Few things are as miserable as a night without sleep. You lie awake while the hours pass, or wake at four in the morning with your mind already racing, and then the alarm goes and the day has to start anyway: getting to work or study, looking after others, holding conversations, all while feeling completely drained. When that happens night after night, it can feel as though your whole life is being lived through a fog.
Sleep problems are very common, and they are very treatable. Decades of research have shown that a specific, structured form of therapy, cognitive behavioural therapy for insomnia (CBT-I), helps the majority of people with insomnia sleep better, and that the improvement tends to last.
What sleep problems can look like
- Taking a long time to fall asleep, often with a mind that won't switch off
- Waking in the night and lying awake for long stretches
- Waking much earlier than you want to, and not getting back to sleep
- Sleep that leaves you unrefreshed, however long you spend in bed
- Dreading bedtime, or worrying about how you will cope tomorrow
- Relying on naps, lie-ins, caffeine or alcohol to get through
When difficulty sleeping happens at least three nights a week, has gone on for three months or more and is affecting your days, it is described as chronic insomnia. It is far more common than most people realise: studies suggest that around one in three adults has some symptoms of insomnia, and roughly one in ten has insomnia that persists.
How poor sleep affects your life
The exhaustion is the obvious part. But a run of bad nights reaches well beyond feeling tired. Aside from the tiredness, poor sleep can lead to:
- Poor focus and memory
- Difficulty controlling and regulating your emotions
- Finding stress much harder to manage
- Irritability and low mood
- A weaker immune system
Together, these change the way you think, feel and behave. Small problems feel bigger, patience runs out sooner, and the energy you need for the people and things you care about simply isn't there. Over time, poor sleep can take a real toll on your closest relationships, your performance at work and your social life.
These effects are well documented in research. Studies of sleep loss consistently find poorer attention and memory, and stronger emotional reactions to everyday stress. In one well-known study, people who usually slept less than six hours a night were several times more likely to catch a cold when exposed to the virus than those who slept seven hours or more. Long-term insomnia is also linked to a higher risk of later developing depression and anxiety.
Why insomnia keeps going
Insomnia often starts with something understandable: a stressful period at work, a bereavement, an illness, a new baby, a worrying time in life. For many people, sleep settles again once things calm down. For others it doesn't, and the reason usually lies less in the original trigger than in what has happened since.
After a few bad nights, it makes sense to try to catch up: going to bed earlier, staying in bed longer in the morning, napping, cancelling plans to rest. Bedtime starts to bring worry about whether sleep will come, and lying awake trying hard to sleep only makes the mind more alert. Gradually, the bed itself becomes linked with frustration and wakefulness rather than rest, and the body clock drifts out of its rhythm. Sleep research describes exactly this: a cycle of habits, thoughts and body-clock changes that keeps insomnia going long after whatever started it has passed. These are natural responses to poor sleep, but they tend to keep it stuck.
How CBT for insomnia (CBT-I) helps
CBT-I is a structured, short-term treatment designed specifically for insomnia. It is recommended as the first treatment for long-term insomnia by NICE in the UK, and by European and American sleep guidelines, ahead of sleeping tablets. Research comparing the two has found that while medication can help in the short term, the improvements from CBT-I tend to last after treatment ends.
Rather than offering general sleep tips, CBT-I works on the specific patterns that are keeping your sleep stuck. Using evidence-based techniques, we work together to break the cycle: settling an unsettled sleep rhythm, rebuilding the connection between bed and sleep, changing the habits that have grown up around bedtime, and easing the worry and effort that keep the mind alert at night. The aim is not to force sleep, which never works, but to create the conditions in which your natural ability to sleep can return.
We usually start by building a clear picture of your sleep, often with a simple sleep diary kept for a week or two, and of what is keeping the problem going for you. Treatment is relatively short, often between four and eight sessions, and it is tailored to your life, your schedule and your own pattern of sleep.
When sleep problems come with other difficulties
Sleep problems rarely arrive alone. A mind that races at night is a common part of anxiety and persistent worry; early waking and exhaustion often come with depression; nightmares and feeling on edge can follow trauma; and long hours with no way to switch off are a familiar part of burnout. Research shows that CBT-I still works well when insomnia comes alongside difficulties like these, and better sleep often makes the other problems easier to tackle. Part of the assessment is understanding how these fit together, so that we work on what will make the most difference.
Some sleep problems need a medical opinion first. If you snore loudly, stop breathing or wake gasping in the night, feel an irresistible urge to move your legs in the evening, or fall asleep suddenly during the day, please speak to your GP, as these can be signs of other sleep disorders. If you take sleeping tablets, you don't need to stop them before starting CBT-I; any changes are best made gradually, with your GP.
Online or in person
Most of my sessions are online, by secure video, across the UK. I also see people in person on Thursdays at Re-Mind The Body Therapy Centre, 260a Kilburn Lane, London W10 4BA, about five minutes' walk from Queen's Park station and close to Kilburn, Maida Vale, Kensal Green and West Hampstead. CBT-I works well online, which also means you don't need to travel when you are already running on very little sleep.
Is this the right service for you?
I work with adults (18 and over) on a private, self-pay basis. My practice is suited to adults who are managing their day-to-day lives, even if that takes considerable effort, and who are not currently at risk. It starts with a free 10-minute phone call, so we can talk about what has been happening with your sleep and whether I can help. From there, the first session is a 50-minute assessment. If I think a different service would suit you better, I'll say so and help you think about where to turn.
If you are having thoughts of ending your life, or feel unable to keep yourself safe, please don't wait for an appointment. Call 999 or go to A&E, call NHS 111, or contact Samaritans, at any time, on 116 123.
