Why Can't I Sleep Even When I'm Exhausted? How CBT-I Can Help
By Lara Petrou, ASW | Magnolia Therapy & Wellness
You’re exhausted all day. You tell yourself that tonight will be different—you’ll go to bed early, finally get a good night’s sleep, and wake up feeling like yourself again. Then bedtime comes, and suddenly your mind is wide awake. You’re thinking about tomorrow, calculating how many hours of sleep you could still get, or wondering why something that should happen naturally has become so difficult.
If this sounds familiar, you’re not alone. One of the particularly frustrating things about chronic insomnia is that the harder you try to sleep, the more elusive sleep can become.
The good news is that insomnia is treatable. And one of the most effective treatments doesn’t involve trying harder to sleep or relying solely on medication. It’s called Cognitive Behavioral Therapy for Insomnia, or CBT-I.
How Insomnia Can Become a Cycle
A few nights of poor sleep can happen to anyone. Stress, illness, travel, pain, hormonal changes, or major life events can all temporarily disrupt sleep. But sometimes the original reason for the sleep problem improves—and the insomnia doesn’t. That’s because our brains and bodies can begin learning patterns around sleep.
Maybe you start going to bed earlier because you’re exhausted. You spend more time in bed hoping to catch up. You sleep later when you can. You begin watching the clock during the night. And understandably, you start worrying about sleep.
What if I can't sleep again tonight? How am I going to function tomorrow? Why can't I just sleep like a normal person?
Over time, the bed itself can become associated with being awake, frustrated, worried, and trying to sleep rather than simply sleeping. That’s where CBT-I comes in.
What Is CBT-I?
CBT-I stands for Cognitive Behavioral Therapy for Insomnia. It is a structured, evidence-based treatment specifically designed for chronic insomnia. Rather than sedating you or simply giving you relaxation techniques, CBT-I looks at the behaviors, thoughts, and patterns that may be unintentionally keeping insomnia going.
Some common patterns include:
Spending too much time in bed
Having inconsistent sleep and wake times
Trying to force yourself to sleep
Worrying about how much sleep you're getting
Developing negative beliefs about your ability to sleep
Racing thoughts at bedtime
Feeling as though you've lost control over sleep
The basic premise is encouraging: if some of the patterns maintaining insomnia have been learned, they can also be unlearned.
Why Trying Harder to Sleep Can Backfire
Sleep is a little unusual because it's something our bodies know how to do—but it's not something we can simply command them to do. Think about what happens when you tell yourself:
I HAVE to fall asleep right now.
Your body probably doesn't relax, instead, you start monitoring whether you're sleepy. You notice every sound, you check the time, you calculate tomorrow's consequences. In other words, you become more alert.
For people experiencing both sleep difficulties and anxiety, this can create a particularly frustrating cycle. Anxiety makes sleep harder, and poor sleep can make anxiety more difficult to manage. Eventually, bedtime itself may become a source of anxiety. CBT-I helps interrupt that cycle.
What Happens During CBT-I?
CBT-I is more structured than many forms of traditional talk therapy. Treatment often includes keeping a sleep diary so you and your therapist can see what's actually happening with your sleep over time. You'll look at factors such as when you're going to bed, when you're waking, how much time you're spending awake, and how your sleep patterns are changing.
From there, treatment focuses on making targeted changes to the behaviors and thoughts affecting sleep.
That can include changing how much time you spend in bed, creating more consistent sleep patterns, reducing behaviors that unintentionally reinforce wakefulness, and addressing thoughts and beliefs that increase anxiety around sleep. The goal isn't simply to make you feel like your sleep is improving. You're actually tracking it.
How Long Does CBT-I Take?
One appealing aspect of CBT-I is that it is designed as a relatively short course of treatment. Many people experience measurable improvement within approximately five to eight weekly sessions. That doesn't mean every week is easy.
CBT-I asks you to change real habits, and some of those changes can initially make you feel more tired before your sleep begins to consolidate. That short-term discomfort can be part of the process of creating healthier, more sustainable sleep.
What If Insomnia Isn't My Only Issue?
It often isn't. Insomnia frequently occurs alongside other concerns, including anxiety, depression, PTSD, chronic pain, medical conditions, and significant life stress. CBT-I doesn't assume that insomnia is "all in your head," nor does it require you to ignore everything else happening in your life. Instead, sleep treatment can often happen alongside other therapy or medical care.
Research has found benefits from CBT-I for people experiencing insomnia alongside conditions including chronic pain, depression, PTSD, cancer, and heart disease. In some situations, however, other concerns need to be treated concurrently or addressed first. Part of the initial assessment is determining whether CBT-I is appropriate for you and how it fits with the rest of your care.
What About Sleep Medication?
You don't necessarily have to choose between CBT-I and medication. If you're currently taking medication for sleep, don't stop or taper it on your own. Medication changes should always be discussed with the medical professional who prescribed it.
CBT-I can be used while someone is taking sleep medication, and your therapist and medical provider can play different roles in your overall treatment.
When a Sleep Problem May Need Medical Evaluation
Not every sleep problem is insomnia. For example, loud snoring accompanied by gasping, choking, or pauses in breathing can be signs of a sleep-related breathing disorder such as sleep apnea. That's important information to share with your therapist. You may be encouraged to speak with your physician or a sleep medicine provider to rule out another sleep disorder before or alongside beginning CBT-I.
You Haven't Forgotten How to Sleep
When you've struggled with insomnia for a long time, it can begin to feel as though something fundamental about your ability to sleep has stopped working. Often, that's not what's happening. Your brain and body may simply have developed patterns around sleep that are now keeping the problem going.
CBT-I provides a structured way to identify those patterns, change them, and help sleep become something your body can do again without quite so much effort.
If you're struggling with chronic insomnia, sleep anxiety, racing thoughts at bedtime, or persistent sleep difficulties, Lara Petrou, ASW, provides CBT-I and insomnia therapy at Magnolia Therapy & Wellness in Roseville and online throughout California.
Learn more about CBT-I and insomnia therapy →
Or reach out to schedule an initial consultation to determine whether CBT-I may be a good fit for you.
Lara Petrou, ASW 117853, is an Associate Clinical Social Worker with Magnolia Therapy & Wellness in Roseville, California. She works with adults experiencing insomnia and sleep difficulties using Cognitive Behavioral Therapy for Insomnia (CBT-I), as well as individuals navigating anxiety, life transitions, chronic pain, and other emotional and relational concerns. Lara is supervised by Olivia Wright, LMFT 142796.
