What is insomnia?

If sleep has started to feel fragile — like something you have to protect or manage rather than something that just happens — that’s usually the moment people start looking for real answers.

Not because you haven’t tried.

Most people I meet have already:

• read the books and blogs
• tried the apps and trackers
• experimented with supplements, yoga, breathing, and endless “sleep hacks”

By the time someone ends up reading a page like this, they’re often:

• feeling like they can’t function and are depleted mentally and emotionally
• obsessed with sleep and how to fix it
• quietly worried about what years of broken sleep might be doing to them

A lot of the people I work with are professionals who can hold complex systems together all day — teams, projects, households — yet lie awake at night unable to switch off.

Many are women in perimenopause who feel as though their body changed the rules without warning: lighter sleep, early waking, night sweats, and anxiety spikes.

So let’s talk about what insomnia actually is, using the same frameworks I use in one-to-one work — primarily CBT-I (Cognitive Behavioural Therapy for Insomnia) and ACT-I (Acceptance and Commitment Therapy for Insomnia), the two psychological approaches with the strongest real-world and emerging evidence base for chronic insomnia.1 2612

Warning: This is NOT a sleep hygiene lecture.

And it is NOT a list of “what to take” to cure your insomnia.

This is about how insomnia works — and why it sticks. And what you can do about that.

What insomnia is – and what it is not

Insomnia isn’t just “bad sleep”. Everyone has rough nights.

During stress, illness, grief, hormonal change, or big life upheavals, it’s normal for sleep to go off track for a while — that’s your nervous system responding to the challenge by keeping you more awake so you can deal with it.

Insomnia becomes a problem when poor sleep persists after the original trigger has eased, or when there isn’t an obvious trigger at all.

Nights start to carry emotional weight: dread in the evening, bargaining with yourself about how many hours you “need”, and catastrophising about what another bad night will mean for tomorrow.

Over time, the problem is no longer just the sleep disruption itself but the layers of anticipation, monitoring, and fear that build around it.345

It becomes a “demon” unto itself.

In fact, many clients say they’d be more accepting of imperfect sleep if this emotional monster didn’t occupy their entire day.

Clinically, we often talk about insomnia as a maintenance problem rather than a pure “onset” problem. Short term insomnia comes around, but it stays around because something is maintaining it and keeping it fed.

Something knocks sleep off course early on — a stressful period, a health scare, parenting demands, perimenopause — but later, the insomnia is kept alive by how your system responds.  This process is described as the 3 P model – and it explains how acute insomnia becomes chronic.

Common things that maintain insomnia:

• heightened alertness whenever night approaches
• increased attention to sleep and “sleep signals”
• effortful attempts to control sleep or force relaxation
• behaviours designed to prevent exhaustion (napping, extending time in bed, cancelling plans)
• fear of being awake, especially in the small hours

None of these mean you’re doing anything wrong.

They’re intelligent, protective moves — your nervous system doing what it was designed to do: prioritise safety and functioning.

The problem is that sleep doesn’t respond like other things in life do.

Repeated often enough, these activities teach the brain that night-time is a situation requiring active supervision.

Bed becomes a place to “fear the battle” rather than a cue for rest.14

That’s the loop CBT-I and I work with: not “how do we knock you out?” but “how do we unlearn the patterns that keep your system on guard at night?”

Why is insomnia so common?

Insomnia has a particular fondness for capable, responsible people.  Especially perfectionists (who share a predisoposition to insomnia development)

Professionals often describe themselves as:

• used to solving problems quickly
• rewarded for vigilance and attention to detail
• highly cognitively engaged throughout the day
• skilled at pushing through fatigue to meet demands

In daytime, those traits are an asset.  We want them, and so do our bosses and clients!

They help you manage complexity, make decisions, and handle responsibility.

At night, the very same traits backfire.

Sleep doesn’t respond to problem-solving.

It responds to experiential safety.

It arrives when sleep drive is high, and arousal is low.

When the mind is in “performance mode” — reviewing the day, planning tomorrow, analysing what went wrong, rehearsing future conversations — the nervous system reads that as “something important is happening; don’t power down yet.”

A sentence I hear a lot is: “My body is exhausted, but my brain won’t stop.”

From a hyperarousal perspective, that makes sense.

Studies show that people with chronic insomnia often have increased cognitive and physiological arousal across both night and day — racing thoughts, an overactive threat-detection system, elevated heart rate, and more high-frequency brain activity during sleep.45

This “tired but wired” pattern isn’t a personal failing; it’s a system that’s been trained to stay switched on.

If your brain is brilliant at spotting problems and preventing mistakes at work, it will happily apply the same skillset to night-time.

It will scan for the “problem” of not sleeping, monitor your body for evidence, and then reward you with more worry when it finds something to fix.

The usual approach you use for daytime problems simply doesn’t work with insomnia.

CBT-I and ACT-I both work on helping that overdeveloped performance mode learn how to power down when it’s dark.

Why does insomnia happen in menopuase?

For many women, insomnia either appears for the first time or changes shape during perimenopause.

Even women who “could always sleep anywhere” sometimes notice their nights become lighter, more fragmented, and more emotionally loaded.

Fluctuating oestrogen and changing progesterone levels can:

• fragment sleep and increase night waking
• trigger hot flushes and night sweats
• heighten emotional reactivity and anxiety
• change temperature regulation, making comfort harder
• reduce the depth and continuity of sleep

These are real, physiological shifts, not “in your head”.5 Even I can experience this!

But hormones don’t tell the whole story.

What often turns perimenopausal sleep disruption into chronic insomnia is the very understandable reaction to those changes:

• worrying that sleep is deteriorating permanently
• starting to monitor nights closely (“how many hours did I get?”)
• going to bed earlier “just in case” or lying in late to catch up
• avoiding evening plans because “I have to protect my sleep”
• losing trust in the body’s ability to self-regulate

By the time many women seek one-to-one help, hormones are part of the picture, but the insomnia is being maintained by heightened arousal, attention to sleep, and increased effort — the same processes we see in other forms of chronic insomnia.[1-35

That’s why CBT-I and ACT-I still apply here.

They don’t aim to “fix your hormones”; they help your nervous system become less reactive and more flexible in the face of fluctuating internal states.

For some people that happens alongside medical treatment or HRT; for others, psychological work alone makes a meaningful difference.

There is solid evidence that women with perimenopause insomnia can sleep better after structured psychological treatment, regardless of symptoms, and that targeting hyperarousal processes is a key part of that.45

Hormonal shifts are not a guarantee of permanent poor sleep — even in perimenopause.

“I’m exhausted — why doesn’t sleep just take over?”

This is one of the most common — and most painful — questions people ask me.

They often say they feel broken.

From the outside it seems logical: if you’re exhausted, surely sleep should eventually win.

But biologically, sleep isn’t driven by exhaustion alone.

Two core systems matter most:

• Sleep drive: the pressure that builds the longer you’re awake
• Arousal: how alert, activated, or threatened your nervous system feels

In chronic insomnia, sleep drive is usually intact — often stronger than average because you’ve been under-slept for a while.3

The issue isn’t a “broken sleep switch”; it’s that arousal stays high enough to override the sleep drive.45

When your brain believes something important needs monitoring — tomorrow’s workload, health worries, the consequences of another bad night, caring responsibilities — it will prioritise vigilance over rest.

From a survival perspective, this is entirely reasonable. It makes perfect sense to stay alert in a perceived threat situation – this has historically kept humans alive.

The problem is that your brain can’t tell the difference between a real predator and a calendar full of meetings plus a scary health article you read at 11pm.

Research on hyperarousal in insomnia shows:

• increased high-frequency brain activity even during sleep
• stronger “threat bias” in attention and thinking
• sustained daytime signs of physiological arousal (e.g., higher baseline heart rate)45

That’s why people describe being “tired but wired” and why being told to “just relax” often makes things worse.

You can’t talk a nervous system out of threat detection.

You have to show it, consistently and gently, that night-time is no longer a crisis regardless of what is happening with the sleep itself.234

How the bed becomes a battleground

Here’s a piece most people find both unsettling and relieving: over time, the bed itself can become part of the problem.

Your brain is a pattern-learning machine.

It constantly links contexts (places, times, bodily states) with outcomes.

When you spend night after night:

• lying awake in bed
• watching the clock
• scanning for signs of sleepiness
• replaying the day or worrying about tomorrow
• experimenting with new tricks and positions
• being in the “place where I sleep” which is now the  “place where I struggle, monitor, and worry.”

This is called conditioned arousal.

Even if your day has been relatively calm, simply getting into bed or turning off the light can trigger a spike in alertness because your brain has learned: “This is where we fight with sleep.”

For many people, that explains a confusing experience: they feel sleepy on the sofa, but wired the moment they get into bed.

CBT-I works very directly with this conditioning process by:

• reducing the amount of time you’re awake and distressed in bed
• rebuilding the association between bed and sleep (and calm wakefulness)
• shifting alert monitoring away from the bedroom

ACT-I complements this by working with the emotional side of that conditioning: fear of being awake in bed, shame about “failing” at sleep, and the urge to escape or fix discomfort at 3am.

Nothing about this pattern means your brain is broken.

It just means it has learned something very thoroughly — and can learn something different with the right structure and support.12

Why trying harder makes it worse

If you’re conscientious and used to working hard for results, this part usually stings.

Sleep is automatic. And the transition into sleep is passive.

You can’t make it happen through force, analysis, or willpower.

What you can do is shape the conditions and then get out of the way. I call this ‘setting the stage’ for sleep.

The trouble is, once sleep feels unreliable, it’s very natural to:

• track your hours obsessively
• double down on rules and routines
• constantly tweak bedtime, supplements, or rituals
• check throughout the evening whether you feel “tired enough”
• lie in bed monitoring whether you’re “dropping off yet”

All of these are examples of sleep effort — cognitive and behavioural attempts to make sleep happen.3

Research on sleep effort suggests that high levels of effort are not just a reaction to insomnia; they can actively maintain it.³

The more something feels high-stakes and tightly controlled, the more your nervous system treats it as work.

Clinically, this looks like:

• “I’m doing everything right and still not sleeping.”
• “I follow all the rules, and I feel worse.”
• “I can’t relax because I’m trying to relax correctly.”

CBT-I tends to loosen unhelpful rules and target behaviours that are actually making things worse (like long naps, excessive time in bed, and constantly changing strategies).

ACT-I goes a step further and helps with the relationship to sleep effort itself: noticing the urge to over-control, making room for discomfort, and choosing actions based on values rather than fear.

The shared principle is simple, but not easy: sleep can’t be forced.

It can be invited — through consistent timing, appropriate exposure to wakefulness, and a different stance toward discomfort.123

What CBTI Targets

CBT-I is often reduced online to a list of rules, but in proper one-to-one work, it’s much more nuanced and collaborative.16

Broadly, CBT-I aims to:

• reduce conditioned arousal around bed and night-time
• consolidate sleep by tuning sleep–wake timing
• challenge and soften beliefs that amplify threat (“I must get 8 hours or I’ll be ruined”)
• adjust behaviours that weaken sleep drive or increase night-time wakefulness

Core components usually include:

• Stimulus control — teaching the brain that bed is for sleep and wind-down, not worry and work
• Time in bed reorganisation — temporarily changing how much time is spent in bed to reduce how much wakefulness happens at night, then reversing that process as sleep consolidates
• Cognitive work — addressing catastrophic predictions, rigid rules, and perfectionistic sleep standards
• Behavioural change — daytime habits that affect sleep drive and arousal

Recent studies suggest that certain elements are especially impactful: cognitive restructuring, “third-wave” components (like acceptance and mindfulness), time in bed reorganisation, and stimulus control.1611

Sleep hygiene and relaxation alone, in contrast, tend to have weaker or inconsistent effects when used in isolation.

CBT-I as a multicomponent intervention repeatedly outperforms education or medication alone and shows durable benefits after treatment ends.1689

In real life, good CBT-I is not about punishingly strict bedtimes or ignoring your life context.

It’s about tailoring evidence-based principles to your nervous system, work patterns, health conditions, and relationships — and adjusting as you go.1

When CBT-I is not suitable

Some people come to me saying, “I’ve done CBT-I and I’m still stuck.”

Often, what they mean is:

• they did a rigid, manualised or app version that didn’t adapt to their life
• they found the behavioural changes too blunt for their anxiety or perfectionism
• they completed an online programme without relational support
• they felt more ashamed and frightened when they couldn’t “follow the rules” perfectly

For others, the core problem is less about timing and conditioning and more about how they relate to wakefulness and thoughts:

• intense fear of being awake at night
• catastrophic loops about long-term health
• strong shame about “failing to sleep like a normal person”
• a life progressively organised around avoiding tiredness

In these situations, classical CBT-I may help to some degree, but there’s often residual distress.

That’s where ACT-I adds something vital.212

The Role of ACT-I

ACT-I doesn’t try to delete wakefulness, thoughts, or feelings.

Instead, it asks: How are you relating to them — and what is that doing to your life and your nights?

ACT-I focuses on:

• fear of being awake
• tightly held sleep rules and control strategies
• the grip that thoughts have on your behaviour (“If I sleep badly, I can’t cope tomorrow, so I must cancel everything”)
• the way life shrinks around protecting sleep212

Emerging research suggests that ACT-based approaches can:

• reduce insomnia severity and distress
• improve subjective sleep quality
• decrease experiential avoidance and dysfunctional beliefs about sleep
• enhance emotion regulation and sleep-related acceptance2[1012

In many trials, improvements begin within the first few weeks and continue over time as people build new skills.

In one-to-one care, CBT-I and ACT-I are often blended:

• using CBT-I tools to stabilise timing, reduce time awake in bed, and break unhelpful cycles
• using ACT-I to soften perfectionism, reduce struggle, and reconnect you with values beyond sleep

The shift many people notice is this: when they stop organising their life around controlling sleep, both their nights and days become more spacious.

Sleep often improves not because they finally found the perfect trick, but because the nervous system is no longer being told “this is an emergency” every evening.

Racing thoughts and night-time anxiety

When someone says, “My mind won’t shut off,” my honest response is: “Of course it won’t — it thinks this matters.”

At night, external distractions drop away and your brain suddenly has more bandwidth to process what’s been pushed aside all day.

Threat bias increases: the mind zooms in on problems, not neutral details.4

Attempts to suppress or argue with thoughts (“don’t think about tomorrow’s meeting…”) tend to backfire, making them more persistent.

Both CBT-I and ACT-I help here, but in slightly different ways:

• CBT-I might zoom in on the content of the thoughts, questioning unhelpful predictions and broadening your perspective.1
• ACT-I might focus on how you relate to the thoughts — helping you notice them as mental events, not facts, and reduce the struggle to control or get rid of them.

The goal isn’t a blank mind (most of us would fail that test).

Instead, it’s a mind where thoughts can come and go without dragging your whole nervous system into alarm.

Health fears and long-term worries

If you’ve read headlines about sleep and health, it’s almost impossible not to worry.

What headlines don’t show is that

• many of these associations are modest and influenced by lots of other factors (including non-insomnia sleep issues)
• treatment can significantly improve insomnia severity and daytime functioning across a wide range of populations, including people with chronic health conditions.189
• fear about long-term damage can itself become a maintaining factor, fuelling arousal every night you don’t sleep well

It makes sense to care about your health.

It also makes sense to recognise when worry has stopped being useful and started making things worse.

CBT-I and ACT-I aim to shift the focus from abstract future risk to concrete, workable processes in the present: how you relate to night-time, how you structure your day, and how much room sleep takes up in your mental life.128[12

The nervous system remains adaptable.
People with decades of insomnia can and do experience meaningful change once the maintaining processes are addressed.

Medication and Insomnia

Medication can absolutely take the edge off in the short term.

But they’re not a panacea, on average improving sleep by a relatively small amount when we look at objective measures across large groups.89

They also don’t retrain the processes that maintain insomnia — the hyperarousal, conditioning, beliefs, and behaviours — which is why relapse after stopping is so common.

In good one-to-one work, medication is:

• considered in the context of your whole health picture

• used, if at all, as a support rather than the main solution
• paired with psychological approaches so you’re building skills while symptom intensity is lower

You should always speak to your doctor about medication decisions.

The evidence repeatedly suggests that CBT-I produces more durable improvements than medication alone, with benefits maintained at follow-up.

That doesn’t mean medication is “bad” — just that it’s not a standalone fix for chronic insomnia.

The shift that actually changes things

Insomnia tends to improve when sleep stops being the centre of your life.

That doesn’t happen through gritted teeth or trying to care less.

It usually happens through guided, relational work that:

• reduces the sense of threat around night-time
• rebuilds trust in your body and nervous system
• helps you re-invest in parts of life that matter to you, even if sleep isn’t perfect12312

From a CBT-I perspective, you’re learning new patterns.

From an ACT-I perspective, you’re changing your stance toward discomfort and reconnecting with values.

In real one-to-one care, those two angles often blend into a very human process: making space for fear, adjusting habits, and slowly letting sleep be “good enough” rather than a test you have to pass.

For many people, that’s when things finally start to move in the right direction.