What counts as chronic insomnia

The clinical definition is specific: trouble falling asleep, staying asleep or waking too early, at least three nights a week, for three months or longer, with a cost the next day — concentration, mood, energy, patience with the people you live with. It is a disorder in its own right, not just a symptom of something else, and it is treated as one.

Almost nobody calls us while the original trigger is still happening. The deployment ended, the baby sleeps through, the hearing was months ago. What is left behind is a set of habits — earlier bedtimes, weekend catch-up, naps, the tablet in bed — and a nervous system that has learned to switch on at bedtime. That learned arousal is the engine of chronic insomnia, and it is the thing CBT-I is designed to shut off. When the switch-on at bedtime is worry rather than habit, the same clinician treats that too — see our anxiety therapy page.

Why guidelines put CBT-I ahead of medication

The American College of Physicians has recommended CBT-I as the initial treatment for chronic insomnia in adults since 2016, and the American Academy of Sleep Medicine's 2021 clinical practice guideline gives multicomponent CBT-I its only strong recommendation among behavioral treatments. The reasoning is practical: a hypnotic works on the night you take it, while CBT-I changes the conditions that produce the bad nights, so the benefit is still there after the sessions stop.

The protocol has four working parts — sleep scheduling from your diary, rules for what to do when you are awake in bed, cognitive work on the thoughts that keep the brain on duty, and a relapse plan — with sleep hygiene as a footnote rather than the treatment. If someone has only ever offered you the footnote, you have not yet had CBT-I.

Is there a cure for insomnia?

An honest answer, because it is one of the most searched questions in Virginia: in clinical trials most people who complete CBT-I improve meaningfully, and a substantial share — commonly around half — no longer meet the criteria for insomnia by the end of treatment. Those gains tend to hold at follow-up a year or more later, which is the main reason the guidelines prefer it to medication.

We do not use the word cure. A bad stretch after a bereavement or a new job can still cost you sleep. The difference after treatment is that you recognize the pattern in its first week and know exactly what to do, instead of watching it settle in for another year.

If you already take something to sleep

You are not asked to stop. Plenty of our patients begin CBT-I on zolpidem, trazodone or an over-the-counter antihistamine and stay on it through the early sessions. If coming off medication is one of your goals, that happens later, on a schedule your clinician agrees with the prescriber, and only once your diary shows sleep that stands on its own. Nobody is tapered in week one.

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

CBT-I is outpatient behavioral health care delivered by a licensed clinician, and the Virginia plans we bill 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 can often be seen through the VA Community Care Network. Coverage details vary by plan, so we confirm your benefits before the first session rather than after it.

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

Yes. A sleep window is built from your diary and your actual obligations, not a textbook bedtime, so a nurse on nights in Norfolk and a federal employee leaving Woodbridge before dawn get different plans. Rotating shifts take more care, and your clinician will say honestly what is realistic on your rotation.

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

Early-morning waking is one of the three recognized forms of insomnia, alongside trouble falling asleep and trouble staying asleep. It responds to the same treatment: the sleep window is adjusted at the morning end, and the time spent lying awake is what gets shortened first.

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

Duration is not a good predictor of how someone responds to CBT-I. Long-standing insomnia is usually held in place by habits and a nightly expectation of wakefulness, and those can be changed in weeks even when the original cause is decades old. Some of our best outcomes are in people who had stopped expecting one.

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

No. Our clinicians hold Virginia licenses, which cover the whole Commonwealth, and appointments are by video, so a patient in Danville, Harrisonburg or the Eastern Shore is seen the same week as one in Arlington. Where in Virginia you live only matters for deciding which clinician you meet.