After a bad night, going to bed earlier and allowing more time for sleep seems a reasonable response, particularly when the following day will be demanding. The remaining hours may then be counted repeatedly, with each period of wakefulness adding to the expectation that tomorrow will be difficult.
People with chronic insomnia can be exhausted while remaining mentally and physically alert, especially when bed has become associated with planning, frustration and effort. Monitoring whether sleep is arriving can make it harder to disengage from the very process the person is trying to control.
How sleep effort develops
We can influence the conditions for sleep, although the transition itself happens automatically and cannot be performed on command. Someone who dozes on the sofa may become alert again in bed when resting becomes an attempt to assess and control whether sleep is happening.
An assessment also needs to consider pain, medication, hormonal changes, breathing disorders, restless legs and other medical or psychiatric conditions. Loud snoring, gasping, unusual movements, severe daytime sleepiness or a sudden change in sleep warrant attention, because a sleep-effort explanation may account for only part of the difficulty.
Time in bed and learned wakefulness
Extending time in bed, reducing activity and napping may help during acute illness or brief sleep loss, but these responses can reduce sleep pressure and make the sleep period less predictable when insomnia persists. Long stretches awake in bed can also strengthen an association between the bedroom and struggling to sleep.
Cognitive behavioural therapy for insomnia, or CBT-I, addresses those patterns through a consistent rising time, an individually set sleep window and changes to what happens during prolonged wakefulness. Treatment also examines catastrophic predictions and habits that interfere with sleep, so its behavioural recommendations sit within a broader understanding of the person's difficulty.
Sleep-window work needs particular care with bipolar disorder, epilepsy, falls risk, some medical conditions and safety-critical work. Individual advice is preferable when the clinical picture is complicated, because a general instruction to spend less time in bed leaves out the assessment and adjustments that treatment requires.
Evidence for CBT-I
A 2024 network meta-analysis included 13 trials and 823 participants comparing CBT-I, sleep medication and combined treatment as initial approaches to chronic insomnia. CBT-I produced better long-term remission than medication alone, while the evidence did not clearly establish an advantage for starting with combined treatment over CBT-I by itself.
A newer review of CBT for insomnia in routine clinical services found improvements broadly comparable with those in controlled efficacy trials. Many included studies carried considerable risk of bias, however, so the large reported effects cannot be treated as an expectation for every person seeking care.
Medication may remain appropriate depending on the cause and duration of sleep difficulty, other health conditions and the prescriber's advice. For persistent insomnia, treatment also needs to consider the learned and behavioural processes that can continue after the original trigger has changed.
Responding to an uncertain night
In therapy, work on sleep effort may include reducing clock checking and examining predictions about what a poor night will mean for the following day. Someone may also need to reconsider the detailed morning review that turns the previous night's sleep into a judgement about how the whole day will unfold.
Sleep loss can affect functioning and safety, which needs to remain part of any plan. Within those limits, the person can practise resting without repeatedly checking whether it is working, and review how a steadier routine changes their sleep across several nights instead of judging every period of wakefulness as a treatment failure.
Research drawn on
- Furukawa Y, Sakata M, Furukawa TA, Efthimiou O, Perlis M. Initial treatment choices for long-term remission of chronic insomnia disorder in adults. Psychiatry and Clinical Neurosciences. 2024.
- Öst L-G, Brattmyr M, Enebrink P, et al. Cognitive behavioral therapy for adult insomnia disorder in routine clinical care. Cognitive Behaviour Therapy. 2025.
AI disclosure
Brent Munro researched, wrote and reviewed this insight, with ChatGPT assisting in literature searches, limited research comparisons, editing and image generation. He retains full responsibility for the published content.