Evidence-Based Psychological Approaches to Insomnia Across All Age Groups

Sleep disturbances and insomnia can significantly impair cognitive, emotional, and physical wellbeing across the lifespan. The psychological assessment and treatment of these disturbances are fundamental, given their strong evidence base and broad applicability (Edinger et al., 2021; Xu et al., 2024). Expanding on the core sections, this article examines the process of assessment, the mechanisms and applications of psychological therapy—especially cognitive behavioural therapy for insomnia (CBT-I)—and considerations unique to different life stages.

Assessment of Psychological Aspects

A comprehensive psychological assessment should address not only sleep patterns and duration but also cognitive, emotional, and behavioural contributors to insomnia. This begins with a detailed clinical interview, which explores:

• Sleep and Psychosocial History: Investigates the onset, duration, and pattern of insomnia, recent stressors, lifestyle, and comorbid mental health symptoms (Edinger et al., 2021).
• Validated Questionnaires: Instruments like the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI) are widely validated and provide quantitative insights into sleep difficulties (Dautovich et al., 2010).
• Sleep Diaries and Actigraphy: These objective and subjective records help identify sleep patterns, variability, and environmental/behavioural triggers (Rossman et al., 2019; Edinger et al., 2021).
• Cognitive and Emotional Analysis: Key psychological factors include dysfunctional beliefs about sleep (e.g., catastrophising the consequences of poor sleep), heightened sleep-related anxiety, the tendency toward rumination at bedtime, and maladaptive pre-sleep behaviours (Altena et al., 2022; Parsons et al., 2021). Identifying these perpetuating factors is critical, as they are central therapeutic targets.

Psychological Interventions

Cognitive Behavioural Therapy for Insomnia (CBT-I)

CBT-I is the gold standard for the psychological treatment of insomnia in all age groups, with robust, long-term efficacy for improving subjective and objective sleep outcomes (Edinger et al., 2021; Altena et al., 2022; Xu et al., 2024). Key components include:

• Stimulus Control Therapy: Breaks the negative association between the bed and wakefulness by restricting bed use to sleep and intimacy, compelling individuals to leave the bedroom when unable to sleep and maintaining a fixed wake-up time, even on weekends (Krystal, 2019).
• Sleep Restriction Therapy: Limits time in bed to actual sleep duration, increasing sleep drive and improving sleep efficiency. Gradual extension occurs as sleep becomes more consolidated.
• Cognitive Therapy: Focuses on identifying and modifying maladaptive beliefs and catastrophic cognitions surrounding sleep. Cognitive strategies such as Socratic questioning, behavioural experiments, and attentional retraining are utilised to reverse cognitive distortions (Jansson-Fröjmark et al., 2021).
• Relaxation Techniques: Methods like progressive muscle relaxation, mindfulness, and guided imagery help reduce physiological arousal and intrusive worrying thoughts at bedtime (Rossman et al., 2019).
• Sleep Hygiene Education: Covers routines and lifestyle practices supportive of sleep health, including limiting caffeine, alcohol, screen time, and optimising the bedroom environment.

Recent theoretical advances emphasize the interplay between cognitive, emotional, and behavioural influences in insomnia. For instance, CBT-I’s effectiveness appears mediated by reductions in dysfunctional beliefs, rumination, sleep-related worry, and anxiety, which, in turn, improve sleep quality and reduce comorbid symptoms (Altena et al., 2022; Parsons et al., 2021; Greeley et al., 2025).

Modes of Delivery and Accessibility

CBT-I can be delivered individually, in groups, via telehealth, or through fully remote digital platforms. Remote and digital CBT-I has demonstrated equivalent efficacy to face-to-face formats for reducing insomnia severity, sleep latency, and improving sleep efficiency, mood, and quality of life (Xu et al., 2024; Hrozanova et al., 2025). Shorter interventions without therapist support can be highly effective and improve accessibility, particularly for underserved populations (Xu et al., 2024).

Behavioural and Mindfulness-Based Treatments

Behavioural interventions are especially effective for children and adolescents, often involving parent training and reinforcement of healthy sleep behaviours. These include establishing positive bedtime routines, reinforcing independent sleep initiation, and scheduling night awakenings when necessary (Lunsford-Avery et al., 2020; Åslund et al., 2018). For adolescents, cognitive-behavioural strategies are often tailored to address academic stress, screen use, and circadian rhythm disruptions. Mindfulness-based elements, when combined with CBT-I, have shown benefits for reducing anxiety and improving perceived sleep quality, particularly in at-risk populations (Blake et al., 2017).

In adults, single-component therapies such as stimulus control, sleep restriction, or brief multi-component therapy also show efficacy and are recommended when full CBT-I is not possible (Edinger et al., 2021). Mindfulness and cognitive restructuring remain central for addressing intrusive thoughts and rumination, common in both young and older adults.

Lifespan and Special Considerations

• Children and Adolescents: Assessment and therapy focus on developmental appropriateness, involving family routines, parental involvement, and anxiety management. Behavioural interventions (e.g., bedtime fading, scheduled awakenings) and cognitive strategies adapted for younger cognitive levels effectively reduce insomnia and associated daytime distress (Lunsford-Avery et al., 2020; Blake et al., 2017).
• Young and Middle-Aged Adults: Treatment often targets stress management, work-life balance, and rumination. Digital and brief group interventions improve accessibility and engagement (Hrozanova et al., 2025).
• Older Adults: Age-related changes in sleep architecture, comorbid physical and mental health conditions, and medication use require individualised assessment and adaptation of CBT-I (Krystal, 2019; Huang et al., 2022; McCurry et al., 2021). Group and remote delivery formats are highly effective, and CBT-I outcomes are durable over time, contributing to sustained improvements in both sleep and quality of life (Vitiello et al., 2009).
• Comorbid and Neurodevelopmental Conditions: CBT-I requires modifications for individuals with psychiatric and neurodevelopmental disorders but retains efficacy across these groups (Rossman et al., 2019; Jansson-Fröjmark et al., 2021; Xu et al., 2024).

Summary

A structured, evidence-based psychological approach—anchored in CBT-I, behavioural and mindfulness-based interventions, and rigorous assessment—offers highly effective, durable, and safe management of insomnia and sleep disturbances across all ages. Personalising intervention to the individual’s developmental stage, comorbid profiles, and practical constraints, as well as leveraging digital delivery, ensures broad and sustainable impact.