specific cognitive, behavioral, and acceptance-based approaches to manage fatigue, sleepiness, and daytime impairment and distress. Specific interventions and recommendations for how these skills can be applied to daytime symptoms were presented and discussed using a case formulation approach. CONCLUSIONS: Insomnia is a 24-hour disorder, and it is important for clinicians to address both nighttime and daytime symptoms. Evidence-informed strategies to address daytime symptoms can be integrated within a CBT-I framework. These strategies carry implications for quality of life as well as overall treatment efficacy. Future research should assess the direct impact of intentional inclusion of these strategies on treatment outcomes.