Insomnia & trouble sleeping

Short-term insomnia can last a few days or weeks. It is often set off by stress or by changes in your schedule or surroundings, like a new job, a move, a loss or travel.

It often settles once the stress passes or you adjust. Gentle habits help stop it from turning into a long-term pattern: keep your wake time steady, avoid long lie-ins and late naps, and don’t lie in bed fighting sleep.

NHLBI describes chronic insomnia as trouble sleeping that happens 3 or more nights a week, lasts more than 3 months, and isn’t fully explained by another health problem.

Over time, insomnia can keep itself going. Worrying about getting enough sleep can make it worse, and habits like lying awake in bed can teach your brain that bed is a place for being awake.

Chronic insomnia has been linked to a higher risk of high blood pressure, heart disease and diabetes. The hopeful part: it can be treated, and CBT for insomnia is usually the first choice.

Trouble falling asleep is very common. In 2020, about 1 in 7 U.S. adults (14.5%) had trouble falling asleep most days or every day. It was more common in women than men.

Common reasons

• Stress, anxiety or low mood
• Caffeine, alcohol or nicotine
• A noisy, bright, too-warm or uncomfortable room
• Screens right before bed
• An irregular schedule, jet lag or shift work

The harder you try to force sleep, the more awake you can feel. Habits that calm your body and teach your brain that bed means sleep usually help most.

In 2020, about 1 in 6 U.S. adults (17.8%) had trouble staying asleep most days or every day. It becomes more common in midlife and later life.

Waking up can be caused by stress, alcohol (which makes sleep lighter and more broken), needing the bathroom, pain, or changes like menopause.

What can help

• Limit drinks close to bedtime
• Avoid alcohol in the evening
• Keep the room cool, dark and quiet
• If you’re awake and frustrated, get up and do something calm in dim light until sleepy

Stress about school, work, relationships or money raises the risk of insomnia, and so does the death of a loved one. Hard times often show up in sleep first.

What can help

• Talk it through with someone you trust during the day
• Try the “Worry dump” worksheet about an hour before bed
• Use slow breathing or a body scan in bed
• Keep your wake time steady while things settle

Worrying about getting enough sleep can raise the risk of insomnia or make it worse. The more you try to force sleep, the more awake you can feel.

Easing this worry is one of the main parts of CBT for insomnia. Small shifts help, like turning the clock around and reminding yourself that resting quietly is still kind to your body.

Shift or night work, frequent travel across time zones, and irregular bed and wake times can all throw off your body’s sleep-wake cycle.

A steady wake time, every day, is one of the strongest signals you can give your body clock.

Noise, light and an uncomfortable temperature can all make it harder to sleep. So can an uncomfortable bed.

Small fixes

• Earplugs or a fan for steady background sound
• Thick curtains, blinds or an eye mask
• A comfortably cool room, with covers you can adjust
• Phone charging outside the bedroom

Caffeine’s effects can last up to 8 hours, so an afternoon coffee can still keep you awake at bedtime. Nicotine is a stimulant too.

Alcohol may make you drowsy at first, but it makes sleep lighter and more broken later in the night.

Insomnia can happen at any age, but the chances rise as you get older. It is more common in women than in men, and hormone changes in pregnancy and menopause can disrupt sleep. It can also run in families.

In 2020, trouble falling asleep most days was more common in U.S. women (17.1%) than men (11.7%), and trouble staying asleep became more common with age.

The U.S. National Center for PTSD says almost everyone who has PTSD also has trouble sleeping. Nightmares can replay what happened, and some people put off going to bed because the night feels unsafe. Feeling on guard or easily startled makes deep rest hard.

CBT for insomnia is recommended as a first-choice treatment for sleep problems with PTSD. The VA says it improves sleep for about 7 in 10 people who complete it, and can reduce how often nightmares happen and how upsetting they are.

Some people use alcohol or other drugs to get to sleep. Over time this tends to make sleep and health worse.

Sleep problems and ADHD often go together. A 2016 review of studies in teens found links between poor sleep and ADHD symptoms, and between poor sleep and harder days at school and at home. The authors noted that the research is still limited.

Ideas people find useful

• A visual bedtime routine with the same steps each night
• Alarms or reminders to start winding down
• A “parking lot” notebook for ideas that pop up at bedtime
• Physical activity earlier in the day
• Morning light and a steady wake time

Sleep and pain affect each other. A 2013 research review found that sleep problems reliably predict new and worsening chronic pain, and that poor sleep may predict pain even more strongly than pain predicts poor sleep.

That means improving sleep is a hopeful way in, even when pain itself is hard to change. CBT for insomnia and relaxation skills can help people living with pain.

Hormone changes can bring tiredness, especially in the first 12 weeks. Later, a growing bump can make it hard to get comfortable, and you may need the toilet more often. Strange dreams about the baby or birth are common too.

From 28 weeks, the NHS says the safest position to go to sleep is on your side, either left or right. If you wake on your back, just roll onto your side again. Pillows under your bump and between your knees can help.

Other tips

• Rest when you can, and accept help
• Avoid tea, coffee and cola in the evening
• Avoid napping in the late afternoon or evening
• Try breathing or relaxation before bed
• Talk about worries with your partner or midwife

Around menopause, many women find it hard to get to sleep or stay asleep. Hot flushes at night, called night sweats, can make this worse. Poor sleep can leave you feeling irritable, stressed or anxious, and mood symptoms can feel worse when you’re very tired.

Ideas

• Keep the bedroom cool and use layers you can throw off
• Keep a fan or a glass of water by the bed
• Track sleep and mood to spot patterns to share with your provider

In a sleep-lab study, 57 young adults spent 5 minutes before bed either writing a to-do list for the next few days, or writing about tasks they had already done. The to-do list group fell asleep faster. The more specific their list, the faster they fell asleep.

Try it

1. About an hour before bed, grab paper or the Worry dump worksheet.
2. Write down everything on your mind: tasks, worries, reminders.
3. For each one, write one small next step, or “not tonight”.
4. Close the notebook. Tell yourself: “It’s written down. I can deal with it tomorrow.”

Relaxation is a key part of CBT for insomnia. Slow breathing gently calms the body’s stress response, which makes it easier to drift off.

Box breathing

1. Breathe in slowly through your nose for a count of 4.
2. Hold gently for 4.
3. Breathe out slowly for 4.
4. Hold for 4.
5. Repeat for a few minutes, letting your body sink into the bed.

Relaxation and meditation skills help you wind down. A body scan is an easy one to try lying down.

Simple body scan

1. Lie comfortably and close your eyes.
2. Notice your feet. Squeeze them gently, then let go.
3. Move slowly up: legs, tummy, hands, shoulders, face.
4. At each part, breathe out and let it soften.
5. If your mind wanders, gently come back to where you were.

If you’ve been lying awake for a while and feel frustrated, get up. Go to another room and do something calm in dim light, like reading or listening to quiet music. Go back to bed when you feel sleepy.

This might sound strange, but it stops your brain linking bed with frustration and worry. It’s one of the main parts of CBT for insomnia.

Worrying about not sleeping can keep you awake. Part of CBT for insomnia is easing this worry.

Kinder thoughts to try

• “Resting quietly is still good for me.”
• “I’ve managed after bad nights before.”
• “Sleep will come when my body is ready.”

This part, called cognitive therapy, helps reduce anxiety about not sleeping. You learn to notice unhelpful thoughts, like “If I don’t sleep 8 hours, tomorrow will be a disaster”, and replace them with more balanced ones.

Stimulus control strengthens your brain’s link between bed and sleep. You go to bed only when sleepy, get up if you can’t sleep, and use your bed only for sleep and sex.

This sounds odd, but it works. You limit your time in bed to a set window, close to how long you actually sleep now. This builds up your natural sleep drive. As your sleep improves, the window gets longer.

You learn relaxation or meditation skills to help you wind down, such as slow breathing and relaxing your muscles.

You learn how sleep works and which habits help, like a steady schedule, a dark and quiet room, and cutting back caffeine and alcohol.

A health care provider may ask you to keep a sleep diary, a simple record of when you go to bed, when you wake, and how you feel. It helps you and your provider see patterns.

Ask your clinical provider about a referral to someone trained in CBT-I. It can be given by a doctor, nurse or therapist, in person, by phone or online, and there are online self-help programmes too.

The U.S. Department of Veterans Affairs offers a free app called Insomnia Coach. It is based on CBT-I, made for everyone (not only Veterans), and has a weekly training plan and a sleep diary. It doesn’t replace care from a professional.

The VA suggests checking with a provider first if you have certain conditions, such as sleep apnea, and notes the app may not suit people who work nights. A related VA app, CBT-i Coach, is designed to be used alongside CBT-I with a provider.

A 2021 sleep-lab study tested seven consumer sleep trackers against a full overnight sleep study in 34 healthy young adults. Most devices were good at detecting when people were asleep, and many did as well as or better than the movement monitors researchers use.

Over weeks, a tracker can help you notice patterns, like later bedtimes on weekends or shorter sleep after late screen time.

In the same study, devices were weaker at spotting when people were awake, their sleep-stage results were inconsistent, and they tended to do worse on nights when sleep was broken. That’s exactly the kind of night people worry about most.

A full sleep study measures brain waves. Most wearables guess your stages from movement and heart rate, so a “low deep sleep” score may not be accurate.

Sleep researchers coined the word “orthosomnia” for people who become so focused on perfect tracker data that it adds stress. In a 2017 report, they described patients who sought help because their tracker showed light or restless sleep, and who trusted the device more than proper sleep tests.

Worry and pressure about sleep are among the things that keep insomnia going. Checking your score first thing every morning can set the tone for the whole day.

Signs to take a break

• You feel anxious before bed about what your score will be
• A bad score ruins your mood even when you feel okay
• You change plans or cancel things because of a number
• You check the app in the night

Try this

• Look at weekly trends, not single nights
• Hide or ignore sleep-stage scores
• Check in with how you feel before you look at the data
• Try a week off and notice how you feel
• Bring trends, not scores, to your clinical provider

Researchers suggest including tracker use in CBT for insomnia, so people can learn to use the data in a helpful way.

Worrying about getting enough sleep can make insomnia worse. Well-meant questions and advice can add to that pressure.

Try this

• Ask how their day is going, not only how they slept
• Avoid comparing (“I was out like a light”)
• Don’t suggest extra time in bed to catch up
• Notice small wins, like a steadier wake time

Things that usually don’t help

• “Just relax.”
• “Just go to bed earlier.”
• Asking “Did you sleep?” every single morning

CBT for insomnia asks people to get out of bed when they can’t sleep, keep a fixed wake time, and sometimes spend less time in bed at first. These steps can look odd from the outside.

Ways to help

• Keep a comfy chair and a dim lamp ready in another room
• Join them for a morning walk in daylight
• Keep evenings calm and screens low
• Help with the sleep diary only if they ask

If one of you lies awake or gets up in the night, both can lose sleep. Agree on a plan together at a calm time, not at 3 a.m.

Ideas

• Agree that getting up quietly in the night is okay and expected
• Use earplugs or an eye mask if lights or movement wake you
• Keep the bedroom cool, dark and quiet for both of you
• Sleeping in separate rooms for a while is okay. It’s not a sign the relationship is in trouble

If trouble sleeping goes on for weeks, or starts to affect their mood, work or safety, gently encourage them to talk to their clinical provider. Offer to help book the appointment or go with them.

Supporting someone through broken nights can leave you running on empty. Your own sleep matters just as much.

Ideas

• Protect a short wind-down for yourself
• Take turns with night-time duties where you can
• Ask family or friends for a night off
• Talk to someone you trust about how you’re feeling