Insomnia therapy in Tunbridge Wells

When sleep becomes a problem in its own right

Most people have a bad night now and then, and sleep usually settles again once a stressful week has passed. Sometimes it doesn’t. You might lie awake for hours, wake at 3am and be unable to get back to sleep, or wake much earlier than you need to. Over weeks and months, worrying about sleep can start to keep you awake as much as whatever caused the problem in the first place.

When poor sleep happens on at least three nights a week and has gone on for three months or more, it is usually called long-term or chronic insomnia. It is very common, and it can be treated.

What insomnia can look like

• Taking a long time to fall asleep, often with your mind going over the day or planning tomorrow
• Waking in the night and lying awake for a long time
• Waking very early and not being able to get back to sleep
• Feeling tired, irritable or foggy during the day, and finding it hard to concentrate
• Dreading bedtime, or feeling more awake as soon as you get into bed
• Going to bed earlier, lying in or napping to try to catch up

Insomnia often comes alongside other things, such as stress, anxiety, low mood, pain, the menopause, a new baby or shift work. Sometimes the original cause has passed and the sleep problem has carried on by itself.

Why insomnia can keep going

When sleep goes wrong, most of us do things that make sense in the short term. We go to bed earlier, stay in bed longer in the morning, nap in the afternoon, drink more coffee, or lie in bed trying hard to sleep. Over time these habits can make sleep lighter and more broken, and the bed can become linked with being awake and frustrated rather than with sleep.

Worry plays a part too. Thoughts such as “if I don’t sleep tonight I won’t cope tomorrow” are understandable, but they make you more alert at exactly the moment you are trying to switch off. Many people with insomnia find they fall asleep on the sofa without trying, then lie wide awake once they get into bed.

How CBT for insomnia works

CBT for insomnia, often called CBT-I, is a structured form of cognitive behavioural therapy designed specifically for sleep. It has the strongest research evidence for long-term insomnia, and it is the approach our psychologists use when sleep is the main problem. It usually includes:

• A sleep diary. You keep a simple record of your sleep for a week or two, so that you and your psychologist can see the pattern clearly.
• Stimulus control. This means using your bed only for sleep and getting up if you have been lying awake for a long time, so that your brain relearns the link between bed and sleep.
• Sleep scheduling. For a short time, the time you spend in bed is matched to the amount of sleep you are actually getting, and then it is gradually extended as your sleep becomes more settled. This is sometimes called sleep restriction.
• Working with thoughts about sleep. You look at the worries and rules about sleep that keep you alert, and test out other ways of thinking about them.
• Winding down. You plan a calmer run-up to bed and practise ways of letting go of the day.

Sleep scheduling can make you feel sleepier during the day at first, so it should be planned with a professional rather than tried alone. It may not be suitable, or may need to be adapted, if you have bipolar disorder, epilepsy or a sleep disorder such as sleep apnoea, or if you drive or operate machinery for work. Your psychologist will go through this with you before you start.

Advice about caffeine, alcohol, light and screens can help, but on its own it is rarely enough for long-term insomnia. CBT-I is usually a shorter piece of work than other kinds of therapy, and your psychologist will talk with you about how many sessions are likely to be useful.

When sleep problems are linked to something else

If poor sleep is part of a wider difficulty, such as anxiety, depression or living with pain or a health condition, your psychologist will look at the sleep problem and the wider difficulty together. Some of our psychologists also work with nightmares, including nightmares after a frightening or traumatic experience.

If you take sleeping tablets or any other medication, keep taking it as prescribed and speak to your GP or psychiatrist before changing anything. You can start CBT for insomnia while taking medication.

Some sleep problems need a medical assessment first. If you snore heavily, stop breathing or gasp for air in your sleep, feel very sleepy during the day even after a full night, or have an uncomfortable urge to move your legs at night, please see your GP.

Who you will see

Several of our Clinical Psychologists work with sleep difficulties, including Dr Rachel Whatmough, Dr Catherine Lankester, Dr Chris Scane, Dr Jo Webber and Dr Sarah Maynard. Sessions are face-to-face in Tunbridge Wells or online. If you are worried about a child’s sleep, our child therapy page explains how we work with children and young people.

Getting started

Fill in our short online form and we’ll match you with the right psychologist. It takes about three minutes, and we reply within 3 working days.

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