Therapy to help you sleep better and worry less at night

What are sleep problems, really?

Sleep problems mean trouble falling asleep, waking through the night, or waking too early and not getting back down. When that persists, it is called insomnia.

The National Institutes of Health describes chronic insomnia as sleep difficulty occurring at least three nights a week for three months or longer, with daytime consequences. Those consequences are usually what drives people to seek help: fatigue, poor focus, low mood, and a short fuse.

What surprises most people is that the original cause often no longer matters. A stressful stretch, a new baby, a schedule change, or a health scare may have started it. By the time you look for help, the cycle is running on its own.

Why does trying harder make it worse?

Because sleep is one of the few things you cannot force. Effort is the enemy of sleep.

Here is the loop. You have a bad night. The next night you go to bed early to catch up. You lie there awake, doing the math on how many hours are left. Bed becomes a place where you fail at sleeping, so your body starts to associate the bedroom with alertness instead of rest. You get more anxious, you try harder, and the loop tightens.

The worry itself is part of the mechanism. Worrying about not sleeping is one of the most reliable ways to not sleep. This is why generic advice like “avoid screens” so often does not fix it. The advice targets habits. The problem is a cycle.

How does CBT-I work?

Cognitive behavioral therapy for insomnia, or CBT-I, is a structured, drug-free treatment recognized as first-line care for chronic insomnia. It attacks the cycle from both directions.

On the behavior side, your therapist works with you on your sleep window, your routine, and what you do when you are awake in the middle of the night. The changes are counterintuitive at first, and they are also the ones that move the needle. You rebuild the link between the bed and sleep.

On the thinking side, you work on the nighttime worry and the catastrophic math. “I will be useless tomorrow.” “I am wrecking my health.” Those thoughts raise arousal at exactly the moment your body needs it to drop. Your therapist helps you catch and defuse them.

You track your sleep in a simple log. The log is what tells you and your therapist whether the plan is working, so you are not guessing.

Why has sleep hygiene advice not worked for me?

Because sleep hygiene is not a treatment. It is a set of sensible habits, and habits alone rarely fix chronic insomnia.

You have probably already done the list. No caffeine after noon. No screens before bed. Cool, dark room. Melatonin. A wind-down routine. Some of it helped a little, none of it stuck, and you concluded there was something wrong with you.

There is not. The advice failed because it targets the wrong layer. Sleep hygiene addresses inputs. Insomnia is a cycle, and cycles need to be broken at the point where they feed themselves: the time you spend in bed awake, the compensating naps and lie-ins, and the anxiety about sleep itself.

The changes CBT-I asks for are more specific and frankly less pleasant at first. Compressing your time in bed. Getting up when you are awake instead of lying there. Holding a fixed wake time even after a bad night. They are uncomfortable for a week or two, and they are the ones that actually work.

That is exactly why doing this with a therapist matters. The plan is easy to abandon on day four when you are tired and it feels backwards. Having someone track the log with you is what carries you through to the point where it turns.

What if my sleep problem is really an anxiety problem?

Often it is both, and that is fine. Anxiety, stress, depression, and insomnia feed each other in loops, and treating one usually helps the others.

Your therapist will look at the whole picture. If worry is the engine, you may spend more time on anxiety skills. If the pattern is more habit-driven, you may spend more time on the sleep window and routine. Most people need some of both.

If a medical cause such as sleep apnea seems likely, your therapist will tell you and suggest you see a physician. Therapy does not replace a medical workup when one is warranted.

What gets tracked, and why the log matters

Insomnia is one of the few conditions where your own memory of the problem is unreliable. People who lie awake routinely overestimate how long it took to fall asleep and underestimate how much they slept. That is not a character flaw. Time passes strangely in the dark when you are anxious about it.

So the work runs on a sleep log rather than on recall. You write down roughly when you got into bed, when you think you fell asleep, how many times you woke, when you finally got up, and how the next day went. It takes about a minute each morning.

From that log your therapist calculates your sleep efficiency, the share of time in bed that you were actually asleep. That single number is what the sleep window is set from, and it is what tells you both whether a change is working. Most people are surprised by it in the first two weeks. Someone who is convinced they slept two hours often finds the log says five, and the gap between the two is itself worth talking about.

The log also catches the compensating behaviors that keep insomnia alive: the 10pm bedtime after a bad night, the weekend lie-in, the 4pm nap that felt necessary. None of those show up in a conversation about how your week went. They all show up on paper.

What makes insomnia hard to shift on your own

The behavioral part of CBT-I is simple to describe and genuinely unpleasant to do alone. If your log shows you are in bed nine hours and asleep six, your therapist will suggest spending closer to six and a half hours in bed. That is sleep restriction, and it works by building sleep pressure until your body takes the bed seriously again.

For the first week or two it makes you more tired, not less. That is where people quit. Doing it with a therapist means someone is reading the log with you and can tell you whether the numbers are moving before your patience runs out, and can widen the window as soon as your efficiency supports it.

The second hard part is stimulus control: getting out of bed when you have been awake for a while, instead of lying there hoping. It feels like giving up. It is actually how you stop teaching your nervous system that the bed is where you lie awake and think.

The third is holding a fixed wake time after a bad night, when every instinct says to sleep in and repay the debt. Repaying it is what pushes the next night later, and the loop continues.

What people get wrong about insomnia

The most common mistake is treating tiredness and sleepiness as the same thing. Tired is a daytime feeling of depletion. Sleepy is the specific pull toward unconsciousness. People with insomnia are often exhausted and not remotely sleepy, which is why going to bed early does not help. Learning the difference changes what you do at 9pm.

The second mistake is assuming that fixing sleep requires finding the original cause. The stress or anxiety that started it may be long resolved while the insomnia carries on under its own power, maintained by the habits built around it.

The third is believing a bad night ruins the next day in the way it feels like it will. Most people function better on poor sleep than they predict. Testing that prediction, rather than arguing with it, is part of the cognitive work.

How do I get started?

We are in-network with most major plans, so for many people care costs a copay. Coverage depends on your plan and location, and we confirm your benefits before your first session.

Sessions are available at our Jamaica, Queens office, our Buffalo office, and by telehealth across New York. CBT-I works well by video, so you can do the whole course from home.

We are accepting new clients now, and we respond within one business day.

• Book online at choose your therapist
• Call (646) 493-4007
• Email info@mindviewtherapy.com

You have probably been managing this alone for a long time. You do not have to keep doing that.