Our sleep functions on two biological systems—sleep drive and circadian rhythm. Sleep drive is like any other human drive (e.g., hunger) in that the less we have, the stronger the drive. Sleep also functions on a 24-hour circadian clock and involves the secretion of hormones that signal alertness and sleepiness. We have the best chances of a good night's sleep when our sleep drive and circadian rhythm are aligned (i.e., our sleep drive is strongest at the same time our body sends sleep signals). When we begin to have difficulty sleeping, we may engage in behaviors that actually serve to worsen our insomnia. For example, we may sleep-in, which serves to disrupt the circadian rhythm, or take naps during the day, which serves to weaken the sleep drive. In addition, we may lay in bed trying to sleep, which actually taps into one of the ways humans learn—association. That is, you begin to associate your bed with being awake rather than being asleep. All of these behaviors may reinforce negative beliefs surrounding your sleep, such as “I won’t be able to function after a poor night sleep” or “I am losing control of my ability to sleep,” which can activate alert signals while you are trying to sleep.

 

In CBT-I, you will first track your sleeping patterns and habits by keeping a sleep diary. As an active treatment, you will then implement a sleep routine and various small changes to your sleep behavior to regulate your sleep drive and circadian rhythm, and to re-associate your bed with sleep. You will then learn to challenge and re-frame your negative beliefs about sleep to be more balanced and realistic. I will work with you to identify your key behaviors and beliefs that can be adjusted to get you back to having restful sleep.