Key points
- In a three-year study, more than one in four people who recovered from insomnia saw their difficult nights return[1].
- The effects of CBT-I fade over time, but remain clinically significant for up to a year afterwards[3].
- A stressful event triggers bad nights; it's the compensating habits that make them last[5].
- At the first signs, going back to the tools from the programme (diary, fixed wake-up time, stimulus control) helps you find your footing again.
Insomnia that comes back is common
A study that followed adults with insomnia for three years found that more than half went into remission, but that 27% of those then relapsed[1]. Over five years, even among people whose insomnia improved, a relapse the following year remained more likely than a further improvement[2].
These figures describe the course of insomnia in the general population, not after a specific treatment. Above all, they show one thing: planning for difficult periods is part of treatment.
The effects of CBT-I over time
A meta-analysis of 30 controlled trials shows that the effects of CBT-I fade over time, but remain clinically significant at 3, 6 and 12 months[3].
In a trial of 160 adults, among people who had started with CBT-I combined with a sleeping pill, the best long-term result came from continuing CBT-I without the pill: 68% remission six months later, compared with 42% among those who continued CBT-I with the pill as needed[4]. Any decision to stop a sleeping pill is always made with your doctor: see sleeping pills and CBT-I.
One bad night is not a relapse
A bereavement, a big project, an illness, a trip: everyone sleeps less well at times like these. The most widely used model for understanding insomnia separates what triggers bad nights from what makes them last: spending more time in bed to compensate, napping, getting up later[5]. That second part is where you have control.
All is not lost
A few difficult nights after a good spell don't mean you have to start all over again. You now know what worked for you.
The warning signs
- You are starting to spend more time in bed again “to catch up”.
- You are letting your wake-up time slip, especially at weekends.
- Naps are creeping back in.
- You stay awake in bed without getting up.
- You are starting to worry about sleep during the day again.
- You start taking a sleeping pill again without talking to your doctor.
Symptoms that linger after an improvement count too: one study linked continuing night-time awakenings, sleep rated as poor quality, fatigue or difficulty concentrating to a higher risk of relapse over the following four years[6]. If some symptoms are still there at the end of the programme, talk to your clinician.
A plan to get back on track
- Go back to your sleep diary for a week or two, to see where you really stand.
- Keep a fixed wake-up time, every day, even after a bad night.
- Apply stimulus control again: bed for sleep only, and get up if you are awake for a long time.
- If your nights stay broken, return to sleep restriction, ideally with your clinician.
- Pick up the work on your thoughts again if the worry about sleep returns.
If insomnia takes hold despite all this, or if it comes with sadness or anxiety that takes over your days, see your doctor or a clinician trained in CBT-I.
With ReSomnia
The last week of the ReSomnia programme is devoted to consolidation: a final ISI test to measure how far you have come, a personal review, and a plan with your warning signs and the steps to go back to. The diary stays open after the programme: you can pick it up again at any time, and share it with your clinician if you wish.