Sleep. It is one of the few biological necessities we die without¹. Sleep isn’t a luxury, it’s a biological necessity, just like food and water. Without it, we quite literally can’t survive¹. A poor night’s sleep can throw everything off: mood, appetite, focus².

While the occasional rough night is normal, many people face persistent sleep problems³.  This pattern can persist for months, years, or even decades. If sleep difficulties cannot be tied to a specific cause and do not resolve within a few months, it may indicate the presence of an insomnia disorder⁴.

Because difficulty sleeping is so common, some people have the misperception that it is just another uncomfortable part of the aging process we have no choice but to tolerate. While most people realize chronic sleep difficulties have a significant negative impact on quality of life⁵, many people do not know that insomnia disorders have been associated with chronic health problems⁶, and, if left untreated, even early mortality. This makes it all the more important to take sleep problems seriously and seek support.

What Causes Insomnia?

With the exception of those with a rare genetic anomaly⁸, insomnia is triggered by a combination of biological, cognitive, behavioral, and environmental factors⁹. While your biology can put you at risk of insomnia, there also needs to be a life stressor or significant environmental change for it to develop. Anything that disrupts your sleep cycle could trigger the insomnia cycle. Changes to your sleeping situation or schedule caused by events such as working rotating shifts, gaining or losing a bed partner, the demands of a new baby or pet, and psychological stress in response to major life events or experiences (e.g., loss, injury, traumatic experiences) are two common types of triggers for short-term or acute insomnia.

When sleep is disrupted, people often try to “catch up” by napping, going to bed earlier, or sleeping in. To stay alert during the day, we might begin to lean on caffeine or nicotine. If the difficulties falling asleep continue, sometimes people turn to alcohol or medications to help them fall asleep more easily.

Once your stress response to the initial trigger resolves through you adjusting to the new situation or the stressful situation ending, it is the things you have been doing to regain sleep or make it through day after a poor night’s sleep that maintain the insomnia cycle^10-11.  If sleep issues persist for three or more nights a week for longer than three months, what was once acute insomnia has become chronic insomnia.

An Example of the Insomnia Cycle

Sleep problems tend to fall into common patterns, each of which has multiple maintaining factors. A typical insomnia cycle might look like this: You sleep poorly, so you nap in the middle of the day. Because of your nap, you are no longer able to fall asleep easily at bedtime. You may take a sleep aid to fall asleep or toss and turn in bed for hours trying to fall asleep.  Sometimes the sleep aid doesn’t even work. Because it took so long to fall asleep, you allow yourself to either sleep in a little, or get up, drink a coffee or two, and take a nap midday. Unfortunately, this nap makes it more difficult to fall asleep the next night.

This cycle continues.  You find yourself in a pattern of late nights and napping, sleeping in or both, never feeling fully rested. The bed becomes a source of frustration at night. In fact, you may even notice that your mind is suddenly wide awake the moment you crawl into bed, even if you felt exhausted only a moment earlier. This phenomenon is called conditioned hyperarousal¹¹.

How Do I Break the Cycle?

Fortunately, recovering from insomnia does not need to involve a lifetime of sleep medications or acceptance of poor sleep quality. While many people think that medications are necessary to improve sleep, evidence suggests the impact of sleep medications is limited and any improvements diminish or disappear when the medications are stopped¹². There is a highly effective, non-medication-based treatment that is the gold standard for treatment of insomnia disorder: this treatment is a psychotherapy called Cognitive Behavioral Therapy for Insomnia (CBT-I)¹³.

Because chronic insomnia is a cycle of factors contributing to sleep problems, CBT-I focuses on breaking the cycle of insomnia by resetting your sleep cycle¹⁴. While this can be challenging, there are both self-help and professional supports available. If you feel stuck in your attempts to break the cycle, a psychotherapist trained in CBT-I can help you identify which behaviors may be keeping you stuck in the insomnia cycle and identify ways to make behavioral change to improve the quality of your sleep. Fortunately, CBT-I is not only effective and medication-free, but people typically experience significant improvements in sleep quality in four to six weeks^5,13.

Summary

• Sleep is critical to survival. Chronic sleep problems are connected to worse overall health and shorter lifespan.

• Acute insomnia is caused by life stress or major life changes.

• Difficulty sleeping for more than three nights a week for more than three months may indicate chronic insomnia

• Chronic insomnia is maintained by behavioral and cognitive factors.

• Cognitive Behavioral Therapy-Insomnia (CBT-I), a brief, medication-free treatment, is the gold standard treatment for chronic insomnia.

Are You Ready to Break the Insomnia Cycle for Good?

If you’re stuck in the cycle of sleepless nights, know that you’re not alone and it’s not hopeless. With the right support and evidence-based strategies, restful sleep is within reach. If you’re curious to learn more or ready to take the first step to healing, I would be happy to help. I have many years of experience treating insomnia using CBT-I and can help you get the rest you need to feel like yourself again.

Self-Help

If you are interested in disrupting the insomnia cycle on your own, you can try the free CBT-Insomnia app here or purchase a CBT-Insomnia self-help book here (you can also find it used on various other websites).

If you would like to learn more about me or are considering therapy, it may also be helpful to learn more about me, my credentials, the types of individual therapy and couple therapy I offer, or read my FAQs. To request a free consultation or schedule your first session, click here.

Please note that the information provided in this blog post is for informational purposes only. This information is not a substitute for professional therapy or mental health treatment.

Works Cited

1. National Institute of Neurological Disorders and Stroke. Brain basics: understanding sleep. National Institute of Neurological Disorders and Stroke. Reviewed February 25, 2025. Accessed March 27, 2025. https://www.ninds.nih.gov/health-information/public-education/brain-basics/brain-basics-understanding-sleep.
2. National Heart, Lung, and Blood Institute. Sleep deprivation. National Heart, Lung, and Blood Institute. Reviewed March 24, 2022.  Accessed March 27, 2025. https://www.nhlbi.nih.gov/health/sleep-deprivation#:~:text=Sleep%20deficiency%20is%20linked%20to,adults%2C%20teens%2C%20and%20children.
3. National Heart, Lung, and Blood Institute. Why sleep is important. National Heart, Lung, and Blood Institute. Reviewed March 24, 2022. Accessed March 27, 2025. https://www.nhlbi.nih.gov/health/sleep/why-sleep-important.
4. American Psychiatric Association. Insomnia disorder. In: Diagnostic and Statistical Manual of Mental Disorders. 5th ed., text rev. American Psychiatric Association; 2022. doi:10.1176/appi.books.9780890425787.
5. Ishak WW, Bagot K, Thomas S, et al. Quality of life in patients suffering from insomnia. Innov Clin Neurosci. 2012;9(10):13-26
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8. Cleveland Clinic. Fatal familial insomnia. Cleveland Clinic. Reviewed April 28, 2023. Accessed March 27, 2025. https://my.clevelandclinic.org/health/diseases/25001-fatal-familial-insomnia.
9. Spielman AJ, Caruso LS, Glovinsky PB. A behavioral perspective on insomnia treatment. Psychiatr Clin North Am. 1987;10(4):541-553.
10. Bootzin RR. Stimulus control treatment for insomnia. Proc Am Psychol Assoc. 1972;7:395-396.
11. Riemann D, Spiegelhalder K, Feige B, et al. The hyperarousal model of insomnia: a review of the concept and its evidence. Sleep Med Rev. 2010;14(1):19-31. doi:10.1016/j.smrv.2009.04.002
12. Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13(2):307-349. doi:10.5664/jcsm.6470
13. Jacobs GD, Pace-Schott EF, Stickgold R, Otto MW. Cognitive behavior therapy and pharmacotherapy for insomnia: A randomized controlled trial and direct comparison. Arch Intern Med. 2004;164(17):1888-1896. doi:10.1001/archinte.164.17.1888.
14. Perlis ML, Benson-Jungquist C, Smith MT et al. Cognitive behavioral treatment of insomnia: A session-by-session guide, 2005. 182 p. DOI: 10.1007/0-387-29180-6