Sleep

Sleep problems: common difficulties and treatment (including CBT-I)

Many people go through periods of poor sleep. For some, it resolves on its own. For others, sleep problems become persistent and start to affect energy, mood, concentration, and day-to-day functioning. Fortunately, there are effective and gentle treatment approaches - and for long-lasting insomnia, CBT-I (Cognitive Behavioral Therapy for Insomnia) is one of the most widely used and best-researched options.

Common types of sleep problems

Insomnia

Insomnia is not only about “sleeping too little,” but a combination of:

• difficulty falling asleep
• frequent awakenings or waking too early
• sleep that feels non-restorative …along with noticeable daytime impairment.

Some people have sleep difficulties for short periods (for example during stress), while others find that it persists over time.

Restless or light sleep

Many describe their sleep as “shallow,” with physical restlessness, frequent micro-awakenings, or a feeling of being on alert. This can be linked to stress, worry, pain, habits, or circadian rhythm factors.

Delayed sleep phase (a delayed body clock)

Some people naturally feel sleepy late and struggle to get up early - especially when work or studies require an early start. This can lead to too little sleep on weekdays and “catching up” on weekends, which in turn can reinforce the rhythm problem.

Sleep-related breathing difficulties (e.g., sleep apnea)

Loud snoring, breathing pauses, gasping at night, and pronounced daytime sleepiness can indicate sleep apnea. In that case, a medical assessment is important. Psychological support can be helpful as an add-on, but breathing-related sleep problems should be assessed medically.

Restless legs / leg discomfort

A crawling or tingling discomfort and a strong urge to move the legs in the evening or at night can disrupt sleep onset and sleep quality. This can have physical causes and should be discussed with a doctor when symptoms are clear.

Why do sleep problems often stick around?

Sleep is shaped by the body, habits, and psychology. What starts as a normal response to strain (stress, life changes, illness, conflict, small children, shift work) can be maintained by patterns that are completely understandable:

• Worrying about sleep: “If I don’t fall asleep now, tomorrow will be ruined.”
• Trying too hard: attempting to “force” sleep can increase physiological arousal.
• An irregular rhythm: long mornings in bed, daytime sleeping, or big weekend shifts.
• The bed becomes a place for wakefulness: scrolling, work, rumination, or frustration in bed.
• Safety strategies: extra coffee, alcohol to fall asleep, long naps - which may help short-term but often worsen sleep over time.

This doesn’t mean you’re “doing something wrong.” It means sleep often needs clear, kind structure to become stable again.

Treatment for sleep problems: what helps?

1) Assessment and clarification

A good first step is to understand what kind of sleep problem you have, and what may be contributing. Treatment often includes:

• a sleep diary (1-2 weeks) to identify patterns
• discussion of stress, circadian rhythm, habits, health, and life circumstances
• consideration of whether there are signs that suggest medical evaluation (e.g., sleep apnea)

The goal is to choose steps that fit your situation and are realistic to carry out.

2) CBT-I (Cognitive Behavioral Therapy for Insomnia)

CBT-I is a structured treatment developed for persistent insomnia. It addresses both sleep patterns and the factors that often maintain sleep difficulties (arousal, worry, unhelpful strategies). It is tailored to the individual, but may include:

Stimulus control

• Strengthening the association between bed and sleep (and reducing “bed = wakefulness”).
• For example: going to bed when sleepy, getting up if you’ve been awake for a long time, and using the bed primarily for sleep.

Sleep restriction / sleep consolidation

• Limiting time in bed to build sleep pressure and make sleep more continuous.
• This is done gradually and safely, and adjusted based on response.

Circadian rhythm and regularity

• Stabilising wake-up time and timing light/activity appropriately.
• Gradual adjustment for delayed sleep phase.

Cognitive techniques

• Working with thought patterns and worry that increase stress around sleep.
• The goal isn’t “positive thinking,” but more realistic and helpful appraisals.

Down-regulation and skills

• Relaxation, breathing, attention training, or other methods to reduce bodily arousal.
• Routines that signal a transition into rest.

Sleep hygiene - as support, not the whole solution

• Caffeine, alcohol, screens, meals, activity, temperature, and environment can affect sleep.
• In CBT-I, sleep hygiene is part of the bigger picture, but it’s rarely enough on its own for long-term insomnia.

Many people find the most helpful element is having a clear plan, following it consistently over time, and adjusting along the way - with room for variation and the occasional “normal” bad night.

3) Other approaches (depending on the cause)

• Treating stress, anxiety, or depressive symptoms can be relevant when these clearly affect sleep (often combined with sleep-specific strategies).
• Pain management and medical follow-up for physical conditions can be crucial.
• Medication may in some cases be a short-term support in collaboration with a doctor, but is often used cautiously for long-term sleep problems.
• Melatonin may be relevant for circadian rhythm challenges for some people, and can be discussed with a doctor when needed.

What you can try yourself - safe first steps

If you want to start gently, these principles can help:

• Keep a consistent wake-up time most days (even after a bad night).
• Avoid using the bed for wakeful activities (work, scrolling, “worry time”).
• Create a short wind-down routine (10-30 minutes) before bedtime.
• Limit caffeine late in the day and be mindful of alcohol as a “sleep aid.”
• Write worries down earlier in the evening (“worry parking”) to reduce racing thoughts in bed.

With persistent insomnia, it can still be difficult to get lasting change without structured support - and CBT-I can be a good next step.

When should you consider seeking extra help?

It may be wise to get an assessment if:

• sleep problems persist over time and affect functioning (work, studies, relationships)
• you have signs of breathing problems at night (loud snoring, breathing pauses, gasping)
• you fall asleep uncontrollably during the day or feel unusually fatigued over time
• you use alcohol or sedatives as a regular “sleep strategy”
• you experience significant psychological distress alongside sleep difficulties

If you are in acute danger, or if you have thoughts of harming yourself: contact the out-of-hours medical service (116 117) or call 113.

Frequently asked questions

How long does treatment take?

It varies. CBT-I is often delivered over several weeks, but pacing and content are tailored. Some notice changes early, while others need more time and fine-tuning.

Do I need to stop resting during the day completely?

Not necessarily, but long or late naps can affect sleep pressure. In CBT-I this is assessed specifically and adjusted gradually.

What if I have a bad night during treatment?

That’s normal. The goal is not perfect nights, but more stable and resilient sleep over time - without sleep becoming a daily stress project.