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Key points
- Often, the root of insomnia is the paradox that the harder we focus on achieving certain actions, the more difficult they become.
- Cognitive behavioral therapy treats insomnia by helping people to arrive at a mental state where sleep is possible.
- When we fall asleep, different stages of sleep offer different forms of cognitive and physical restoration.
The first uncomfortable truth of sleep is this: We can’t get to sleep, we can’t life-hack our way to sleep, and we can’t will our way to sleep. Instead, we fall asleep much like we fall in love or fall ill—it’s more surrender than action. In a culture that values actualization, this isn’t a popular message.
The second uncomfortable truth of sleep is this: The harder we try to get to sleep, the less likely it will come. With intention comes stress; with stress comes wakefulness. Most of us have endured the frustrating experience of lying in bed for long stretches of time as we chastise ourselves for not being able to do what the body should do so naturally: sleep. We think of the wasted time we spend staring at the ceiling and the tired and moody consequences we face in the day to come. Yet the more we focus and the longer we worry, the more we distance ourselves from sleep.
We spend about a third of our lives in this unconscious state that we can’t induce and that we don’t remember, yet our mental and physical health is largely dependent on sleep. By the moment we fall asleep, we’re already unaware of it. What we do remember, however, are repeated failed attempts to sleep, which can accumulate into a mental association: bedtime equals stress and effort. With insomnia, we’re trying to drive the car; we’re trying to tell sleep what to do and when to do it. Sleep simply doesn’t work that way.
This leads to the third uncomfortable truth about sleep: The right time to fall asleep is different for everyone—and it’ll even change for the same person at different stages of their life. For night owls, a bedtime won’t make sense until later. Early birds should give into their yawns earlier. Teenagers often need to stay up late before they can fall asleep, while seniors prefer to call it a day long before then. It’s wise to obey our chronotype to increase our chances of restful sleep.
Thankfully, these three uncomfortable truths about sleep give way to one overarching promising truth: We do know how to help sleep occur naturally. Cognitive behavioral therapy (CBT) has been effective as an insomnia treatment because it meets a psychological problem with a psychological approach. It enables people to reach the place where sleep occurs naturally, to surrender their efforts to control sleep. CBT trains people to address the paradox that the less we try at certain actions, the more successful we can become at them. Some things—from breathing to golf swings—are just better when we stop focusing so hard.
CBT can address the root of insomnia by helping people alleviate the worry and stress that accompanies bedtime. CBT releases the brain from the negative associations that have built up when insomnia took hold and re-establishes the natural automatic behavior and mindset of falling asleep involuntarily. While sleep medications may compel rest the first night they’re taken, they’re not intended for long-term use, and they only offer symptomatic relief. CBT may take longer to work, but it can offer a lifetime of good sleep by resolving the underlying cause of insomnia. Few disorders have such a cure.
The goal of CBT as an insomnia treatment is to use the natural drive for sleep (called the homeostat) to build pressure to fall asleep at night, arriving at the right biological (or circadian) time for sleep’s gate to open. CBT also addresses anything that might get in the way of being in the right mental state to fall asleep or to fall back to sleep if you awaken at night. Once the gate opens, the body enters several stages of sleep. Some stages offer physical restoration, while others offer cognitive restoration. All are necessary to our physical and mental health, but they depend upon falling—not getting—to sleep.
Once we do, people experience the following stages during a successful night of sleep:
Non-Rapid Eye Movement (NREM) Sleep
Sleep kicks off with NREM sleep, which across the night accounts for about 75 percent of our sleep. Within NREM sleep are three stages:
- N1: This is the moment when we first nod off to sleep. It’s the quick transition between wakefulness and sleep.
- N2: People usually spend nearly half of their sleeping hours in this stage, which transitions us into a slightly deeper stage of sleep. Our temperature and heart rate drop, but we’re still easily awakened.
- N3: This is the sleep that tends to be the favorite kind of sleep—that deep sleep from which it’s hard to be woken. This deep sleep, which accounts for about a quarter of a night’s sleep, is when much of the physical restoration work of sleep occurs, when cells regenerate and the immune system gets a boost. We get less N3 sleep as we get older.
Rapid Eye Movement Sleep (REM)
REM sleep is known as dreaming sleep, and it accounts for about a quarter of our sleeping hours. As our minds go off on adventures (or miss high school final exams), our eyes move quickly under our lids while our bodies stay still. This is when the emotional restoration work of sleep occurs. From the perspective of an electroencephalogram (EEG), REM sleep doesn’t look much different from wakefulness. Even as we lie still, our brains are active. Even though this stage might not feel as restful as the deep sleep of NREM N3 sleep, it’s vital to our minds. It helps our memories associate related events and helps us regulate our emotions.
Cycles of Sleep
It takes about an hour and a half to complete the first cycle of sleep, going through each of the NREM stages and ending with a spell of REM sleep. Across a good night of sleep, we will have four to six of these cycles, with most of the N3 occurring early in the night and REM becoming longer and deeper in the late cycles.
Sleep Itself Is CBT’s Secret Ingredient. Falling asleep when we go to bed and falling back to sleep when we awaken during the night is something that sleep does to us and for us. It can’t be deliberate. The good sleeper sleeps just like they walk or talk, without thinking about it. CBT helps us to re-learn how to abandon wakefulness, to let sleep happen, and, crucially, to stop trying to get to sleep intentionally. If we surrender control, the real work of sleep can begin.
To find a therapist, visit the Psychology Today Therapy Directory.
