Insomnia

The house is quiet and you are not. The clock has become something you check and resent. You count the hours that are left, then the little you will manage tomorrow, then the cost of another night like the last one. The counting itself keeps you awake, and you know that, which does not help.

You have probably tried the usual advice already. Less caffeine, no phone in bed, a darker room, an app, a routine. None of it is wrong. It stops being useful when your difficulty is no longer that you do not know what good sleep habits are. You know them. You are still awake.

Persistent insomnia is rarely still driven by whatever first disturbed your sleep. A stressful period, an illness, a bereavement, a newborn, a change in shift pattern, all of these can set it off. What keeps it going months later is usually different. The bed becomes associated with being awake rather than asleep. The effort to sleep produces the alertness that prevents it. Time in bed stretches longer and longer to catch whatever sleep is available, which thins the sleep out across more hours and deepens the sense that the night cannot be trusted. This is the pattern that has to be worked with, not the original trigger.

How the night keeps itself awake

Cognitive Behavioural Therapy for insomnia, usually shortened to CBT-I, is a specific psychological treatment for persistent insomnia. It is not a repackaging of sleep hygiene. NICE guidance says cognitive behavioural therapy for insomnia should be offered as the first-line treatment for long-term insomnia in adults of any age, and that sleeping tablets such as benzodiazepines and z-drugs should be avoided for long-term use.

The work is targeted at the mechanisms that now maintain the problem. One part is behavioural. We look closely at when you go to bed, when you get up, and how many of those hours are actually spent asleep rather than lying awake waiting. Matching your time in bed more honestly to your sleep, and keeping the bed for sleep rather than for effortful wakefulness, is a central part of CBT-I. It is done carefully and gradually. The first weeks can make you sleepier before they make you sleep, which affects driving and reaction time, and this is exactly why it is done with a therapist rather than off a website. I explain the reasoning before we use any of it, and we review what your nights are doing rather than pushing through a formula.

Another part is cognitive. Insomnia makes the mind search for certainty at exactly the hour it cannot be found. It turns sleep into something to be achieved, monitored and defended, when sleep only arrives once you stop trying to produce it. If you have lain awake calculating how much sleep is still possible before the alarm, you already know that the calculation is part of what is keeping you up. Therapy gives us a way to loosen that grip rather than adding another rule to follow in the dark.

Working with the night you actually have

I am Henry Adu Bobi, and my work as a Consultant Cognitive Behavioural Psychotherapist means you will not have to convince me that you have already tried the darker room and the earlier wind-down. What interests me is the specific shape of your nights now, the checking of the clock and the arithmetic of the hours left, and how we begin to unpick the effort that has quietly become the thing keeping you awake.

Therapy sits alongside medical care and does not replace it. I do not diagnose and I do not prescribe. Some sleep difficulties have physical contributors, including sleep apnoea, the effects of medication, pain or hormonal change, and if something like that seems relevant I will say so, so you can raise it with your GP while the psychological work stays properly bounded.

Sessions are fifty minutes, online, and usually weekly to begin with.

People rarely arrive with sleep as the only thing on the page. There may be anxiety, low mood, pain, the aftermath of a difficult event, medication, hormonal change, shift work, or a stretch at work that will not let go. I trained in an NHS specialist unit working with chronic pain and fatigue, where broken sleep and the fear of it are constant companions, and I am used to treating sleep in the context of a whole life rather than as a technical fault to be corrected in isolation.