Key points
- Some people's sleep reacts far more to stress: when exposed to major stress, they develop insomnia markedly more often[1][2].
- Worrying about sleep predicts insomnia that lasts; monitoring your sleep less goes hand in hand with remission[4].
- Writing down your worries and a possible way forward early in the evening reduced mental agitation at bedtime in a small study[5].
- Working on your thoughts is part of CBT-I, with results that vary between studies[6][7].
Stress, a common trigger
Losing a job, money troubles, a separation, an illness or a bereavement: events that threaten our safety, stability or sense of identity are the ones most likely to trigger insomnia[1].
But not everyone is affected equally. Some people have sleep that is highly “reactive” to stress: one tense evening is enough to keep them awake. In a recent study, more than 19% of people with highly reactive sleep who went through a major stressor developed insomnia, compared with about 5% of people with low reactivity and no such exposure[1]. Researchers think it is this reaction to stress, more than a constant state of alertness, that signals the risk[2].
Why insomnia takes hold
The cognitive model of insomnia describes a vicious circle: you worry about not sleeping and what it will do to you, you keep an eye on the clock and on signals from your body, and you fall back on “safety behaviours” (staying in bed longer, cancelling plans, taking a sleeping pill “just in case”). All of this raises tension and draws more attention to sleep, which makes it harder still[3].
A study that followed people over several months found that worry about sleep predicts insomnia that persists, and that monitoring sleep less and dropping these safety behaviours go hand in hand with remission[4].
What helps in the evening
- Clear your head before bed. Early in the evening, take a few minutes to write down what's worrying you and, for each worry, one possible next step. In a small study, this “constructive worry” technique reduced mental agitation at bedtime[5].
- Give yourself time to wind down. A quiet spell before bed, with no work or screens, helps you let go of the day.
- Don't try to sleep at all costs. The harder you force sleep, the further away it gets. Aim to rest, and sleep will come.
- If your thoughts keep going round in bed, get up and go back when you feel sleepy again: that's stimulus control.
- Don't look at the clock, and put your phone away: watching the time pass feeds worry[3].
What about relaxation?
Slow breathing and muscle relaxation help you unwind and can be part of an evening routine. But within CBT-I, the large analyses find no specific effect from them[6]. See relaxation.
CBT-I and your thoughts
CBT-I includes work on your thoughts (cognitive restructuring): spotting the ideas that keep worry going (“if I don't sleep, tomorrow will be a disaster”) and replacing them with more balanced ones. One large analysis ranks it among the most effective components[6]; another did not find this effect[7]. The method is explained in detail in thoughts and sleep. Either way, it is used alongside the behavioural components, sleep restriction and stimulus control.
When stress becomes too much
Anxiety that takes over your days, panic attacks, lasting sadness or a loss of interest in everything are worth talking over with your doctor or a psychologist. Insomnia and anxiety or depression often feed each other, and both can be treated.
If you are in distress
If difficult thoughts are taking over, you can call at any time: in Belgium, 0800 32 123 or 1813 (in Dutch); in the UK and Ireland, 116 123; in the US, 988. If you are in danger, call 112 or your local emergency number.