CBT-I Therapy for Insomnia in San Ramon, CA
Structured, evidence-based treatment for adults and teens who are tired of working so hard to sleep.
Sleep should not require hours of planning, negotiating, and second-guessing. If you spend the evening bracing for another difficult night, lie awake with a busy mind, wake repeatedly, or begin the day already depleted, the problem may not be a lack of effort. Insomnia can become a self-reinforcing cycle — one that improves when treatment addresses the patterns keeping it in place.
At Ritenour Counseling, Michelle provides focused therapy for insomnia using principles of Cognitive Behavioral Therapy for Insomnia (CBT-I). This practical, skills-based approach is designed to help you understand your sleep, change the habits and thought patterns that maintain insomnia, and build more consistent sleep over time.
Services are available to adults and teens in person in San Ramon and online throughout California and Nevada.
When sleep becomes a problem you cannot solve by trying harder
Insomnia does not always look like being awake all night. It can show up as a recurring pattern that affects your energy, concentration, mood, school, work, or confidence in your ability to sleep.
You regularly need a long time to fall asleep.
You wake during the night and struggle to return to sleep.
You wake earlier than intended and cannot fall back asleep.
Your sleep schedule shifts from one day to the next.
You spend more time in bed trying to compensate, but sleep does not become more reliable.
You monitor the clock, calculate remaining sleep, or predict how poorly the next day will go.
You feel exhausted during the day but more alert or tense at bedtime.
You have read the advice, changed the routine, and tried the supplements — without durable improvement.
You do not need to wait until sleep is completely unmanageable. If the problem is persistent and is starting to shape your decisions, treatment can help you replace trial and error with a clear clinical plan.
CBT-I targets the cycle that keeps insomnia going
Cognitive Behavioral Therapy for Insomnia is a structured, time-limited treatment for persistent sleep difficulty. It is more than sleep hygiene. Rather than offering a generic list of habits, CBT-I uses your sleep patterns to identify the specific behaviors, schedules, and beliefs that may be reinforcing wakefulness.
For adults with chronic insomnia, major professional guidelines recommend CBT-I as an initial treatment. A standard course often takes place over four to eight sessions, although the pace and length of care depend on your history, symptoms, progress, and any conditions that need to be considered alongside insomnia.
What CBT-I may include
A focused assessment. We review your sleep history, current schedule, daytime functioning, health factors, and the situations in which sleep improves or worsens.
Sleep tracking. A brief sleep diary provides useful data. It replaces estimates and assumptions with a clearer picture of what is happening across the week.
An individualized sleep schedule. Time in bed and wake time may be adjusted to strengthen sleep drive and consolidate sleep. Recommendations are tailored rather than copied from a standard checklist.
Stimulus control. You learn strategies that rebuild the connection between bed and sleep instead of bed and prolonged wakefulness, work, worry, or frustration.
Cognitive strategies. We examine predictions, rules, and catastrophic conclusions about sleep that increase pressure and keep the mind activated.
Skills for reducing arousal. When appropriate, treatment includes practical methods for settling physical and mental activation without turning relaxation into another performance test.
Maintenance planning. You leave with a plan for travel, schedule disruption, stressful periods, and the occasional poor night so that a setback does not become a new cycle.
This is active treatment — not open-ended discussion
CBT-I works best when you are willing to observe patterns, test targeted changes, and practice between sessions. We will define what we are working on, use your data to make decisions, and adjust the plan based on what happens — not on whether you had one perfect night.
The goal is not to control sleep minute by minute. It is to reduce the conditions that interfere with sleep and build a system that is more stable, efficient, and resilient.
For high-achievers, sleep can become another performance problem
People who are capable, disciplined, and used to solving problems often respond to insomnia by increasing effort. They research more, optimize every variable, monitor every sensation, and try to make sleep happen on command. The harder they work, the more consequential bedtime can feel.
Perfectionism and performance pressure can also turn a normal fluctuation in sleep into a threat: "If I do not get eight hours, tomorrow is ruined." That prediction increases arousal, encourages compensating behaviors, and keeps attention fixed on sleep.
Treatment takes a different approach. We use structure without overcontrol. You will learn which actions meaningfully support sleep, which ones keep the cycle going, and how to respond to an imperfect night without escalating it.
CBT-I for teens accounts for real adolescent schedules
Teen sleep is shaped by biology, school start times, homework, activities, social life, technology, and family routines. Effective treatment has to account for those realities rather than treating a teenager like a smaller adult.
CBT-I for teens uses the same core principles — careful assessment, sleep tracking, schedule adjustments, stimulus control, cognitive strategies, and relapse prevention — with developmentally appropriate pacing and expectations. Depending on the teen's age and needs, parents or caregivers may be included to support the plan while preserving appropriate privacy and independence.
This work may be appropriate when a teen is taking a long time to fall asleep, waking repeatedly, sleeping at sharply different times on school days and weekends, missing school, struggling to concentrate, or becoming increasingly worried about sleep.
When academic pressure, anxiety, or perfectionism is part of the picture, therapy can address both the insomnia cycle and the broader patterns that keep the nervous system on alert.
A clear process from assessment to maintenance
Consultation — We begin with a brief conversation about the sleep problem, relevant health or mental health concerns, goals, and whether this service appears to fit.
Assessment and baseline — Early sessions clarify the pattern. You may complete sleep measures and a short daily diary so treatment is built around actual trends.
Individualized plan — We identify the most relevant CBT-I strategies, explain the rationale, and define what you will practice between sessions.
Review and adjustment — We evaluate the data, troubleshoot barriers, and update the plan as sleep becomes more consolidated and predictable.
Maintenance — We prepare for setbacks and schedule changes so you can respond early without returning to the old cycle.
Evidence-based care with a structured clinical approach
Michelle Ritenour is a licensed marriage and family therapist, a Certified Anxiety Treatment Professional, and a former educator trained at UC Berkeley. Her approach is organized, collaborative, and designed around defined goals rather than open-ended therapy without a clear direction.
Michelle is currently completing the Stanford Sleep Health & Insomnia Program (SHIP) Training for Licensed Providers. The program includes a foundational three-day CBT-I workshop followed by six months of weekly consultation in small groups. Michelle's participation in SHIP’s accredited CBT-I Program reflects advanced, ongoing training. Her work with insomnia also builds on extensive experience treating anxiety, perfectionism, stress, and academic pressure — the same patterns that often intensify when sleep becomes uncertain.
Treatment is available for adults and teens at the San Ramon office, serving San Ramon, Alamo, Danville, Dublin, and Pleasanton. Online sessions are available to clients located in California and Nevada.
Frequently asked questions
Q: How long does CBT-I take?
A: A standard CBT-I course often involves four to eight sessions, but treatment length varies. Your history, age, symptom pattern, progress, and any co-occurring concerns will guide the plan.
Q: Is CBT-I just a list of sleep hygiene rules?
A: No. Sleep hygiene can support treatment, but CBT-I is a multicomponent clinical approach. It uses assessment, sleep data, behavioral strategies, cognitive work, and maintenance planning to address the factors that keep insomnia going.
Q: Will I be told to spend less time in bed?
A: Adjusting time in bed is one evidence-based component of CBT-I. Any recommendation should be individualized and monitored. The purpose is to improve sleep efficiency and strengthen sleep drive — not to deprive you of needed sleep.
Q: Do I need to stop taking sleep medication?
A: No. Medication decisions belong with the prescribing clinician. CBT-I can be discussed alongside your existing medical care, and coordination may be recommended when appropriate.
Q: Can CBT-I help if anxiety is part of the problem?
A: Yes. Anxiety and insomnia often reinforce one another. Treatment can address sleep-specific worry and behaviors while also identifying whether broader anxiety, perfectionism, or stress should be part of the therapy plan.
Q: How is treatment different for teens?
A: The core methods are adapted for adolescent biology, school demands, activities, family routines, and developmental needs. Caregiver involvement is determined individually and discussed clearly at the outset.
Q: Do you offer online CBT-I?
A: Yes. Online therapy is available to clients located in California and Nevada. In-person appointments are available in San Ramon.
Q: What if another sleep disorder may be involved?
A: A focused assessment can identify signs that warrant medical or specialty evaluation. If symptoms suggest another sleep disorder or health condition, you may be referred to a physician or sleep specialist before or alongside therapy.