CBT-I for Chronic Insomnia in La Jolla

If you’ve been struggling to fall asleep or stay asleep for months, you’re not alone and you’re not stuck. Chronic insomnia is one of the most common conditions I treat, and Cognitive Behavioral Therapy for Insomnia (CBT-I) is the most effective treatment available. It works better than sleeping pills, and the results last.

I’m Dr. Michael Pinover, a licensed clinical psychologist in La Jolla. I’ve been providing CBT-I to adults with chronic insomnia for years, and I’ve seen it change people’s sleep and their lives in ways that medication simply doesn’t.

What is CBT-I and does it work?

CBT-I is the only scientifically proven, non-drug treatment for chronic insomnia. It has been recommended as the first-line treatment by the American College of Physicians, the American Academy of Sleep Medicine, and the National Institutes of Health.

Here’s what the research shows:

CBT-I improves sleep in 75 to 80 percent of patients. In direct comparisons with sleep medications including Ambien, CBT-I has been shown to be more effective. Unlike medication, CBT-I produces lasting improvements because it changes the underlying behaviors and thought patterns that are causing your insomnia, not just the symptoms. Most people who complete CBT-I no longer need sleep medication, and the improvements hold up months and years after treatment ends.

CBT-I also improves depression, anxiety, PTSD, chronic pain, and fibromyalgia in patients who have insomnia alongside these conditions. Treating the sleep problem directly tends to improve everything else too.

What does CBT-I involve?

CBT-I is a structured program that typically runs five to eight sessions. Each session builds on the last. You’ll keep a sleep diary throughout treatment so we’re working from your actual data, not general impressions. Here’s what the treatment covers:

Sleep scheduling. We calculate a specific sleep window based on how much sleep you’re currently getting. This sounds counterintuitive, but temporarily limiting time in bed builds up sleep pressure, consolidates your sleep, and quickly improves sleep quality. Most people notice meaningful changes within the first two to three weeks.

Stimulus control. If you’ve been lying awake in bed for hours, your brain has learned to associate bed with wakefulness rather than sleep. Stimulus control techniques rebuild that association so that getting into bed reliably triggers sleepiness again.

Cognitive restructuring. Worrying about sleep is one of the main things that keeps people awake. We identify the specific thoughts and beliefs that are driving your anxiety about sleep and work through them systematically. Thoughts like “I need eight hours or I can’t function” or “I’ll never be a normal sleeper” create performance pressure that makes sleep harder. We change those patterns directly.

Relaxation techniques. You’ll learn daytime and bedtime relaxation techniques that reduce the physical and mental arousal that interferes with sleep. These are specific techniques, not generic advice.

Sleep hygiene and lifestyle habits. Practical adjustments to your environment, schedule, and daily habits that support the biological systems regulating your sleep.

Medication tapering (if applicable). If you’re currently using sleep medication and want to reduce or stop it, CBT-I provides a structured path for doing that safely. Research shows that 90 percent of patients who use medication reduce or eliminate it through CBT-I.

Is CBT-I right for you?

CBT-I works for most adults with chronic insomnia, meaning difficulty falling asleep, staying asleep, or waking too early at least three nights a week for at least three months.

It’s particularly effective if:

• You’ve tried sleep medication and it isn’t working the way you hoped, or you want to stop taking it.
• You’re looking for a treatment that addresses the cause of your insomnia, not just the symptoms.
• Your insomnia started during a stressful period, illness, or life change and has outlasted the original trigger.
• Your sleep problems are affecting your mood, energy, concentration, or daily functioning.
• You have anxiety or depression alongside insomnia, since CBT-I consistently improves both.

CBT-I versus sleep medication

This is one of the most common questions people bring to their first session, so it’s worth being direct about it.

In the short term, sleep medication and CBT-I produce similar results. Over time, CBT-I is more effective. Three studies published in major medical journals comparing CBT-I directly with sleeping pills, including a landmark NIH-funded study at Harvard Medical School, found that CBT-I outperformed medication. Medication works while you take it. CBT-I changes the underlying patterns so you sleep better on your own.

Sleep medication also carries real risks: next-day sedation, cognitive effects, dependency, and tolerance. The FDA has issued black box warnings on medications like Ambien, Lunesta, and Sonata for potentially serious side effects. CBT-I has no side effects.

That said, medication and CBT-I can be used together, and for some people a short course of medication while starting CBT-I makes sense. This is worth discussing based on your specific situation.

What working with me looks like

Before we start, I do a thorough assessment of your sleep history, current sleep patterns, and any contributing factors. We use that picture to set your initial sleep schedule and tailor the treatment to what’s actually happening with you.

Sessions run weekly and are 50 minutes. You’ll complete a sleep diary each week, which we review together at the start of each session. The diary gives us real data to work from and usually reveals patterns neither of us anticipated.

Because my background includes depth psychology alongside behavioral approaches, if your insomnia is connected to anxiety, unresolved stress, grief, or relationship pressures, we can work on those directly alongside the behavioral protocol. This is one advantage of working with a psychologist rather than a sleep coach or a shorter-term program.

I offer sessions in person in La Jolla and via telehealth throughout California.

Insurance and booking

I accept Aetna, Blue Shield of California, Optum/UHC, and Medi-Cal. Out-of-pocket rates are available.

If you’re ready to get started or want to find out whether CBT-I is the right fit for you, use the contact form below or call the office. I offer a brief phone consultation before the first session so we can go over your situation and make sure we’re a good match.