Keeping it going
CBT-I ends with a plan for later. Sleep has its ups and downs for everyone, and a hard week will come sooner or later, with stress, illness, travel, a new job, or grief. A few bad nights at a time like that are ordinary. It doesn’t mean insomnia is back.
How a few bad nights turn into insomnia
Arthur Spielman and his colleagues noticed that insomnia usually starts with a trigger, like stress or a change, and then lasts because of what people do to cope. Going to bed early to catch up, sleeping in, napping, lying in bed awake, and worrying about sleep all make sense in the moment. Over weeks, they keep the problem going long after the trigger has passed.
Bad nights will still come. The plan is for not reaching for those old ways of coping when they do.
What to keep doing
- Get up at the same time every day, even after a bad night, and even on days off. This anchors everything else.
- Go to bed when you’re sleepy, not just tired, and not earlier to make up for lost sleep.
- Get up when you can’t sleep. If you’re lying awake and getting frustrated, go somewhere dim and do something quiet until you’re sleepy.
- Keep the bed for sleep and sex.
- Keep the wind-down. A buffer before bed is worth keeping even when sleep is going well.
If a rough patch starts
- Notice it early. Common signs are a few nights in a row of lying awake, starting to worry about sleep during the day, or going to bed earlier to give sleep more time.
- Go back to the diary for a week. It shows what’s really happening, which is often better than a rough week feels.
- Go back to the basics above, all of them, and give them a week or two.
- If it lasts more than two weeks or so, restart the sleep window from your diary, the way you did the first time.
- Talk with a doctor if insomnia keeps coming back, lasts despite all this, or comes with low mood.
Your own plan
Your plan works best in your own words. What helped you most? What are your early signs? What will you do first? “Keeping it going” has a place to write it down, so it’s there when you need it.
References
- Spielman, A. J., Caruso, L. S., & Glovinsky, P. B. (1987). A behavioral perspective on insomnia treatment. Psychiatric Clinics of North America, 10(4), 541–553. doi.org/10.1016/S0193-953X(18)30532-X
- Edinger, J. D., Arnedt, J. T., Bertisch, S. M., Carney, C. E., Harrington, J. J., Lichstein, K. L., Sateia, M. J., Troxel, W. M., Zhou, E. S., Kazmi, U., Heald, J. L., & Martin, J. L. (2021). Behavioral and psychological treatments for chronic insomnia disorder in adults: An American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine, 17(2), 255–262. doi.org/10.5664/jcsm.8986
Helpful links
Everyday Insight’s tools are for education and personal reflection. They are not therapy or medical care, and they are not for emergencies. In an emergency, call 911. If you are in crisis in the United States, call or text 988.