Trouble Sleeping? How Therapy Can Help You Sleep Better

Sleep affects almost every part of daily life. When you are not sleeping well, it can become harder to concentrate, regulate your emotions, manage stress, and feel like yourself. After enough difficult nights, the worry about sleep itself can become part of the problem.

It is understandable to try to fix sleep by changing your bedtime routine, spending less time on screens, exercising more, or trying supplements. These strategies may be useful for some people, but persistent sleep difficulties can have many contributing factors. Stress, anxiety, depression, trauma, physical health conditions, medications, shift work, changing schedules, and learned patterns around sleep can all play a role.

This is where therapy can sometimes help. Depending on what is contributing to your sleep difficulties, therapy may address the thoughts, behaviours, emotions, and circumstances that are keeping sleep from coming easily.

Why Does Stress Make Sleep So Difficult?

Sleep is an active biological process rather than simply a matter of deciding to switch off. Our sleep and wake systems are influenced by our circadian rhythms, behaviour, environment, physical health, and psychological state.

Stress and anxiety can make this process more difficult. If you spend the day under pressure and then find yourself lying awake thinking about everything that needs to be done tomorrow, your mind may remain focused on problems rather than settling into sleep.

There can also be a frustrating cycle. A few nights of poor sleep may lead you to become increasingly concerned about whether you will sleep tonight. You may start watching the clock, going to bed earlier, staying in bed longer, or becoming preoccupied with how tired you will feel the next day. Those responses are understandable, but over time they can contribute to the patterns that maintain insomnia.

Research supports a relationship between sleep difficulties and anxiety, with evidence suggesting that the relationship can work in both directions. Poor sleep can contribute to anxiety, while anxiety and sleep-related worry can also make insomnia more difficult to resolve (Cunningham & Shapiro, 2021).

What Can Contribute to Sleep Problems?

Sleep difficulties rarely have just one explanation.

You may be dealing with ongoing stress at work or home, anxiety that becomes more noticeable when the day finally becomes quiet, changes in mood, grief, trauma-related symptoms, chronic pain, caregiving responsibilities, major life changes, or a schedule that makes consistent sleep difficult.

Sometimes the original trigger for poor sleep is no longer present, but the sleep problem continues. After enough nights of lying awake, your bed itself can become associated with frustration, worry, or trying desperately to fall asleep.

This is one reason chronic insomnia is not simply a matter of needing better "sleep hygiene." Behavioural and psychological factors can become part of the problem, and they can also become part of the solution.

How Therapy Can Help

Therapy can be useful when emotional or psychological factors are contributing to sleep difficulties. The focus will depend on what is actually happening for you.

You might explore anxiety or persistent worry, difficult emotions that become more noticeable at night, beliefs about productivity and rest, stressful circumstances, or the pressure you feel to be asleep by a particular time.

Therapy may also help you notice patterns that have developed around sleep. For example, you may have begun spending more and more time in bed because you are exhausted, only to find that you are awake for much of that time. Or you may have developed a strong fear of having another sleepless night.

Understanding these patterns can reduce some of the struggle around sleep and create opportunities to respond differently.

CBT-I: A Therapy Specifically for Insomnia

If insomnia is the primary problem, one of the most important treatments to know about is Cognitive Behavioural Therapy for Insomnia (CBT-I).

CBT-I is specifically designed to treat persistent insomnia. Rather than simply offering general advice about getting better sleep, it addresses the thoughts, behaviours, and learned associations that can maintain insomnia.

It can include strategies such as stimulus control, sleep restriction or sleep compression, cognitive restructuring, and other behavioural approaches. A large 2024 systematic review and component network meta-analysis examined 241 randomized clinical trials involving more than 31,000 participants. Several components, including cognitive restructuring, sleep restriction, and stimulus control, were associated with improved outcomes.

Research also suggests that the benefits of CBT-I can last beyond the end of treatment. An American Academy of Sleep Medicine evidence review found moderate evidence for CBT-I, including improvements in insomnia outcomes and evidence that treatment gains can be durable over time.

This makes CBT-I different from general counselling for stress or anxiety. If chronic insomnia is the main concern, it is worth asking whether a therapist has specific training in behavioural sleep medicine or CBT-I.

What About Mindfulness?

Mindfulness-based approaches can be helpful for some people, particularly when stress, anxiety, or persistent mental activity is contributing to sleep difficulties. Mindfulness can help people relate differently to thoughts rather than becoming caught up in every thought that appears at bedtime.

However, it is important not to present mindfulness as a replacement for CBT-I. The evidence is more mixed.

A 2022 meta-analysis found that mindfulness-based therapies were associated with improvements in insomnia symptoms and sleep quality compared with inactive or psychological placebo controls, although the evidence base was relatively limited. Another systematic review found that mindfulness-based stress reduction did not consistently improve sleep quality in people with chronic insomnia and highlighted limitations in the available research (Rash et al., 2022; Seo et al., 2022).

For some people, mindfulness may therefore be a useful part of treatment rather than the central treatment for chronic insomnia.

What If Trauma Is Affecting Your Sleep?

Sleep can be particularly difficult when trauma-related symptoms are present. Nightmares, intrusive memories, heightened alertness, and fear associated with bedtime can all interfere with rest.

In these circumstances, therapy may address both the sleep problem and the experiences contributing to it. Research on PTSD suggests that interventions specifically targeting sleep can improve sleep outcomes, and sleep-focused treatment may be useful alongside trauma-focused psychotherapy rather than waiting until one problem has completely resolved before addressing the other (Maher et al., 2022; Bottari et al., 2023).

Trauma-informed therapy can provide an important framework for this work, but it is helpful to distinguish a trauma-informed approach from a specific evidence-based treatment for insomnia. If insomnia is persistent, CBT-I remains the treatment with the strongest direct evidence for chronic insomnia.

What Happens in Therapy for Sleep Problems?

Your first conversations with a therapist may focus on understanding what your sleep actually looks like.

You might talk about when the problem began, what happens when you try to sleep, what you do when you cannot sleep, how you feel during the day, and whether anxiety, depression, grief, trauma, stress, or other concerns are affecting your nights.

Depending on the type of therapy, you may also examine the thoughts that appear around bedtime. Perhaps you find yourself thinking, "If I don't fall asleep soon, tomorrow will be a disaster." Perhaps you feel pressure to make up for a poor night's sleep by spending extra time in bed. Perhaps bedtime has become the quietest part of your day, which is when worries that were pushed aside all day finally have room to surface.

These patterns are not signs that you are doing something wrong. They are understandable responses that can sometimes become part of a cycle that keeps insomnia going.

Therapy can help you understand that cycle and determine which changes are most appropriate for you.

You Do Not Have to Solve Sleep by Yourself

It is easy to become frustrated when another person tells you to "just relax" or "stop thinking about it."

Anyone who has struggled with insomnia knows that trying harder to sleep does not necessarily make sleep happen.

In fact, the effort to control sleep can sometimes become part of the problem. Effective insomnia treatment does not depend on forcing yourself to sleep. Instead, it works with the behaviours, thoughts, habits, and circumstances that influence sleep.

That may involve changing some patterns around bedtime. It may involve addressing anxiety or depression. It may involve learning how to respond differently to thoughts about sleep. And when appropriate, it may involve a structured treatment such as CBT-I.

When Should You Talk to Your Doctor?

Not every sleep problem is primarily psychological.

Sleep apnea, restless legs syndrome, chronic pain, medication effects, hormonal changes, substance use, neurological conditions, and other medical factors can affect sleep. Persistent snoring, gasping or choking during sleep, significant daytime sleepiness, unusual movements during sleep, or other concerning symptoms deserve medical assessment.

This is why therapy and medical care do not have to be either/or. Sometimes the most effective approach involves addressing both the physical and psychological contributors to poor sleep.

If you have persistent or worsening sleep difficulties, speaking with your primary care provider can help determine whether further medical or sleep assessment is appropriate.

Frequently Asked Questions About Therapy and Sleep

How long does it take for therapy to improve sleep?

There is no single timeline. It depends on what is contributing to the sleep problem, how long it has been present, and what type of treatment you are receiving.

CBT-I is generally delivered as a structured, time-limited treatment, while therapy addressing anxiety, trauma, grief, or other concerns may follow a different timeline. Some people notice changes relatively quickly, while others need more time.

The goal is not simply to have one good night. It is to develop changes that are sustainable.

Do I need a diagnosis to seek help?

No. You do not need to wait for a formal diagnosis before talking to a therapist about sleep difficulties.

If poor sleep is affecting your mood, relationships, concentration, work, or quality of life, that is reason enough to seek support.

A therapist can also help you determine whether your concerns appear appropriate for counselling or whether additional medical or sleep assessment would be useful.

What if worrying about sleep is making sleep worse?

This is a common experience for people with insomnia.

When you begin monitoring the clock, calculating how many hours are left, or worrying about how tired you will be tomorrow, sleep can become something you are constantly evaluating rather than something that happens naturally.

CBT-I specifically addresses the thoughts and behaviours that can develop around insomnia, including the fear and frustration associated with being unable to sleep.

Can I take medication and attend therapy?

Yes. Medication and therapy are not mutually exclusive.

Some people use medication as part of their sleep treatment, while others use psychological treatment alone or in combination with other approaches. The right choice depends on the individual and should be discussed with a physician, nurse practitioner, pharmacist, or other qualified healthcare provider.

Therapy should not be viewed as a guarantee that someone will no longer need medication. Instead, it can be one part of a broader approach to improving sleep and addressing the factors contributing to insomnia.

Finding Your Way Back to Rest

Poor sleep can affect far more than your nights. Over time, it can influence your mood, concentration, relationships, and ability to cope with everyday life.

The good news is that persistent sleep difficulties are treatable, and there are evidence-based psychological approaches specifically designed to address insomnia.

If stress, anxiety, grief, trauma, or another emotional concern is contributing to your sleep difficulties, therapy can provide a place to understand what is happening and work toward meaningful change. If chronic insomnia is the primary concern, asking about CBT-I can be an especially important first step.

At Authentic Living London, therapy can provide a supportive space to explore the factors affecting your sleep and determine what kind of support makes sense for you.

You do not have to spend another night feeling like you have to figure it all out on your own.

Author Brenda Deaves (RP-qualifying, BA, MACP) is a therapist at Authentic Living London who specializes in grief and chronic pain/illness.

References

Bottari, A., et al. (2023). Effects of sleep disturbance on trauma-focused psychotherapy outcomes in posttraumatic stress disorder: A systematic review. Annals of the New York Academy of Sciences. doi:10.1111/nyas.15029

Cunningham, J. E. A., & Shapiro, C. M. (2021). Cognitive behavioural therapy for insomnia (CBT-I) to treat anxiety or depression: A systematic review. Journal of Sleep Research, 30(1), e13228. doi:10.1111/jsr.13228

Furukawa, Y., Sakata, M., Yamamoto, R., et al. (2024). Components and delivery formats of cognitive behavioral therapy for chronic insomnia in adults: A systematic review and component network meta-analysis. JAMA Psychiatry, 81(4), 357–365. doi:10.1001/jamapsychiatry.2023.5060

Maher, A. R., Apaydin, E., Hilton, L., Chen, C., Troxel, W. M., Hall, O., Shah Azhar, G., Larkin, J., Motala, A., & Hempel, S. (2022). Sleep management in posttraumatic stress disorder (PTSD): A systematic review. RAND Health Quarterly, 9(3), 14.

Rash, J. A., Kavanagh, V. A. J., & Garland, S. N. (2022). A meta-analysis of mindfulness-based therapies for insomnia and sleep disturbance: Moving toward processes of change. Journal of Sleep Medicine and Disorders, 17(3), 329–353. doi:10.1016/j.jsmc.2022.06.002

Seo, H.-J., et al. (2022). Effects of mindfulness-based stress reduction on adults with sleep disturbance: An updated systematic review and meta-analysis. BMJ Open, 12(11), e058032. doi:10.1136/bmjopen-2021-058032

Steinmetz, L., Simon, L., Feige, B., Riemann, D., Johann, A. F., Ell, J., Ebert, D. D., Baumeister, H., Benz, F., & Spiegelhalder, K. (2024). Network meta-analysis examining efficacy of components of cognitive behavioural therapy for insomnia. Clinical Psychology Review, 114, 102507. doi:10.1016/j.cpr.2024.102507

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