Insomnia is a sleep disorder characterized by difficulty falling asleep, staying asleep, or waking too early, in a way that persists and interferes with daily functioning.

It often begins with stress, illness, travel, or life disruption. But over time, insomnia can become self-perpetuating.

Many people describe feeling at the mercy of their sleep. The more they try to force sleep, the harder it becomes. They may sleep in on weekends, nap to compensate, rely on caffeine to function, or spend extended time awake in bed hoping sleep will return. Nighttime becomes a time of clock-watching, planning, or worrying.

Gradually, life can begin to organize around exhaustion. Mood declines. Anxiety about sleep increases. Activities feel harder.

Insomnia frequently co-occurs with anxiety and depression. If you are struggling more broadly with worry, panic, or chronic stress, you may also benefit from reading about treatment of anxiety.

When sleep becomes a control struggle

Sleep is a biological process. It cannot be forced.

Ironically, the harder we try to control sleep, eliminate wakefulness, or guarantee a perfect night, the more activated the nervous system becomes.

From an Acceptance and Commitment Therapy (ACT) perspective, insomnia often becomes a struggle with internal experience — fighting wakefulness, resisting discomfort, trying to silence the mind. This struggle can unintentionally increase arousal and reinforce the cycle.

You can learn more about how integrating Acceptance and Commitment Therapy (ACT) into treatment across concerns including anxiety, insomnia, and health-related stress can be useful.

Effective treatment involves both behavioral retraining and a shift in your relationship to nighttime thoughts and sensations.

Evidence-based treatment: cognitive behavioral therapy for insomnia (CBT-I)

Cognitive Behavioral Therapy for Insomnia (CBT-I) is the gold-standard, evidence-based treatment for chronic insomnia.

CBT-I is structured, active, and collaborative. Rather than simply discussing sleep, treatment involves practical strategies and between-session exercises that directly retrain the sleep system.

CBT-I may include:

• Strengthening sleep drive

• Resetting circadian rhythm patterns

• Reducing time awake in bed

• Addressing unhelpful beliefs about sleep

• Decreasing nighttime monitoring and worry

• Building a more flexible, less effortful relationship with sleep

Research consistently shows that CBT-I leads to improvements in sleep quality, sleep efficiency, and long-term stability. Unlike medication alone, CBT-I builds durable skills.

What about sleep medication?

Some individuals are prescribed medication to promote sleep. Medication can be helpful in certain situations, particularly short term.

However, research indicates that without behavioral and cognitive changes, insomnia often returns after medication is reduced or discontinued.

CBT-I can be provided alone or in combination with medication. If you are working with a prescribing physician, we are happy to coordinate care, with your permission, to ensure an integrated approach.

What are realistic goals for therapy?

The goal of CBT for insomnia is not perfect sleep every night.

The goal is to:

• Retrain the sleep system

• Reduce anxiety about wakefulness

• Increase psychological flexibility at night

• Restore energy and engagement in daily life

Sleep becomes more stable when the struggle decreases.