How to Fall Asleep & Stop Insomnia: What to Do When Your Brain Won't Shut Off

After another difficult day just trying to get by, Charles gets ready for his usual routine. A cup of chamomile tea, thirty minutes of yoga, and a hot shower. Being well-versed in sleep strategies, he gets into his bedroom, turns off the lights, rolls down the blackout blinds, hides his phone, and gets into bed—hoping, praying, that he will just be able to fall asleep tonight.

It’s 12:00 AM, and he’s used to this routine, going through it almost nightly for the past few months. He’s absolutely exhausted. He needs to fall asleep. A familiar worry pops up: "If I can’t fall asleep soon, my day is going to be so much harder tomorrow."

Thirty minutes pass and Charles is still awake. He finds himself getting more stressed and more worried. He tries harder. He turns over for the 15th time—switching from his side to his back, and then again to his side. Still, sleep is elusive. This is incredibly frustrating. He did all the steps. All the sleep tips he’s seen on Instagram. But no matter what he tries, he just can’t seem to figure out how to fall asleep.

It’s now been 90 minutes since he got into bed, and sleep just doesn't seem to be coming. Charles finds himself dreading tomorrow, thinking that it will be just like the past day: exhausting and difficult. After a three-hour battle, Charles finally passes out, managing about four hours of sleep before his alarm forces him up. Grudgingly, he manages to eventually pull himself out of bed and prepare for the next day of work. The nightmare never seems to end. He’s exhausted, and he needs a solution. He’s done all the "right" things—so why is nothing working?

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What Is Insomnia?

If Charles’s story sounds exhausting and familiar, it’s because millions of people go through this exact struggle every night. Sleep difficulties are remarkably common, with research indicating that roughly 30% to 35% of adults experience brief symptoms of insomnia, while about 10% meet the criteria for chronic insomnia disorder (Morin et al., 2015).

Clinically, insomnia involves persistent difficulty with sleep onset, duration, consolidation, or quality, despite having adequate opportunity and time for sleep (American Psychiatric Association, 2022). It typically manifests through a few key symptoms:

• Difficulty falling asleep at night (taking longer than 30 minutes)

• Frequent nighttime awakenings with trouble getting back to sleep

• Waking up far too early in the morning

• Unrefreshing or poor-quality sleep

• Daytime distress, fatigue, irritability, or cognitive fog

  
  

As human beings, we have a real need for sleep. Sleep plays an essential role in restoring our physical and mental capacities and enabling us to have the energy we need to go about our days (Walker, 2017). Sleep deprivation can impede our ability to function and have negative effects on our physical and mental health (Besedovsky et al., 2019). An inability to get sufficient sleep can have a real toll on our health, well-being, and everyday functioning. Considering this, it is no wonder that insomnia can become a major source of stress and anxiety for people struggling with it.

"Why is nothing working?"

The concern and anxiety that experiences of insomnia bring are incredibly understandable. Everyone wants to function well, and sleep problems can very quickly seem to become a primary obstacle to living well. And to some extent, sleep problems are an obstacle to living well! We most commonly will feel worse when we get less sleep and better when we get more sleep.

The issue is twofold. Firstly, whatever impact sleep problems can have, it is the struggle with sleep specifically that tends to result in the most significant negative effects. The second issue to consider is that paradoxically, once we learn how to stop struggling so much, it becomes much easier to actually fall asleep and get the sleep that we need. Let’s dive into these ideas.

The Struggle with Sleep is a Major Driver of Insomnia

Habits: Facilitative but Not the Core Solution

Our ability to fall asleep at night can be facilitated by a variety of foundational habits. These habits help prep our body's biological systems so that when it is time for bed, we are actually ready for it. These include:

Building Sleep Drive Sleep drive is essentially your body's "hunger" for sleep. The longer you are awake, the more a neurochemical called adenosine builds up in your brain, making you feel sleepy. If you snack right before dinner, you ruin your appetite; if you "snack" on sleep during the day, you ruin your sleep drive for the night.

• Limit or avoid napping: Napping relieves that sleep pressure, making it much harder to fall asleep at your actual bedtime.

  
  

• Stay physically active: Regular daytime physical activity helps build up robust sleep pressure by the end of the day.

  
  

Practicing Sleep Hygiene Sleep hygiene involves optimizing your environment and intake to remove barriers to sleep. It’s about making your bedroom a place that naturally invites rest.

• Keep it cool and dark: A cooler room (around 65°F or 18°C) and blackout curtains help signal to your body that it's time to rest.

  
  

• Watch the late-day intake: Avoid caffeine in the afternoon and limit alcohol before bed, as both disrupt the natural architecture of your sleep.

  
  

Establishing Consistent Sleep/Wake Routines Your body runs on an internal 24-hour clock called the circadian rhythm. When this clock gets confused by erratic schedules, sleep becomes a chaotic guessing game.

• Wake up at the same time every day: Yes, even on weekends. Consistency anchors your body's internal clock.

  
  

• Get morning sunlight: Exposure to natural light early in the day halts melatonin production and resets your circadian rhythm.

  
  

Sleep Habits Only Take Us So Far

Building healthy sleep habits is important. At the same time, good sleep habits and routines only set the stage for sleep; they don’t control our ability to actually fall asleep. Ensuring that you wake up at regular times, have a day that engages you mentally and physically, avoid late consumption of caffeine, and practice similar habits is helpful for making it more likely that you will be tired and sleepy at the end of the day. Without such practices, you run the risk of trying to get into bed when you are not actually tired—which is absolutely a contributing factor to insomnia. However, while preparation is important, it's not the whole story.

Preparing for a vacation is an important step in getting ready to take a vacation. Without the necessary planning—booking flights, planning trips, and building an itinerary—you may have a hard time having an optimal experience. However, preparing for a vacation is not actually the same thing as taking the vacation itself. It only gets you into the right context for having a great vacation, but it does not automatically ensure that you will enjoy it.

It’s the same with sleep. There are things to do that can be helpful and make it more likely that we will be able to sleep well, but doing those things does not automatically mean we will actually sleep well. Sleep habits tell us what to do to help us fall asleep; they do not tell us how we can actually fall asleep.

So, how can we actually fall asleep?

While preparation is important, it's not the whole story.

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How to Have a Terrible Vacation

Monica planned it all out. The perfect vacation with her husband in Rome. It took months of planning. Flights were booked, tour tickets were purchased, hotel stays secured. A great itinerary was planned as well. They would see all the sights: the Colosseum, the Pantheon, St. Peter’s Basilica, toss a coin in Trevi Fountain. She planned out where they would eat, travel routes, and all the stops to take along the way. It was perfect. The trip would be perfect.

The day of the trip arrived, and Monica and Peter flew off to Rome, ready for a wonderful vacation.

Unfortunately, it didn’t take too long before the problems started. First stop: the Colosseum. While the couple were initially blown away by the grand scale of the structure, taking in its history, architecture, and grandeur, stress started creeping in. The walk through the Colosseum was taking longer than expected. Monica kept anxiously glancing at her watch the whole time, mindful that they needed to make their way through this stop quickly so they could get to the next one. The couple followed the plan and rushed their way through the Colosseum, regretting that they had to leave so quickly.

At the next stop, the lines into St. Peter’s Basilica were much longer than anticipated. They rushed through this too, ensuring strict alignment to the plan.

And so it went throughout the whole trip until it was finally over and back home they flew. On the flight back home both Monica and Peter were exhausted, stressed, and felt like they needed to plan out a vacation to help them recover from their vacation!

What went wrong? It was all planned out so nicely. And so it was. The problem is that Monica and Peter viewed the plan as the guaranteed ticket to their enjoyment. If they followed their plan, then they would enjoy themselves.

However, in reality, they were so focused on following the plan, and all their energy was so engaged in sticking to the plan, that they never actually left any space or capacity for actual enjoyment. They forgot that planning to relax is not actually the same thing as relaxing. And they neglected to consider that the mental state of rigid plan-following is not actually compatible with the psychological experience of relaxing.

The plan was important. Without a plan, they might not have done anything in Rome in the first place. But at some point, it was necessary for them to realize that they had done ‘good enough’ planning, that actual experience would not always follow a plan—however good—and that after reasonable planning and adopting a flexible outlook, their best step forward was to simply allow their experience to unfold.

They focused on the question of: "What do we need to do to enjoy ourselves?" while failing to consider that the more important question—after a reasonable amount of planning—was: "What do we need to STOP doing to enjoy ourselves?"

Travelling from Wakefulness to Sleep 

Monica and Peter’s experience is unfortunately all too common with well-intentioned travel plans. The same kind of experience is also incredibly common when it comes to the sleep travel plans of those struggling with insomnia.

As Charles’s experience in the introduction to this article suggests, you can have the best plan in the world when it comes to sleeping and still fail to actually fall asleep. During their trip to Rome, Monica and Peter worried anxiously about getting to their next destination, with their worry creating a mental state that was simply incompatible with true relaxation. During his attempt to sleep, Charles worries anxiously about what will happen if he does not fall asleep—a mental state that is incompatible with sleeping.

How can someone actually fall asleep when they are simultaneously worrying about sleep? How can you fall asleep when you are constantly checking to see if you will soon be ready to fall asleep?

The more Charles worried and struggled with his sleep problem, the further away from sleep he was.

Sleep is important! We do want to function well. Good sleep will help with that, bad sleep less so. Considering that, it's entirely understandable that difficulties with sleep can create anxiety about one’s sleep difficulties. Unfortunately, the worry that this situation creates can become a primary contributor and maintaining factor of one’s sleep difficulties. Brains. Annoying things, aren’t they?

How can you fall asleep when you are constantly checking to see if you are asleep?

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Navigating The Paradox

The problem is straightforward enough to see: worrying and struggling only makes sleep problems worse. You get it. But, you ask: "I NEED to sleep! I am not functioning! How can I possibly not be stressed about this? It’s not so easy to control my feelings!"

Great question! Here’s the thing. What if this wasn’t about controlling feelings at all? And what if you could be stressed, but okay with being stressed?

I know, it doesn’t sound like I’m making much sense, but please—just bear with me for a bit as we explore these ideas.

Controlling What You Do is Easier Than Controlling What You Feel

As you may be well experienced with, it's not particularly easy to control feelings. If you are experiencing anxiety, simply wishing the anxiety away doesn’t seem to work very well. If you have a thought that you don’t like, simply trying to push it away doesn’t usually help.

In fact, these kinds of approaches more likely than not will worsen the problem. Want to ensure that you keep thinking about an unwanted thought? Your best bet is to try to get rid of that thought. This phenomenon is called Ironic Rebound (Wegner, 1994), so-called because when you try to get rid of an unwanted inner experience such as a thought or feeling, it ironically rebounds right back.

The best approach for dealing with unwanted inner experiences is (also ironically?) to let those inner experiences be exactly as they are.

Experiencing an unwanted feeling such as anxiety? Okay, let it stick around for a while. Mind keeps giving you a thought you don’t like? Cool, let your mind do what minds do.

The idea is to, in a sense, lay out the welcome mat for unwanted internal experiences. It’s not that you magically do want them all of a sudden, it's just that you recognize that this is simply the most functional path forward. It’s hard enough that you’re having thoughts and feelings you don’t want to have; fighting these thoughts and feelings just creates more stress and tension.

So, why not just let them be? They are already here. Let them be free to stay if they need to, and they can move on of their own accord when they are ready to.

Meanwhile, you’ve just taken away maybe a good 50% or more of the problem. The 50% of the problem that is added when you stress and struggle and fight your feelings. All that tension, effort, and work you would have been spending on that problem otherwise is now major energy saved!

Maybe you are stressed, but you are not allowing the stress to dictate the battle. Freeing up energy and mental capacity to engage in other things in fact makes it more likely that the feelings, on their own, will move on.

It’s hard for unwanted thoughts and feelings to go anywhere when you are locked in a struggle with them and watching them so closely. Now, these experiences can fade into the background as your life once again becomes the foreground.

The best approach for dealing with unwanted inner experiences is to let them be exactly as they are.

Shifting Your Focus to Action

With mental energy no longer being wasted on what you cannot truly control, you now become free to focus on what you can control: your actions.

While you may have a hard time wishing your thoughts away, you ARE able to control what you are actually doing in a given moment. When you are experiencing unwanted thoughts during the daytime, you can shift your attention and energy to another activity. For example, maybe you turn your attention to working on a work task. Maybe you go and call a friend that you want to catch up with. Maybe you go for a walk.

It’s not that you are running away from or trying to avoid the thoughts or feelings. Remember—that approach is only more likely to make unwanted thoughts and feelings persist. Instead, you are simply carrying on with your life, engaging in the other actions you would otherwise be doing if you weren’t busy engaged in the action of ruminating and worrying!

It happens to be that by engaging in another activity, it does make it easier for the mind to move on and have unwanted thoughts and feelings fade into the background more quickly. Kind of nice how that works.

Fighting thoughts and feelings just creates more stress and tension.

Applying This to Bedtime Struggles

Now, I know what you’re thinking: "That’s all very nice when it comes to daytime worries, but what on earth am I supposed to do when I’m trying to fall asleep and all my brain is doing is worrying about the fact that I can’t fall asleep! I can’t exactly go and do another activity."

Oh. But can’t you? Maybe you should.

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Nighttime Rumination

So here's the second piece of the puzzle: why your bed itself becomes part of the problem. At this point, it is necessary to describe another significant contributing factor to sleep issues: associative conditioning.

Have you heard of Pavlov and his dogs? While studying digestion in the late 1800s, Ivan Pavlov noticed that dogs would begin salivating at specific cues (like researchers in lab coats), even before food showed up. Curious, he ran a formal experiment: he'd give the dogs meat while ringing a bell, and after enough repetitions, the dogs would salivate at the bell alone — no meat required. Pavlov had identified a basic process of learning, now called classical (or associative) conditioning: pair a neutral cue with something that naturally triggers a response often enough, and the cue alone starts triggering that response on its own.

This isn't just a dog thing — humans learn the exact same way. Well, first of all, if you're reading this currently because you're having trouble falling asleep, this questionably stimulating historical account is bound to help facilitate your journey to sleep! But besides that, there's another reason you might want to know this: associative conditioning can be a major contributor to sleep difficulties.

We have pleasant experiences when hanging out with someone and find ourselves wanting to spend more time with them—the person becomes associated with warmth, connection, and positive experiences. We find that going into certain settings gives us anxiety—we learn to avoid those settings, which on their own now start to give us anxiety.

And when we find ourselves up in bed late at night, tossing and turning, desperately trying to fall asleep—an experience full of frustration, anxiety, exhaustion, and anguish—well, our very beds start to become associated with those experiences. Our beds become a cue for frustration, anxiety, exhaustion, and anguish.

The more time we spend tossing and turning in our beds fighting desperately for sleep, the stronger the association that develops. This phenomenon is a significant contributor of sleep difficulties for many people. The truth is, it's not just associations with negative mood states that is at issue here—the more time we spend awake in our beds, the more our beds become associated with and a cue for wakefulness.

Leaving the Bed - The Power of Stimulus Control

In consideration of this, one of the primary tools used with Cognitive Behavioural Therapy for Insomnia (CBT-I)—the gold standard psychological treatment approach for insomnia—is stimulus control.

Stimulus control involves limiting the amount of time one spends in bed awake, so that someone’s bed itself can become maximally associated with sleep. Of course, some time in bed awake is expected—it takes time to fall asleep after all—but the idea here is that of the percentage of time someone is in bed, that time is maximally spent asleep.

The single most important guideline regarding stimulus control is this: If you’ve been in bed trying to sleep for about 10-15 minutes already and you haven’t fallen asleep yet, get out of bed and go do something else for about 20-30 minutes before you try again.

What should you do? It doesn’t really matter tremendously (although check out the Q&A below for a discussion of this and other issues related to stimulus control). The point is that you interrupt the process of struggling and you ensure that as little time as possible is spent in bed stressing about not sleeping, so that your bed can start to become more of a cue for restful sleep than stressful struggles.

So there we have it. Struggling with rumination and unwanted thoughts during the daytime? Acknowledge the thoughts, make space for the inner experience, AND continue on with your life doing something else.

Struggling with rumination and unwanted thoughts, and worries about the impact of sleep deprivation while you’re trying to fall asleep? Acknowledge the thoughts, make space for the inner experience, AND leave your bed and go do something else. Not only does it interrupt the rumination/worry habit, it lessens your time in bed struggling, helping your bed be a place associated with sleep rather than sleep deprivation. A true 2 for 1 deal.

If you’ve been in bed trying to sleep for about 10-15 minutes already and you haven’t fallen asleep yet, get out of bed and do something else for about 20-30 minutes before you try again.

Do I really have to leave the bed? Can’t I just accept my thoughts and stay in bed? 

Technically, yes! Doing that would technically also interrupt the ruminative process and it would reduce associations of bed and struggle. However, two important counterpoints:

1. True acceptance of unwanted thoughts and feelings while you are desperately wanting to fall asleep is a very difficult ask. It is usually more effective to change the environmental context.

2. Even if you manage to truly accept the thoughts and experience and really find that you can relax in bed with your unwanted thoughts and feelings present, the fact of the matter is that you remain awake. Your bed is still being associated with wakefulness, when the primary goal is for your bed to be associated with sleep itself.

For someone struggling with regular insomnia difficulties, it is usually far more effective to leave the bed for a short period before getting back in bed.

Cognitive Coaching

While acceptance of your experience combined with the practical action of leaving the bed is where most of the magic happens, it is absolutely fair to acknowledge that this can be quite difficult, especially for the chronically sleep-deprived.

For this reason, it can be helpful to bring in an additional strategy: cognitive coaching—or for the more technical term, cognitive restructuring.

Cognitive restructuring is a strategy from cognitive behavioural therapy. A core tenet behind CBT is the idea that our thoughts, feelings, and behaviors are all interconnected, and how we interpret a situation powerfully dictates how we feel about it. When your mind tells you that if you don’t fall asleep in 30 minutes, your day tomorrow is going to be completely ruined, you can remind yourself of a few grounded truths:

• You've functioned okay in the past: You have likely survived days on little to no sleep before. It wasn't fun, but you got through it, and you will get through tomorrow if needed.

• Sleep quality is far more important than sleep quantity: A few hours of deep, consolidated sleep can often be more restorative than 8 hours of anxious tossing and turning.

• Short-term strategy for long-term success: Tell yourself, "Yes, getting out of bed right now is annoying, but this stimulus control is an investment in fixing my sleep for good."

  
  

The goal with this kind of strategy is not to get into a battle with your thoughts—that only creates more struggle and more of the problems we’ve already discussed. Instead, the goal is simply to talk to that anxious part of your brain and give it some helpful reminders that may help it relax a bit, as you continue doing your best to open up to your experience, and move towards effective strategies such as stimulus control.

Coping with Sleep Deprivation

It also helps to remind your anxious brain that you have tangible ways to cope with sleep deprivation during the day. Missing sleep is tough, but you are not entirely helpless the next day.

There are specific things you can do during the day that can help soften the impact of sleep deprivation. For example, research suggests that taking even a brief 5 to 10-minute walk can significantly boost arousal, increase energy levels, and reduce the impact and effects of sleep deprivation (Thayer, 1987).

• Get outside for natural light: Sunlight exposure tells your circadian rhythm it’s daytime, helping burn off some of the grogginess.

• Pace yourself: Focus on your most critical tasks when you have energy, and give yourself permission to lower the bar on non-essential tasks.

• Stay hydrated and eat balanced meals: Your body will crave heavy sugars for quick energy after a bad night, but sticking to hydration and protein will prevent severe afternoon crashes.

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Putting It All Together

So let’s recap what we have covered in this article. Sleep difficulties can be caused by many factors. Anxiety and effortful attempts to sleep can play a major role in the maintenance of sleep difficulties. For those struggling with insomnia, several strategies can be employed:

• Build Sleep Facilitators:

  • Limit or avoid daytime napping to preserve sleep drive.

  • Stay physically active during the day.

  • Wake up at the same time every morning to anchor your circadian clock.

• Reduce/Remove Sleep Inhibitors:

  • Keep the bedroom cool, dark, and comfortable.

  • Avoid late afternoon caffeine and evening alcohol.

  • Stop watching the clock when you are struggling in bed.

• Embrace Acceptance AND Wise Action:

  • Stop fighting your nighttime worries; lay out the welcome mat and let them be.

  • Use cognitive coaching to gently remind yourself that you can cope with a bad night of sleep.

  • Practice stimulus control: If you've been awake in bed for 15-20 minutes, get out of bed and do something relaxing until you are sleepy again.

    
    

Going Deeper - CBT-I

The concepts we’ve explored here—stimulus control, cognitive restructuring, and sleep hygiene—are foundational pillars of Cognitive Behavioural Therapy for Insomnia (CBT-I).

CBT-I is a structured, short-term, evidence-based program that goes beyond basic sleep tips to actually retrain your brain and body's relationship with sleep. In addition to what we've discussed, a full CBT-I protocol often involves Sleep Restriction/Consolidation (temporarily matching your time in bed to your actual sleep time to build a massive, consolidated sleep drive) and formal sleep tracking to guide your progress.

If you want to start tracking your sleep accurately without relying on anxious guesswork or hyper-sensitive fitness trackers, the Consensus Sleep Diary is a fantastic, clinically validated tool (designed and developed by researchers right here in Toronto!). Additionally, the CBT-i Coach mobile app (developed by the US VA and Stanford) is an excellent free resource that provides sleep diaries, stimulus control reminders, and guided relaxation exercises directly on your phone.

CBT-I goes beyond basic sleep tips to help you retrain your brain and body's relationship with sleep.

Additional Considerations in Insomnia and Sleep Issues

While the strategies described in this article can be tremendously helpful for those struggling with insomnia, it is important to acknowledge that sleep difficulties can be caused by a wide variety of factors. While behavioural and therapy approaches such as Cognitive Behavioural Therapy for Insomnia (CBT-I) are the gold standard for treating insomnia, it is important to assess for and address potential other contributing factors.

Sleep conditions such as sleep apnea or restless leg syndrome can be common causes of sleep issues. Medications and other health conditions can also play a role in sleep difficulties and be a cause or contributor of insomnia. It is important to discuss sleep issues with your primary care provider to rule out other potential causes and contributors of insomnia.

Sleep studies are typically covered by OHIP in Ontario and other parts of Canada, and may often be covered by insurance plans in the US. If you’re struggling with sleep issues, it may be worthwhile to discuss the potential benefits of doing a sleep study with your primary care physician, as sleep studies can help rule out other potential contributors to sleep issues. While insomnia can co-occur with sleep disorders and still primarily benefit from a behavioural approach such as the one described in this article, understanding potential contributing factors is important to ensure maximal benefit.

Getting Help for Insomnia

Living with insomnia often means spending a great deal of time trying to stay one step ahead of tomorrow's exhaustion. When so much energy goes toward preparing for what might happen if you don't sleep, bedtime becomes a battleground instead of a place of rest. Therapy can help you step out of the struggle and rebuild a healthy, effortless relationship with sleep.

If you are looking for a therapist to help you with insomnia in Toronto or virtually across Ontario, our team can help. To learn more about how to fall asleep naturally again, connect with our Client Care Coordinator at Radcliffe Psychotherapy Clinic. They can answer your questions, discuss your needs, and help match you with a therapist trained in CBT-I. You can reach out at admin@angerandanxiety.com, call us at (289) 801-4133, or book a consultation online.

Therapy can help you step out of the struggle and rebuild a healthy, effortless relationship with sleep.

Frequently Asked Questions

What should I actually do for 20-30 minutes when I get out of bed? 

While recommendations can vary depending on the specific nature of someone’s sleep problems, in an acute phase of insomnia, the recommendation is typically that time in bed is exclusively reserved for sleeping or sex. When you get out of bed, go to another dimly lit room and do something mildly engaging but relaxing. Reading a physical book, listening to calm music, or doing a crossword puzzle are great options. Avoiding bright screens, working, or eating snacks may be a good idea, but the research is actually mixed on how much of a negative impact those activities would have. It may be most important simply to interrupt the process of rumination and sleep struggle, rather than focusing on particular activities to do or not to do. 

Can CBT-I for insomnia work for ADHD? 

Yes! Sleep difficulties are exceptionally common in individuals with ADHD, often due to delayed circadian rhythms, racing thoughts, or "revenge bedtime procrastination." Early evidence is promising: a pilot study adapting CBT-I into a group format for adults with ADHD found meaningful improvements in insomnia severity (Jernelöv et al., 2019), and a broader review of sleep interventions in adult ADHD echoes CBT-I's potential when adapted to this population (Surman & Walsh, 2021). While large randomized trials specific to ADHD are still catching up to the broader CBT-I evidence base, an ADHD-informed approach works with the executive functioning challenges of the ADHD brain rather than against them. 

Can CBT-I help teenagers and children who struggle with insomnia?

Yes. While teen insomnia often stems from delayed circadian rhythms, academic stress, and late-night screen time, sleep struggles in younger children frequently involve bedtime anxiety or relying on a parent to fall asleep. Fortunately, Cognitive Behavioural Therapy for Insomnia (CBT-I) is highly effective when adapted for their developmental stage. Research demonstrates that CBT-I for adolescents significantly reduces the time it takes to fall asleep and improves overall sleep efficiency (de Bruin et al., 2015). Treatment helps teens manage stimulus control and nighttime anxiety, while helping parents of younger children build consistent routines that foster independent sleep confidence. Considerations regarding your child's or teen's sleep struggles, including ruling out underlying medical issues, should be discussed and evaluated with your pediatrician or primary care provider.

I have a hard time leaving the bed because it's cold outside the covers. What should I do?

This is a very common barrier to stimulus control! It helps to prepare your "awake space" ahead of time. Keep a warm robe or blanket right next to your bed, and have a cozy chair set up in the other room with a book already waiting for you. Making the transition as frictionless and comfortable as possible makes it much easier to follow through when it’s 2:00 AM and you feel frustrated.

Why do I fall asleep so easily on the couch, but wake up as soon as I get into bed? 

This is a classic example of associative conditioning in action! If you regularly struggle to sleep in your bed, your brain learns to treat the bed as a cue for stress, frustration, and wakefulness. Your couch, on the other hand, hasn't been contaminated by that anxiety—your brain just associates it with watching TV and relaxing. When you move from the couch to the bed, your brain detects the change in environment and triggers a conditioned arousal response, waking you right back up. This is exactly why practicing stimulus control (getting out of bed when you can't sleep) is so essential for retraining your brain.

Is it better to take sleeping pills or try CBT-I for insomnia? 

While sleep medications can sometimes provide short-term relief during acute crises, they are generally not recommended as a long-term solution. Medications can come with side effects, grogginess, and a risk of dependency, and they don't teach you how to actually fall asleep on your own. Major medical organizations, including the American College of Physicians, recommend Cognitive Behavioural Therapy for Insomnia (CBT-I) as the first-line treatment for chronic insomnia. Unlike medication, CBT-I addresses the root behavioral and psychological causes of your sleep struggles, providing a long-lasting, sustainable solution without the side effects. Considerations regarding the potential risks and benefits of sleeping pills, medication, or supplements in your situation should be discussed and evaluated with your primary care provider. 

Does melatonin help with chronic insomnia?

Many people reach for over-the-counter melatonin hoping it will work like a natural sleeping pill to quickly knock them out. However, melatonin is actually a sleep regulator, not a sleep initiator. It is a hormone your brain naturally produces to signal that it is nighttime, which helps align your body's circadian clock. While it may be effective for specific timing issues like jet lag or shifting a delayed sleep schedule (which is especially common for individuals with ADHD), research shows it is generally not an effective frontline treatment for chronic, anxiety-driven insomnia. Taking melatonin will not stop your mind from racing, nor will it undo the conditioned anxiety of tossing and turning in bed. For chronic sleep struggles, addressing the behavioral and psychological patterns with CBT-I is typically far more effective. Considerations regarding the potential risks and benefits of melatonin or other supplements in your situation should be discussed and evaluated with your primary care provider.

How do I stop my mind from racing at night? 

The short answer is: you don't. When you actively try to force your brain to stop thinking, you trigger the "Ironic Rebound" effect, which only makes your thoughts louder and more persistent. Instead of treating racing thoughts as an emergency that you need to shut down, try practicing acceptance. Let your mind chatter away in the background without engaging in a battle with it. If the racing thoughts are creating too much anxiety to relax, that is your cue to get out of bed, move to a dimly lit room, and give your brain a low-stimulation activity (like reading a book) to focus on until the mental storm passes and sleepiness returns.

Disclaimer: The information provided in this article is for educational and informational purposes only and is not intended as medical, psychiatric, or psychological advice. Shlomo Radcliffe is a Registered Psychotherapist, not a physician, and the content of this article should not be used as a substitute for professional medical diagnosis, treatment, or consultation. Always seek the advice of your physician or a qualified healthcare provider with any questions you may have regarding a medical condition, sleep disorder, or medication. Never disregard professional medical advice or delay in seeking it because of something you have read in this article. Reading this article does not establish a therapist-client relationship. 

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

Besedovsky, L., Lange, T., & Haack, M. (2019). The sleep-immune crosstalk in health and disease. Physiological Reviews, 99(3), 1325–1380. https://doi.org/10.1152/physrev.00010.2018

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