Sleep becomes uncertain
Stress, illness, pain, schedule change or another disruption can start a run of poor sleep.
Continue around the loop.Visual field guide 07Brain + sleep
The harder you
try to sleep,
the louder awake feels.
Insomnia is more than a short night. It is repeated difficulty falling asleep, staying asleep or getting restorative sleep—even when there is enough opportunity to sleep.
Follow the loop ↓A calm, 5-minute visual guide
TIRED + WIREDSleepiness can be present while the brain remains watchful. That is not a failure of willpower.
THE MAINTENANCE LOOPOne bad night can become
One bad night can become
a nightly performance test.
The trigger and the pattern are not always the same thing. An initial disruption may pass while habits, worry and conditioned alertness keep insomnia going.
THE PARADOXSleep is automatic.
Effort can make it less automatic.
Effort can make it less automatic.
You can prepare the conditions for sleep, but you cannot command unconsciousness. CBT-I reduces the struggle and rebuilds the conditions in which sleep can happen on its own.
WHAT COUNTS AS INSOMNIA?Look for the pattern
Look for the pattern
across night and day.
Diagnosis is clinical. A sleep diary is often more useful than a single wearable score because it shows timing, opportunity and daytime impact over one to two weeks.
Trouble falling asleep, repeated or prolonged waking, waking too early, or sleep that feels poor in quality.
The difficulty occurs despite having enough opportunity and circumstances for sleep—not simply because sleep time was cut short.
Fatigue, reduced concentration, irritability, worry about sleep, or difficulty functioning makes the night-time problem clinically important.
Chronic insomnia typically occurs at least three nights a week for at least three months. Shorter problems still deserve care when distressing.
SLEEP DIARY
BED10:30
LIGHTS OUT11:15
AWAKE65 min
UP6:30
Track estimates, not perfect measurements. Include naps, caffeine, alcohol, medicines and daytime sleepiness.
Not every late night is insomnia.
A delayed body clock, sleep apnea, restless legs, pain, menopause, mood disorders, medicines, substances and an inadequate sleep opportunity can look similar or coexist. A sleep study is not routine for uncomplicated insomnia, but may be used when another sleep disorder is suspected.
FIRST-LINE FOR CHRONIC INSOMNIACBT-I changes the system,
CBT-I changes the system,
not just the bedtime routine.
Cognitive behavioural therapy for insomnia is a structured, multi-component treatment. It can be delivered in person, by telehealth or through validated digital programmes.
RELEARN THE CUE
Make bed predict sleep again
Go to bed when sleepy, use the bed for sleep and intimacy, and leave for a quiet dim place when wakefulness becomes prolonged. Return when sleepiness comes back.
The goal is not to punish wakefulness. It is to weaken the learned bed–alertness link.WHY NOT SLEEP HYGIENE ALONE?Good habits support sleep. They may not undo chronic insomnia.
A dark room, regular schedule and thoughtful caffeine timing can help, but guidelines recommend CBT-I as the core treatment because it directly addresses the behavioural and cognitive loop.
THE NEXT USEFUL STEPMeasure the pattern.
Measure the pattern.
Then treat the right problem.
Record bed, sleep and wake estimates plus naps, substances and daytime impact.
Discuss pain, mood, snoring, restless legs, menopause, medicines and schedule.
Look for a trained clinician or a validated programme, not just a list of sleep tips.
Track daytime wellbeing and the sleep pattern—not perfection on any single night.
GET HELP SOONERSeek prompt help for severe daytime sleepiness, unsafe driving, breathing pauses, rapidly escalating mood symptoms, or sleep loss with unusually high energy, agitation or risky behaviour.
If you may harm yourself or someone else, contact emergency services or a crisis service now.
SOURCESEvidence behind