What Is Sleep Therapy? How to Overcome Insomnia Without Medication
Therapy probably isn’t the first thing you considered when you started struggling with poor sleep. So, you may be surprised to learn that Cognitive Behavioural Therapy for Insomnia is the recommended treatment for insomnia and, unlike medication, benefits persist beyond completion of therapy (NICE, 2024).
In this article, I’ll be exploring what insomnia is, how it develops & is maintained and what my approach to sleep therapy involves.
Whether you’ve recently started struggling to sleep or have had insomnia for years, therapy can help you - read on to find out how!
Disclaimer: Please remember that this blog post is not a substitute for therapy or medical advice. If you feel you need more help I encourage you to seek professional support or contact your GP.
Table of Contents
Signs of Poor Sleep and Insomnia
Sleep problems are common with 1 in 3 adults experiencing poor sleep at least once a week, and approximately 10% of adults meeting the criteria for insomnia.
Insomnia involves difficulty falling asleep, staying asleep or waking too early and being unable to get back to sleep. You don’t have to experience all three to have insomnia. This non-restorative sleep also leads to impaired daytime functioning, such as fatigue, irritability or difficulty concentrating.
Insomnia can be short-term or acute, whereby symptoms last for less than three months. This is often due to stressful events or big life changes, such as:
Changing job
Moving house
A breakup
Redundancy
Illness
Financial difficulties
Having a baby
Environmental disturbances
It can also be triggered by mental or physical health conditions and medications.
Chronic insomnia is when symptoms have occurred on a minimum of three nights a week for three months or more.
Insomnia can be diagnosed by a qualified professional, such as your GP. It is also important to rule out any other potential causes of poor sleep, such as anaemia & thyroid problems, or other sleep disorders.
Why Am I Still Struggling to Sleep?
If you used to sleep well, and the trigger for your difficulty sleeping has passed, you may be wondering why you are still struggling. You might be having thoughts like, “Will I ever sleep normally again?”.
Despite researching self-help advice and improving your sleep habits (also known as sleep hygiene), nothing seems to result in a consistent improvement. You probably feel like you’ve tried everything, from magnesium supplements to meditation apps, and herbal teas to weighted blankets. Although these sleep aids may help you optimise good sleep, they are unlikely to resolve your sleep problem.
And you may be surprised to learn that while healthy sleep habits will support good sleep, they are not a requirement for it. In other words, these habits increase your chance of better sleep, but if you don’t do them, it doesn’t mean you won’t be able to sleep.
Once you’ve improved your sleep habits, you may feel that there’s nothing else you can do to improve your trouble sleeping. This leaves you feeling hopeless and out of control. You might believe your poor sleep is down to genetics or a chemical imbalance that you can’t do anything about. But the reality is, you have more control than you think.
To understand this better, let’s look at the three key factors that contribute to the development & maintenance of chronic insomnia.
The 3 Factors Involved in the Development & Maintenance of Insomnia
1 - Predisposing Factors
These are underlying risk factors for insomnia, such as genetics, family history, or even environmental, social or psychological factors. For example, being unable to move away from a noisy environment if you live near an airport.
Predisposing factors tend to be out of our control or difficult to change. These factors alone do not cause chronic insomnia or poor sleep.
2 - Precipitating Factors
Often there are specific events or situations that trigger the onset of poor sleep.
For example, losing a job, moving house or ending a relationship. It might be one stressor or an accumulation of things. They may be out of your control.
These factors can “push” someone over the threshold into experiencing acute insomnia.
3 - Perpetuating Factors
The precipitating factors or triggers often resolve over time, either getting better on their own or with support, and sleep returns to normal.
But sometimes, during these challenges, people may unintentionally engage in unhelpful thinking or behavioural patterns in order to cope with the discomfort & poor sleep.
These thinking and behavioural patterns or habits are perpetuating factors, which maintain chronic insomnia even when the initial trigger has passed.
These habits may serve a short-term purpose, but don’t support good sleep in the long-term. Some examples of unhelpful habits include, but are not limited to:
Going to bed earlier to try and get extra sleep, even if you are not sleepy - this may mean you lie in bed awake, reducing your brain’s association between bed and sleep
Repeatedly monitoring your sleep or checking your sleep stats on your watch every morning - this can increase sleep anxiety, making it harder to sleep
Regularly lying-in to catch-up on sleep - this can confuse your body clock and make it hard for your body to get into a healthy, regular sleep-wake rhythm
But the good news is that perpetuating factors are within your control. Fortunately, you have the power to change the thinking and behaviour patterns that are keeping you stuck.
These unhelpful patterns or habits develop through no fault of your own, but by identifying and addressing them we can break the cycle of poor sleep for good. This is exactly what I do with my clients in therapy.
What Does Sleep Therapy Involve?
In my practice, I combine Cognitive Behavioural Therapy for Insomnia (CBT-I) with other evidence-based therapeutic approaches.
This enables me to tailor therapy to the client, tackling poor sleep or insomnia, as well as any stress & anxiety that may trigger or maintain the problem.
Let’s take a look at the main approaches I use in more detail and how they can help you:
Cognitive Behavioural Therapy for Insomnia (CBT-I)
CBT-I is commonly recommended as the first-line treatment for insomnia, with multiple research studies indicating its effectiveness.
As the name suggests, CBT-I involves multiple components, including cognitive (thought) and behavioural interventions for insomnia, as well as sleep education. It helps address the unhelpful thinking and behaviour habits you may have unintentionally developed, that are maintaining your trouble sleeping.
CBT-I is somewhat similar to CBT but involves more tailored strategies specifically for insomnia. So, if you have tried CBT but not found it helpful, don’t be put off trying CBT-I!
It should also be noted that CBT-I goes beyond sleep hygiene which, while important, will not resolve insomnia alone.
Acceptance and Commitment Therapy (ACT)
ACT focuses on changing the relationship you have with your thoughts rather than the thoughts themselves. It increases your ability to tolerate and navigate challenges, but without proper explanation the concept can be misunderstood.
You might wonder why you would possibly want to work on acceptance. If you’re struggling to sleep, the last thing you want to do is accept it – that’s why you’re seeking support after all!
I think acceptance is often confused with resignation. Acceptance does not mean giving up and staying stuck. Instead, it’s about acknowledging the situation and being able to tolerate, or sit with the discomfort you’ve been trying to avoid.
When you struggle with insomnia, it’s easy to get caught up in overthinking, resisting unpleasant feelings and trying to control your sleep.
But paradoxically, when we let go of the resistance to being awake, that’s when we create the conditions for sleep to occur naturally.
As a therapist, I share a variety of tools and techniques to help you build the skill of acceptance. When you understand and implement this concept consistently it really is a game-changer!
The other key aspect of ACT is taking aligned action with your values, despite the difficulties you are currently experiencing. Poor sleep can leave you feeling exhausted, irritable and frustrated. You may find yourself cancelling plans and withdrawing from things that previously bought you joy.
All your energy goes towards trying to fix your sleep and avoid further discomfort. But the problem with this is insomnia can start to consume your life.
While avoidance may bring short-term relief, in the long-term it negatively impacts your mood and keeps you stuck in a vicious cycle of poor sleep.
In therapy, we may explore how you can continue to take action towards the things that give you meaning, even if that involves being more flexible or modifying your usual activities.
Cognitive Behavioural Hypnotherapy & Visualisation
Having trained in Cognitive Behavioural Hypnotherapy (CBH), I know how powerful your imagination is in helping you create change and reach your wellbeing goals.
There is lots of research showing that hypnotherapy is an effective form of psychological therapy and studies suggest that when integrated with CBT it is more effective than CBT alone for many people.
Unfortunately, there are many misconceptions about clinical hypnotherapy due to stage hypnosis, so I completely understand any scepticism towards hypnotherapy as I previously had this myself.
CBH is collaborative and involves guiding you to use your imagination to evoke more helpful emotions and rehearse behaviour change. It is very relaxing, safe and you are not in a ‘trance’ or state of mind control. It is often described as feeling similar to daydreaming or being engrossed in a film.
Hypnotherapy, guided meditations and mental imagery exercises are particularly helpful for consolidating what we have discussed during sessions and to practice relaxation.
The 5 Pillars of Sleep
I developed my 5 Pillars of Sleep concept to summarise the key aspects of sleep therapy. When working with clients 1:1, these are the areas we focus on to improve sleep, drawing on the approaches shared above.
Therapy is tailored to you and your unique circumstances, so we might spend more time on one pillar than another depending on what is maintaining your trouble sleeping.
For example, if you have only been struggling to sleep for a few weeks, addressing the trigger or stress may be enough to resolve the problem. Whereas, if you have had insomnia for several months we’ll focus more on strategies to retrain your normal sleep pattern.
© Therapy with Amy
The 5 Pillars of Sleep Explained
KNOWLEDGE
There are various persistent myths, which can cause people to have unhelpful beliefs about sleep. These beliefs can fuel sleep anxiety, holding you back from overcoming poor sleep. In therapy, we can ensure you have an accurate understanding of the basics of sleep and debunk any misconceptions you may have.
HABITS
Sleep habits are also known as sleep hygiene, and are behaviours that can improve your sleep, such as having a warm bath, avoiding caffeine after midday or not going on your phone before bed.
You may come to therapy having already worked on your sleep habits, but if not this can be a good place to start.
But, as I mentioned earlier, while sleep habits support good sleep, they are not a requirement for it. Addressing sleep habits alone is unlikely to resolve insomnia, so we will also need to consider the other pillars in my 5 Pillar approach.
MIND
Anxiety and poor sleep, often go hand in hand. General anxiety & worry can trigger trouble sleeping, and poor sleep can lead to sleep anxiety.
It can be easy to get stuck in a vicious cycle whereby the less you sleep, the more anxious you feel and the harder it becomes to sleep. In therapy, we’ll explore a range strategies for managing sleep anxiety, general anxiety and stress.
Further reading: Optimising Your Sleep Mindset: 3 Thinking Biases That Can Impact Your Sleep
BODY
This involves looking at how to get the body into a sleep-ready state, which often includes relaxation practises.
BEHAVIOUR
Rebuilding the association between the bed and sleep is a key aspect of retraining normal sleep patterns. There are various strategies to do this that I can support you with.
5 Reasons To Work with A Sleep Therapist
Hopefully, by now you have a better understanding of how helpful sleep therapy is. But if you’re not yet convinced, or need a reminder, here are five benefits of working with a sleep therapist:
Identify and address the unique factors maintaining your difficulty sleep, including unhelpful thinking and behaviour habits
Break the vicious cycle of anxiety and poor sleep
Compassionate and actionable support to help you reach your personal sleep goals
Retrain your normal sleep pattern and rebuild the association between the bed & sleep
Make sustainable change - unlike medication, benefits persist beyond completion of therapy
Because I know you’re ready to feel calmer & have more energy, so you can enjoy time with your loved one’s, achieve your career goals, enter that running race or try a new hobby.
Further Support
I’d love to know if you found this post helpful. Do feel free to pop me a message if you have any feedback. You can find me on Instagram @therapywithamy_ , where I share more tips and insights about sleep.
To find out more about 1:1 support for poor sleep, insomnia and general anxiety, click the links below:
References
National Institute for Health and Care Excellence: Insomnia Guidelines https://cks.nice.org.uk/topics/insomnia/
Wright et al. (2019) A Framework for Understanding the Role of Psychological Processes in Diseases Development, Maintenance, and Treatment: The 3P-Disease Model.
van Straten et al. (2018) Cognitive and behavioral therapies in the treatment of insomnia: A meta-analysis.