Key points
- Worry, rigid expectations, a feeling of helplessness: these beliefs keep insomnia going[1][2].
- Worrying about your sleep predicts insomnia that lasts; monitoring it less goes hand in hand with remission[3].
- The aim isn't to “think positive”, but to think in a more balanced way.
- One large analysis ranks cognitive restructuring among the most effective components of CBT-I, another does not: it is used together with the behavioural components[4][5].
Why thoughts matter
The cognitive model of insomnia describes a vicious circle: you worry about not sleeping and what it will lead to, you keep an eye on the clock and on how your body feels, and you adopt “safety” behaviours (staying in bed longer, cancelling plans). All of this makes you more alert and sleep more difficult, which confirms the original worry[1].
Researchers have grouped the beliefs that keep insomnia going into four groups: the feared consequences of a bad night, worry and helplessness about sleep, rigid expectations (“I need 8 hours”), and ideas about medication[2]. A study that followed people for several months found that worry about sleep predicts insomnia that persists[3].
The most common thinking traps
- Catastrophising: “If I don't sleep, my whole day will be ruined.”
- All-or-nothing thinking: “Either I sleep 8 hours or it's a write-off.”
- Overgeneralising: “I'll never sleep well again.”
- Mental filter: remembering only the bad nights and forgetting the decent ones.
- “Should” statements: “I should fall asleep straight away.”
- Helplessness: “There's nothing I can do about my sleep.”
The method, step by step
- Spot the thought. When the worry starts to build (at bedtime, at 3 am), write the thought down just as it came to you, along with the emotion that goes with it.
- Rate its intensity, from 0 to 10.
- Examine it with questions: what evidence do I have that this is true? What contradicts it? The last time I slept badly, was the day really a disaster? What would I say to a friend who thought this?
- Come up with a more balanced thought, realistic rather than positive: “I've got through days after a bad night before. It was hard, but I managed.”
- Rate the intensity again: often, it has come down.
Balanced, not positive
This isn't about convincing yourself that everything is fine. A more balanced thought acknowledges the difficulty (“tomorrow will be more tiring”) without blowing it out of proportion (“but I'll be able to cope”).
In the evening: clearing your head before bed
Thoughts tend to surface at bedtime, when there is nothing left to occupy them. In one small study, taking a few minutes early in the evening to write down your worries and, for each one, a possible next step reduced mental agitation at bedtime[6]. To find out more: insomnia and stress.
What the studies say
The analyses comparing the components of CBT-I do not agree. The largest, covering 241 trials, ranks cognitive restructuring among the most effective components for insomnia remission[4]. Another, covering 80 studies, finds no specific effect from working on thoughts, and points mainly to sleep restriction[5].
In practice, the CBT-I recommended first for chronic insomnia combines the two[7]: work on thoughts, and the behavioural components, sleep restriction and stimulus control.
With ReSomnia
The ReSomnia thought journal follows this method: you note the situation, the thought and the emotion with their intensity, you identify thinking traps from a list of examples, questions help you reframe, and then you note the more balanced thought and the intensity afterwards. If you wish, your clinician can have access to it so you can talk about it in a session.