Client treatment preferences are recognized as a key factor in delivery of evidence based practice. The current study investigated pregnant couples’ treatment preferences for insomnia; the modalities assessed included pharmacotherapy and cognitive behavioral therapy for insomnia (CBT-I). Method: Expectant couples completed an online questionnaire asking them to read expert validated treatment descriptions of pharmacotherapy and CBT-I; they then indicated their preference and perceptions of each approach. Results: Pregnant women indicated that if they were experiencing insomnia they would prefer CBT-I to pharmacotherapy (p < .001). Women rated CBT-I as more credible and indicated stronger positive reactions to it than pharmacotherapy (p < .001). Expectant fathers indicated that they would prefer CBT-I to pharmacotherapy for both their own (p < .001) and the mother’s insomnia (p < .001). Conclusion: The current findings suggest that expectant mothers and father prefer CBT-I to pharmacotherapy as a treatment for insomnia.