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 does therapy here actually look like?

The structure is the same for everyone, and the content is yours.

Session 1 is an intake. Your therapist asks what brought you in and about your history, and you rate the intensity of the sleep trouble and the nighttime worry on a 0 to 10 scale. That number becomes the baseline everything is measured against. You set a recurring weekly time before you leave.

Session 2 is a psychosocial assessment. Your therapist walks through your life across stages, looking for the patterns and strengths behind what you came in with. You can decline any question you do not want to answer.

Session 3 is the treatment plan. You build it together. Goals are tied to what you came in for, each with concrete objectives, plus one personal goal that matters to you and has nothing to do with a diagnosis.

Then the work runs weekly. You keep a sleep log, adjust the sleep window and routine, and work on the worry that keeps you awake. Once a month you and your therapist review progress using standardized measures, so you can both see whether the plan is working. If the measures say it is not, the plan changes. Therapy here is measured, not guessed at.

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 and Indiana, including Carmel. 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 mindviewtherapy.clientsecure.me
• 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.