Learning library · Understanding your diagnosis
InsomniaUnderstanding sleep problems
Why sleep goes wrong, how the cycle keeps itself going, and the first-line approach that retrains healthy sleep.
What insomnia is
Insomnia means trouble falling asleep, staying asleep, or waking too early, even when you have the chance to sleep, and feeling tired or unrefreshed during the day.
Short spells are common, often during stress, and pass on their own. When it happens at least three nights a week and lasts more than three months, it's called chronic insomnia.
Why sleep goes wrong
Many things can set it off: stress, a new schedule or shift work, pain or other health conditions, depression or anxiety, some medicines, and caffeine, nicotine, or alcohol.
And then it can keep itself going. Worrying about sleep, and spending long hours lying awake in bed, can make the next night harder too.
Getting help
A clinician will ask about your sleep, your schedule, your health, and your medicines, and may suggest keeping a sleep diary for a week or two. If another sleep problem, like sleep apnea, might be involved, they may suggest a sleep study.
Questionnaires like the ISI, which you may see under Assessments in your portal, help measure how you're sleeping over time.
CBT for insomnia
The first treatment usually recommended for long-term insomnia is cognitive behavioral therapy for insomnia, or CBT-I. It's a structured program, often six to eight weeks, that helps you fall asleep faster and stay asleep longer.
It includes stimulus control, which helps your body link your bed with sleep and build a regular sleep-wake cycle, and sleep restriction, which limits your time in bed for a while. Both are best done with a clinician's guidance.
CBT-I also works on the worried thoughts that keep you awake. Medicines are sometimes used too, but they can have side effects, so whether one makes sense for you is a decision to make with your provider.
Habits that help
Keep the same wake-up time every day, even on weekends. Get daylight and movement during the day, and cut back on caffeine later in the day and alcohol in the evening.
Give yourself time to wind down, and keep your bedroom cool, dark, and quiet, with screens put away. Routines in your portal can walk you through a bedtime routine, one step at a time.
When to reach out
If poor sleep lasts more than a few weeks or is affecting your days, talk with your care team. You can start with a message in your portal.
And if sleepless nights ever come with thoughts of harming yourself, call or text 988, any time. This video is general education, not medical advice. Your provider can help you find the right plan for you.
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