What counts as chronic insomnia

Chronic insomnia involves difficulty falling asleep, staying asleep or returning to sleep at least three nights a week for three months or longer. It occurs despite adequate opportunity to sleep and affects your mood, energy, concentration or daily functioning.

Sleep difficulties can continue after the original stress or disruption has passed. Spending extra time in bed and worrying about sleep may help maintain the problem. CBT-I addresses these patterns. We also treat related anxiety; see our anxiety therapy page.

Why guidelines put CBT-I ahead of medication

The American College of Physicians recommends CBT-I as the initial treatment for chronic insomnia. The American Academy of Sleep Medicine also strongly recommends it. Research shows that benefits can continue after treatment ends.

CBT-I combines an individualized sleep schedule, strategies for reducing wakefulness in bed and work on unhelpful thoughts about sleep. It includes a plan for managing setbacks. General sleep hygiene advice alone does not cover all of these components.

What improvement can you expect?

Clinical trials show that many patients improve with CBT-I, and some no longer meet the criteria for insomnia after treatment. Follow-up studies have found lasting benefits. Results vary, and stress or illness may still disrupt sleep. Your clinician helps you prepare for those setbacks.

If you already take something to sleep

You can start CBT-I while taking sleep medication. Tell your clinician about all prescriptions, over-the-counter products and other sleep aids you use.

If reducing medication is a goal, discuss it with your clinician and prescriber. Any dose changes or tapering should be managed by your prescriber.

Does Anthem, Sentara or another Virginia plan cover CBT-I?

In most cases, yes. CBT-I is billed as outpatient behavioral health visits with a licensed clinician, and the Virginia plans we work with include Aetna, Anthem Blue Cross Blue Shield, Cigna / Evernorth, Medicare, Sentara / Optima Health, UnitedHealthcare / Optum, UnitedHealthcare Medicare Advantage and Veterans Affairs Community Care Network. Veterans are often covered through the VA Community Care Network. Every plan is different, so we verify your benefits before the first session rather than after it.

I work shifts or start at 5 am. Can the schedule still work?

Your clinician considers your work hours and sleep diary when recommending a schedule. Early starts and rotating shifts can require adjustments. You will discuss what is practical for your week and what treatment may help.

I fall asleep easily but wake at 4 am and cannot get back to sleep. Is that insomnia?

It can be. Difficulty returning to sleep after waking early is one form of insomnia. A clinician considers how often it happens, how long it has lasted and how it affects you during the day before recommending treatment.

My insomnia is more than ten years old. Is therapy still worth trying?

Yes. CBT-I can help people with long-standing insomnia. It addresses current sleep habits and thoughts, even when the original trigger has passed. Your response depends on your individual circumstances and is reviewed throughout treatment.

Do I need to live near Richmond or Northern Virginia to be seen?

No. Our clinicians can see patients throughout Virginia, and most visits are by video. You must be physically in Virginia during your appointments. Check current appointment availability when booking.