Improving Sleep: Psychological Strategies That Help

The most effective psychological treatment for ongoing insomnia is cognitive behavioural therapy for insomnia (CBT-I). It's recommended as the first-line treatment for chronic insomnia in adults by major clinical guidelines, ahead of sleeping tablets, because it addresses the habits and thought patterns that keep poor sleep going and its benefits tend to last after treatment ends. Good sleep hygiene helps too, but on its own it's rarely enough for persistent insomnia.

When sleep problems become insomnia

Everyone has occasional bad nights, especially during stress. Insomnia is generally considered chronic when:

• you have difficulty falling asleep, staying asleep or waking too early

• it happens at least three nights a week

• it has lasted three months or more

• it happens despite having the opportunity to sleep

• it affects how you feel or function during the day

Sleep problems can also be caused by medical conditions such as obstructive sleep apnoea, restless legs, pain, hormonal changes or medications. If you snore loudly, stop breathing during sleep, or feel very sleepy during the day, see your GP for assessment.

Why insomnia keeps going

Insomnia often starts with a trigger: stress, illness, a new baby, shift work or grief. For many people sleep returns to normal once the trigger passes. For others, it becomes self-sustaining because of what they do and think in response:

• Spending more time in bed to "catch up", which makes sleep lighter and more fragmented

• Irregular sleep times, such as sleeping in after a bad night, which disrupts the body clock

• Lying awake in bed for long periods, so the brain learns to associate bed with being awake and frustrated

• Worry about sleep itself: "If I don't sleep, tomorrow will be a disaster"

• Trying hard to sleep, which increases arousal and makes sleep less likely

CBT-I targets these specific factors.

CBT-I basics

CBT-I is usually delivered over about four to eight sessions and combines several components.

Sleep restriction (sleep scheduling)

This is the most powerful element and the most counterintuitive. You temporarily limit your time in bed to roughly the amount of time you're actually sleeping, then gradually extend it as sleep becomes more efficient. It builds sleep pressure and consolidates sleep. It can make you more tired at first, so it's best done with guidance, and it isn't suitable for everyone (for example, some people with bipolar disorder, epilepsy or who drive for work).

Stimulus control

The aim is to re-train your brain to associate bed with sleep.

• Go to bed only when sleepy, not just tired.

• Use the bed only for sleep and sex.

• If you can't sleep after what feels like 15 to 20 minutes, get up, go to another room and do something quiet in dim light until you feel sleepy.

• Get up at the same time every day, regardless of how you slept.

• Avoid daytime naps, or keep them short and early.

Cognitive strategies

These address worry and unhelpful beliefs about sleep, such as "I need eight hours or I can't function" or "Insomnia is ruining my health". Realistic information about sleep reduces the pressure and anxiety that keep people awake.

Relaxation and arousal reduction

Techniques such as slow breathing, progressive muscle relaxation and mindfulness help lower physical and mental arousal before bed.

Scheduled worry time

Setting aside 15 minutes earlier in the evening to write down worries and possible next steps can reduce night-time rumination.

Sleep hygiene: helpful foundations

Sleep hygiene on its own is usually not enough to fix chronic insomnia, but these habits support good sleep:

• Keep a regular wake time, seven days a week.

• Get morning daylight to anchor your body clock. A morning walk helps.

• Limit caffeine after midday. Caffeine can affect sleep for many hours.

• Go easy on alcohol. It may help you fall asleep but fragments sleep later in the night.

• Wind down for 30 to 60 minutes before bed with low-stimulation activities.

• Dim lights and reduce screens in the hour before bed.

• Keep your bedroom cool, dark and quiet.

• Exercise regularly, ideally not too close to bedtime.

• Don't clock-watch. Turn the clock away.

Sleep, stress and mental health

Sleep and mental health are closely linked. Insomnia is a risk factor for depression and anxiety, and treating insomnia can improve mood. Stress, anxiety, depression, trauma and ADHD commonly disrupt sleep, and working on those underlying issues often helps sleep too. See Chronic Stress: How It Affects Your Body and Mind.

New parents face a particular challenge: broken sleep is unavoidable, but anxiety can make it harder to fall back asleep even when the baby does. Strategies can be adapted for this stage.

What about sleeping tablets?

Sleeping medications can help in the short term but are generally not recommended for long-term use because of side effects, tolerance and dependence. Talk with your GP about options. CBT-I can also help people reduce reliance on sleeping tablets, with medical guidance.

Getting support

Our psychologists use CBT-based strategies to help with sleep difficulties, alongside treatment for the stress, anxiety or low mood that often goes with them. Sessions are available by telehealth, in person in Nobby Beach, or through Walk and Talk therapy on the Gold Coast. Book a session, or read our workplace stress and burnout recovery guide.

This article is general information and isn't a substitute for medical advice. See your GP if you suspect a sleep disorder such as sleep apnoea.