Does Cognitive Behavioral Therapy Improve Insomnia In Perimenopausal Women?

August 7, 2022

Valerie Cacho MD

Cognitive behavioral therapy for insomnia (CBTi) is a science backed proven method to improve chronic insomnia without needing to rely on a pill.  If you take sleeping pills and want to stop or reduce your dose because of the potential harmful side effects CBTi can help with this too. CBTi is a holistic approach to improve your sleep as it walks you through the potential reasons why your mind and body can’t settle down at night and gives you practical steps on how to improve this. CBTi can even help with some of the pesky perimenopausal symptoms that keep you up at night. Keep reading to learn more about CBTi and how it can improve insomnia during perimenopause. 

Cognitive behavioral therapy for insomnia (CBTi)

Sleep physicians recommend CBTi as the first line treatment for chronic insomnia, and it is advised to use prior to starting sleeping pills. Cognitive behavioral therapy examines your thoughts (cognition) and behaviors in and around sleep and teaches you how to fall asleep faster, sleep longer, and reduce the negative feelings of anxiety, fatigue, and distress that result from a poor night’s sleep. 

CBTi is typically run over four to eight weeks and can be performed 1:1 or in a group setting by a trained healthcare professional (therapist, social worker, or sleep physician). There are books, online courses, and apps that offer CBTi for the self-directed learner. CBTi consists of five main tools: cognitive therapy, relaxation techniques, stimulus control, sleep restriction, and sleep hygiene education. People often assume sleep hygiene for CBTi — however, it is only one component of this therapy. Here are five tools we use in CBTi:

· Cognitive therapy: We often have limiting and negative beliefs that affect our ability to sleep. Examples of this are “I am a bad sleeper” or “I have to sleep eight hours and if I don’t tomorrow will be awful.” Through cognitive restructuring, you can learn to shift from negative sleep thoughts to pro-sleep thoughts. 

· Relaxation techniques: Slowing down your breathing, progressive muscle relaxation, listening to calming music, and guided imagery can turn down the stress response and arousal system in your brain which often can keep you from sleeping.

Stimulus control: This tool will help you put an end to tossing and turning in bed and strengthen the cue between your bed and sleep. Once you train your body and brain to use your bed ONLY for sleep, you’ll find yourself being able to fall asleep and stay asleep easier.  

· Sleep restriction: Give yourself enough time in bed to just sleep. After finding how much time you sleep on average, you can slowly increase your time in bed and thus, the time you spend sleeping.  

· Sleep hygiene education: This teaches you how to cultivate healthy sleep habits such as avoiding caffeine too late in the day or drinking alcohol too close to bedtime. Sleep hygiene also includes recommendations about your bedroom environment, regular exercise, and limiting your exposure to screens at night. 

Can CBTi Help With Hot Flashes at Night?1

Hot flashes are never convenient and can lead to insomnia if they occur repeatedly at night. 

Lifestyle factors such as caffeine, alcohol, and spicy foods can increase your body temperature, worsening your hot flashes. These same factors can also disrupt your sleep if ingested too close to bedtime. Anxiety from the anticipation of hot flashes can also stimulate the stress response, which further interferes with sleep. Yeah, not fun stuff. 

Research shows that women aged 40-65 years old who underwent a clinical trial of CBTi for insomnia during perimenopause versus menopause education had a significant improvement in their sleep quality after two months of CBTI sessions. The number of daily hot flashes didn’t decrease after going through CBTi; however, women reported that their hot flashes were less likely to interfere with their daily functioning. Researchers believed that this improvement was due to the cognitive tools of learning how to reduce the distress from less sleep and how improved quality of sleep results in better tolerance to the stress from a hot flash. These benefits continued through four months after the CBTi sessions ended — compared to taking a sleeping pill, where the effects only remain when you continue taking it.

CBTi helps women who suffer from perimenopausal insomnia due to hot flashes sleep better. If you are looking for a proven method to improve your sleep, consider CBTi. The benefits are long lasting and unlike sleeping pills, CBTi doesn’t have negative side effects.

For more information on how to get the best sleep of your life during perimenopause contact Dr. Val at, 1:1 sleep coaching is available.


Mccurry, S. Telephone-Based Cognitive Behavioral Therapy for Insomnia in Perimenopausal and Postmenopausal Women with Vasomotor Symptoms. JAMA intern Med. 2016:176(7):913-920. doi:10.1001/jamainternmed.2016.1795

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