Services · Insomnia & Sleep Disorders Treatment
Insomnia & Sleep Disorders Treatment
Psychological treatment for insomnia and sleep difficulties
Difficulty sleeping can affect much more than how tired you feel the next day. Ongoing sleep difficulties can affect concentration, memory, mood, energy, work, relationships and everyday functioning.
For some people, sleep difficulties begin during a stressful period and then continue even after the original stress has passed. For others, their natural sleep-wake cycle may not align well with the times they need or want to sleep.
At The Psychology Hub, we offer psychological treatment for insomnia and some circadian rhythm sleep-wake disorders, including evidence-based Cognitive Behavioural Therapy for Insomnia (CBT-I).
Appointments may be available online across Australia, making treatment accessible without needing to attend the clinic in person.
When might it help to see a psychologist about sleep?
You may benefit from psychological support for sleep if you:
- regularly struggle to fall asleep
- wake repeatedly during the night
- wake much earlier than you would like and cannot return to sleep
- spend a long time awake in bed
- feel anxious or frustrated about whether you will sleep
- find yourself constantly calculating how many hours of sleep you have left
- have developed routines or habits around sleep that no longer seem to be helping
- sleep reasonably well when you can follow your preferred schedule, but struggle when work, school or everyday commitments require different sleep and wake times
- work shifts and have difficulty sleeping or remaining alert at the times you need to
- have ongoing sleep difficulties that are affecting your mood, concentration, energy or functioning during the day.
Sleep problems are not always caused by poor habits or “not trying hard enough.” Sleep is influenced by biological rhythms, sleep pressure, behaviour, thoughts, emotions, physical health, mental health, medications, substances, environment and daily routines.
Understanding what is maintaining the problem is an important part of treatment.
Insomnia
Insomnia involves persistent difficulty falling asleep, staying asleep or waking earlier than intended, despite having adequate opportunity for sleep.
It can also affect how you feel and function during the day. People experiencing insomnia may notice fatigue, reduced concentration, irritability, low energy, difficulty with memory, anxiety about sleep or reduced ability to manage everyday demands.
Insomnia can occur on its own or alongside conditions such as anxiety, depression, trauma, chronic pain, menopause and other medical or psychological conditions.
Treatment therefore needs to consider the whole person, rather than simply providing a list of general sleep tips.
Cognitive Behavioural Therapy for Insomnia (CBT-I)
Cognitive Behavioural Therapy for Insomnia, commonly called CBT-I, is an evidence-based psychological treatment specifically designed for insomnia.
CBT-I is recommended as a first-line treatment for chronic insomnia by Australian and international sleep medicine guidelines.
Unlike general sleep advice alone, CBT-I looks at the patterns of thoughts, behaviours and sleep scheduling that can unintentionally keep insomnia going.
Treatment is individualised, but may include the following components.
Understanding sleep and healthy sleep practices
Your psychologist can help you understand how sleep works, including your body’s sleep drive and internal body clock, and identify environmental, behavioural or lifestyle factors that may be affecting your sleep.
Healthy sleep practices can be useful, but they are generally only one part of CBT-I, rather than the entire treatment.
Stimulus control
When someone spends long periods awake, worrying, scrolling, working or becoming frustrated in bed, the brain can gradually begin to associate the bed with being awake rather than sleeping.
Stimulus-control strategies aim to strengthen the connection between bed and sleep again.
Sleep restriction or sleep-compression strategies
People with insomnia often respond to poor sleep by going to bed earlier, sleeping in, napping or spending longer periods in bed trying to catch up.
Although understandable, this can sometimes make sleep more fragmented.
Carefully planned changes to time spent in bed can help consolidate sleep and strengthen the body’s natural sleep drive.
These strategies should be tailored to the individual and monitored appropriately rather than attempted as a rigid one-size-fits-all approach.
Cognitive therapy
Difficulty sleeping can understandably lead to thoughts such as:
- “I’m never going to function tomorrow.”
- “I have to fall asleep now.”
- “If I don’t get eight hours, tomorrow will be a disaster.”
- “Something is wrong with me because I can’t sleep.”
Unfortunately, the pressure to sleep can make the brain more alert precisely when we want it to switch off.
Cognitive strategies can help identify and respond differently to unhelpful beliefs, predictions and worries about sleep.
Relaxation strategies
Some people experience significant physical or mental arousal at night.
Treatment may incorporate evidence-based relaxation strategies such as controlled breathing, progressive muscle relaxation, imagery or other approaches that help reduce physiological arousal.
Importantly, the aim is not to force yourself to sleep, which can sometimes create even more pressure around sleep.
Circadian Rhythm Sleep-Wake Disorders
Sometimes the main difficulty is not the ability to sleep itself, but when the body’s internal clock is telling the person to sleep and wake.
Circadian rhythms are biological processes that follow an approximately 24-hour cycle and help regulate sleep, alertness, hormones and other bodily functions.
When a person’s internal body clock is significantly out of alignment with their required or desired schedule, this may contribute to a circadian rhythm sleep-wake disorder.
We can provide psychological support for a range of circadian sleep difficulties, including:
Delayed Sleep-Wake Phase Disorder
People with Delayed Sleep-Wake Phase Disorder have a sleep-wake schedule that is substantially later than the conventional or desired schedule.
For example, someone may naturally become sleepy very late at night and have considerable difficulty waking early for work, school or other responsibilities.
When allowed to follow their preferred schedule, their sleep itself may be relatively normal.
Advanced Sleep-Wake Phase Disorder
This involves becoming sleepy and waking considerably earlier than desired.
Someone may find themselves struggling to remain awake in the evening and then waking very early in the morning, even when they would prefer to sleep later.
Non-24-Hour Sleep-Wake Rhythm Disorder
In Non-24-Hour Sleep-Wake Rhythm Disorder, the person’s sleep-wake cycle does not remain aligned with the conventional 24-hour day.
Sleep and wake times can progressively shift later or, less commonly, earlier across days.
Irregular Sleep-Wake Rhythm Disorder
People experiencing an Irregular Sleep-Wake Rhythm Disorder may not have one clearly defined major sleep period.
Instead, sleep may occur in multiple periods across the day and night.
Shift Work Disorder
Working overnight, rotating shifts or very early starts can place work requirements in direct conflict with the body’s natural circadian rhythm.
Some shift workers experience significant insomnia when trying to sleep and/or excessive sleepiness when they need to remain awake.
Treatment may help people understand their sleep-wake patterns and develop strategies around sleep scheduling, routines and other factors that influence circadian timing.
Jet Lag Disorder
Travelling rapidly across multiple time zones can temporarily place the body’s internal clock out of alignment with local time.
For some people, particularly frequent travellers, this can cause significant difficulty sleeping, excessive daytime sleepiness or impaired functioning.
How can psychological treatment help circadian sleep difficulties?
Treatment depends on the particular sleep pattern, the person’s lifestyle and what is contributing to the difficulty.
Your psychologist may explore:
- your typical sleep and wake times
- differences between work days and non-work days
- shift patterns
- daytime sleepiness
- naps
- light exposure
- activity and exercise
- caffeine, alcohol and other substances
- sleep-related behaviours
- anxiety or frustration about sleep
- mental health and wellbeing
- environmental factors
- relevant medical conditions or medications.
Sleep diaries may also be helpful in identifying patterns over time.
Depending on your needs, treatment may incorporate CBT-I strategies, behavioural approaches, sleep scheduling and psychological strategies to reduce the struggle and anxiety that can develop around sleep.
Where appropriate, your psychologist may also draw on approaches such as Acceptance and Commitment Therapy (ACT). For example, ACT strategies may help someone step away from an ongoing battle with sleep, respond differently to difficult thoughts and sensations, and reduce the pressure to “make” sleep happen.
Sleep problems are not all the same
There are many different types of sleep disorders.
Some sleep difficulties require assessment or treatment from a GP, sleep physician or another medical professional, either instead of or alongside psychological treatment.
For example, symptoms that may warrant medical investigation include:
- loud snoring or pauses in breathing during sleep
- waking gasping or choking
- significant or unexplained daytime sleepiness
- unusual movements or behaviours during sleep
- symptoms suggestive of restless legs syndrome
- sudden episodes of sleep
- new or unexplained sleep changes associated with a medical condition or medication.
If concerns arise during your appointments, your psychologist can discuss whether additional medical assessment may be appropriate.
Psychological and medical care do not need to be either/or. Where appropriate, we can work alongside your GP or other treating professionals.
What happens at the first appointment?
Your first appointment gives you and your psychologist an opportunity to develop a detailed understanding of your sleep concerns.
Your psychologist may ask about:
- when the problem began
- your current sleeping pattern
- bedtime and waking routines
- what happens when you cannot sleep
- daytime tiredness or sleepiness
- work and family routines
- shift work or travel
- physical and mental health
- medications and substances that may influence sleep
- previous strategies or treatments you have tried
- what you would most like to change.
You may also be asked to complete questionnaires or keep a sleep diary so that you and your psychologist can identify patterns in your sleep.
From there, treatment can be tailored to your individual circumstances rather than following a generic set of sleep rules.
You don’t have to be “bad at sleeping” forever
When sleep has been difficult for a long time, bedtime itself can start to feel stressful.
People can become caught in an exhausting cycle of trying harder and harder to sleep, worrying about the consequences of not sleeping and restructuring more of their life around trying to get enough sleep.
Treatment aims to help you understand what is happening and develop practical, evidence-based strategies for changing the patterns that may be keeping the problem going.
Ready to take the next step?
New to the clinic? Read what happens at your first appointment.
Frequently Asked Questions
What is CBT-I?
CBT-I stands for Cognitive Behavioural Therapy for Insomnia. It is a structured psychological treatment that addresses thoughts, behaviours and sleep patterns that contribute to ongoing insomnia.
It can include cognitive therapy, stimulus control, carefully planned changes to time in bed, relaxation strategies, education about sleep and other individualised interventions.
Is CBT-I evidence based?
Yes. CBT-I is recommended as a first-line treatment for chronic insomnia in Australian and international clinical guidelines.
Is CBT-I just sleep hygiene?
No.
Sleep hygiene refers to habits and environmental factors that can support healthy sleep. These may be discussed during CBT-I, but sleep hygiene alone is not the same as CBT-I.
CBT-I is a broader treatment that targets the psychological and behavioural processes that can maintain insomnia.
Do I need a diagnosis of insomnia before making an appointment?
You do not necessarily need to already have a formal diagnosis to discuss your sleep concerns with us.
Your psychologist can explore your difficulties and determine whether psychological treatment appears appropriate. If your symptoms suggest that medical assessment or specialist sleep assessment would be helpful, this can also be discussed.
Can a psychologist help with a circadian rhythm disorder?
Psychological and behavioural strategies may form part of the management of circadian rhythm sleep-wake difficulties.
Because treatment differs depending on the particular disorder and individual circumstances, your psychologist will first explore your sleep pattern and relevant history.
In some situations, collaboration with a GP or sleep physician may also be recommended.
Do you treat sleep apnoea?
Sleep apnoea is a medical sleep disorder that requires appropriate medical assessment and treatment.
A psychologist may help with associated insomnia, anxiety, adjustment or behavioural factors, but psychological therapy does not replace medical investigation or treatment for obstructive sleep apnoea.
Can insomnia occur alongside anxiety or depression?
Yes. Sleep difficulties commonly occur alongside psychological and physical health conditions.
Treatment can consider both the sleep problem and other factors affecting your wellbeing rather than assuming that one must be treated before the other.
Can I have appointments online?
Sleep treatment may be provided by telehealth, depending on clinician availability and whether telehealth is appropriate for your circumstances.
This means people may be able to access treatment from across Australia.
