Why Sleep Problems Are Rarely Just About Sleep

Sleep can be one of the first things to be affected when something is psychologically wrong. Sleep can also be one of the last things to resolve when the issue is addressed. Sleep is also one of the experiences that you can feel most alone with. Lying awake at three in the morning, watching the hours accumulate, aware that the inability to rest is making everything else harder during the day.

What tends to be less well understood is that sleep difficulties are rarely primarily about sleep. They are usually a symptom of something else and treating them as the problem, rather than as a signal, tends not to resolve them.

What sleep problems often signal

The most common psychological causes of disrupted sleep are anxiety and rumination. The mind that will not quieten at night is usually a mind that has been managing something during the day. Suppressing worry, deferring difficult thoughts, keeping the mind busy enough during the day that the underlying challenges stay at a distance.

Night removes these distractions and the thoughts that were held at bay during the day tend to surface in those quiet moments when there is nothing left to hold them away.

Depression can disrupt sleep differently. Sometimes sleep becomes more excessive, sometimes early morning waking occurs with a quality of bodily and mental heaviness that is distinct from ordinary tiredness.

Trauma can produce hypervigilance that makes genuine rest feel physiologically unsafe. And significant life stress (perhaps a relationship under strain, a work situation that is not sustainable, or a life decision that has not yet been made) tends to call for the body's attention at night in ways that it cannot during the day.

 

The sleep hygiene trap

The advice most commonly offered for sleep difficulties is behavioural: consistent sleep times, no screens before bed, a cool dark room, reduced caffeine. These recommendations are not wrong, and they can help at the margins. But for many people they are insufficient because the problem is not the sleep environment. It is what the mind is doing when the environment is otherwise perfect.

If your insomnia is driven by unprocessed anxiety, it will not be significantly helped by going to bed at the same time each night. The anxiety, rather than the bedtime, needs to be attended to.

 

What disrupted sleep does over time

Chronic sleep disruption is not simply unpleasant. It has significant effects on mood, cognitive function, emotional regulation, and physical health. When we are consistently sleeping poorly we tend to become less able to manage the very difficulties that are disrupting you sleep. We may feel more reactive, less resilient, more prone to the kind of anxious or depressive thinking that compounds the original problem. It is a self-reinforcing cycle that is very difficult to interrupt.

 

What therapy can offer

Therapy for sleep difficulties is not primarily about sleep. It is about understanding what the night time alertness is trying to signal or protect you from (where the mind is going in the night hours, and what it has been unable or reluctant to attend to during the day). When that underlying material is addressed, sleep tends to improve as a consequence, often with little specific sleep intervention at all.

If you have been struggling to sleep and have tried the practical recommendations without much impact, it may be worth looking at what the sleeplessness is trying to communicate to you. This is where therapy might be able to help.

Dr Erin Reid is a counselling psychologist offering online therapy to individuals, couples, adolescents, and families across the UK and internationally, and 'Walk and Talk' therapy in Northwest London green spaces. Visit drerinreid.com to find out more.