Introduction: Why Therapy Helps When Nothing Else Does

Most people don’t realize this yet, but insomnia has one of the most effective psychological treatments in all of mental health. A structured behavioural method called CBT-I consistently outperforms sleep medications in long-term outcomes, yet remains surprisingly underused in the general population.

As I’ve sat with countless clients across British Columbia—people who arrive exhausted, frustrated, and often convinced that “nothing works”—I’ve learned something simple but important:
Insomnia is rarely a sign that your body is broken. More often, it’s a pattern that has become stuck.

And patterns can be changed.

This article is my attempt to give you what I wish every tired person knew. If you struggle with falling asleep, staying asleep, waking too early, or lying awake with a mind that refuses to quiet, know this:
Insomnia is treatable, even if it’s been with you for years.

CBT-I provides the structure.
ACT provides the willingness, compassion, and psychological flexibility.
Together, they change lives.

Let’s walk through exactly how—and what treatment with a CBT-I therapist looks like from start to finish.

What Insomnia Really Is (And What It Isn’t)

What is insomnia, clinically?

Insomnia isn’t defined by how much sleep you get. It’s defined by difficulty:

• Falling asleep (usually >30 minutes)

• Staying asleep (frequent wake-ups)

• Waking too early

• Experiencing impairment during the day (fatigue, irritability, concentration issues)

It must occur at least three nights a week, for at least three months, and despite adequate opportunity for sleep.

But real insomnia feels far messier than a diagnostic checklist.

People describe:

• “My body is tired but my brain won’t shut off.”

• “I fall asleep fine but wake at 3 AM like my brain flipped a switch.”

• “I worry at night in ways I never do during the day.”

• “Every night feels like a test I’m failing.”

Why insomnia becomes chronic

This is the part most people misunderstand. Acute insomnia (from stress, illness, travel, etc.) often resolves on its own. But chronic insomnia is held in place by what CBT-I calls maintenance factors:

1. Conditioned arousal
   The bed becomes associated with wakefulness, worry, and effort.

2. Compensatory behaviours
   Napping, sleeping in, going to bed early, cancelling activities, staying in bed awake.

3. Sleep effort
   Trying to force sleep (which paradoxically increases arousal).

4. Worry and over-monitoring
   “What if I can’t sleep again?”
   “What if I’m ruined tomorrow?”

Once these processes kick in, sleep becomes a nightly battleground—not a biological rhythm.

Why People Don’t Realize Therapy Is the Treatment

Most of the world thinks insomnia is a medical problem or a chemical imbalance.
In truth, insomnia is primarily a learning problem, a conditioning problem, and a behavioural cycle problem.

And the most effective treatments—CBT-I and ACT—work because they target the process of insomnia rather than the symptoms.

This is why your doctor may tell you to improve your sleep hygiene, cut caffeine, or limit screens… yet you still lie awake.

Sleep hygiene is helpful.
Sleep hygiene is not treatment.

Real treatment changes the conditioning, the patterns, and the relationship you have with nighttime wakefulness.

The Science of CBT-I (The Gold Standard Treatment)

CBT-I is a structured, scientifically validated therapy that directly recalibrates your sleep system. Decades of research support its effectiveness for all forms of chronic insomnia.

Here is what CBT-I involves, in clear, human terms.

1. Sleep Restriction Therapy

(the core intervention)

This is the most counterintuitive—and the most powerful—component.

Sleep restriction limits your time in bed to match your actual sleep ability, then gradually expands it.

For example:

• You spend 8.5 hours in bed

• You only sleep 5.75 hours

• Treatment begins by setting your “sleep window” to 5.75 hours

This increases your sleep pressure (a biological drive to sleep), overpowers conditioned wakefulness, and consolidates sleep.

Clients often say:

• “I slept deeper this week than I have in years.”

• “It feels strange, but it’s working.”

• “For the first time, I woke up only once.”

Sleep restriction is not sleep deprivation.
It is precision recalibration.

2. Stimulus Control

This intervention repairs the broken association between the bed and wakefulness.

In stimulus control:

• Go to bed only when sleepy

• Use the bed for sleep and intimacy only

• If awake >20 minutes, leave the bed

• Return only when sleepy again

Over time, your bed becomes a cue for sleep, not a battleground for thoughts.

3. Cognitive Shifts (Not Classic “Challenging Thoughts”)

CBT-I includes cognitive restructuring, but modern CBT-I recognizes that over-fighting thoughts can backfire.
This is where ACT blends naturally.

Rather than trying to “debate” thoughts, we shift toward:

• Realistic expectations

• Reducing catastrophic interpretations

• Letting go of unhelpful over-analysis

For example:
“I’ll feel awful tomorrow” becomes
“I may feel tired, and I’ve coped with tiredness many times.”

4. Sleep Hygiene… as a supporting role

Things like:

• Light exposure

• Caffeine timing

• Evening routines

• Bedroom environment

These matter, but not nearly as much as most people think.

In therapy, hygiene is used to support sleep—not to “fix” it.

5. Relaxation (Optional, but helpful)

Relaxation is not a cure for insomnia.
But it can reduce physiological arousal.

I often teach:

• Diaphragmatic breathing

• Progressive muscle relaxation

• Autogenic training

• Mindfulness grounding

Relaxation helps.
Relaxation does not produce sleep.
But it can make the process less overwhelming.

Where CBT-I Alone Sometimes Falls Short

Some clients understand exactly what to do… and still can’t do it consistently.

Why?

Because:

• Their anxiety spikes when they stay up later

• Leaving the bed at 2:00 AM feels impossible

• They become perfectionistic about “doing CBT-I right”

• Sleep restriction triggers fear, frustration, or hopelessness

• They cling to control strategies that make sleep worse

For these people (which is many), adding ACT transforms the entire process.

How ACT Complements CBT-I

ACT—Acceptance and Commitment Therapy—adds the emotional and psychological flexibility necessary to stick with CBT-I even when anxiety and frustration rise.

Here’s how each ACT process helps insomnia.

1. Acceptance (Not Resignation)

Acceptance means learning to make space for unwanted thoughts, sensations, and wakefulness—without escalating the struggle.

Examples:

• Allowing your heart to race without trying to force calm

• Letting wakefulness be present at 3:00 AM instead of fighting it

• Letting frustration rise and fall without acting on it

Acceptance reduces sleep effort.
Sleep effort is the enemy of sleep.

2. Defusion

This process teaches you to see sleep thoughts as thoughts, not truths or commands.

You learn to:

• Notice the “what if I don’t sleep?” story

• Notice the “I’ll be ruined” story

• Name the patterns

• Respond with distance, curiosity, and gentleness

Instead of wrestling with thoughts, we make room for them.

3. Present-Moment Awareness

Mindfulness helps reduce catastrophic future-thinking during the night.

A mindful 3 AM moment sounds like:
“This is unpleasant, but I can allow it.
My breath is here.
The room is here.
I don’t need to solve this right now.”

You shift from threat mode to experience mode.

4. Values

ACT uses values to answer the question:

“What kind of life am I trying to build, even when sleep is hard?”

Values give direction when motivation is low.

Examples:

• “I want to be present with my kids in the morning.”

• “I want to rebuild my health.”

• “I care about my creativity.”

Values guide action even when sleep anxiety is loud.

5. Committed Action

This is where ACT and CBT-I merge beautifully.

Even when:

• You’re tired

• You’re frustrated

• You’re scared it won’t work

You take the next helpful step because it aligns with who you want to be.

A Combined CBT-I + ACT Treatment Plan (Week by Week)

Every therapist does this slightly differently, but here’s a typical integrated approach.

Week 1 — Assessment, Education, and Sleep Diary

You learn:

• What insomnia is

• Why it persists

• How your specific patterns maintain it

You complete:

• A detailed sleep diary

• An ACT matrix or values reflection

• Identification of avoidance patterns

You receive your initial sleep window at the end of week 1.

Week 2 — Stimulus Control + Early ACT Skills

You learn how to:

• Leave the bed when awake

• Reduce the “clock-watching” cycle

• Practise early defusion techniques

ACT tools introduced:

• “Leaves on a Stream”

• “Name the Story”

• Mindful breathing

Week 3 — Sleep Restriction + Acceptance Tools

Sleep restriction intensifies.

Most people feel more tired—this is expected and intentional.

You learn:

• Open-hands acceptance

• Making room for fatigue

• Allowing nighttime anxiety without escalation

Week 4 — Middle-of-the-Night Protocol

We build a plan for:

• What to do when awake

• Mindful wakefulness

• Redirecting worry

• Gentle, values-based behaviours

• Returning to bed only when sleepy

Week 5 — Cognitive Flexibility and Catastrophe Softening

We explore:

• “What if?” thinking

• The performance mindset

• The identity of “I’m a bad sleeper”

Skills:

• Defusion

• Self-as-context

• Compassionate internal voice

Week 6 — Daytime Expansion

Insomnia shrinks your life.
Treatment expands it again.

This week builds:

• Routines

• Social engagement

• Physical activity

• Daytime value-based habits

The goal:
A full, rich life that supports strong sleep pressure and reduces nighttime rumination.

Week 7–8 — Consolidation and Relapse Prevention

We finalize:

• Stable sleep window

• Consistent wake time

• Long-term coping plans

You learn:

• How to handle future stressors

• How to prevent relapse

• How to recover quickly when setbacks occur

A Fictionalized Client Story (Composite Example)

Let me introduce Jordan, a composite of many clients I’ve worked with in British Columbia.

Jordan was a 38-year-old teacher who had been sleeping poorly for four years.
He fell asleep fine but woke at 3:15 AM like clockwork.
He tried everything:

• Melatonin

• Magnesium

• Audiobooks

• Podcasts

• YouTube sleep hypnosis

• Earlier bedtime

• Later bedtime

• Eliminating screens

• Supplements

• Cutting caffeine

Nothing worked.

Jordan told me, “The nights are where my life collapses.”

What we discovered

His insomnia was maintained by:

• Staying in bed while awake

• Napping after work

• Cancelling exercise classes

• Lying awake and scanning for tiredness

• Fear-driven sleep effort

• Believing he “needed 8 hours or else”

Treatment

Over 7 weeks we used:

• Sleep restriction

• Stimulus control

• ACT defusion

• Acceptance of wakefulness

• Values (“I want to be an engaged teacher again.”)

Outcome

By week 6:

• He was sleeping through the night

• He no longer feared bedtime

• He woke once briefly, then fell asleep easily

• He returned to morning workouts

• He reported “my brain feels like it exhaled for the first time in years.”

Most importantly, he no longer identified as “a bad sleeper.”

He became a person who sleeps again.

Common Questions

Why can’t I fall asleep even when I’m exhausted?

Because exhaustion is not the same as sleep pressure.
Overthinking and conditioned wakefulness override your natural sleep drive.
CBT-I restores it.

Why do I wake up at 3 AM every night?

Because the brain has been conditioned to become alert at that time.
With CBT-I and ACT, this pattern can be retrained.

Do I need a CBT-I therapist?

If insomnia has lasted more than three months and is affecting your life, professional help is recommended—especially if you’ve already tried basic sleep tips.

How long does CBT-I take to work?

Most people notice improvement within 2–3 weeks.
Full treatment usually takes 6–8 weeks.

What if anxiety is my real problem?

CBT-I and ACT both directly address nighttime anxiety by reducing struggle and expanding tolerance for wakefulness.

Can therapy help if I’ve had insomnia for years?

Absolutely.
Chronic insomnia is maintained by patterns—not permanent damage.
Patterns can change.

Self-Help Tips to Try Before Therapy

1. Keep a consistent wake time

2. Reduce time spent awake in bed

3. Avoid napping

4. Build morning light exposure

5. Stop checking the clock

6. Practise mindful acceptance of nighttime wakefulness

7. Increase daytime activity

If these don’t make a difference after two weeks, that’s when therapy becomes essential.

When to Seek Professional CBT-I Treatment

You should consider working with a CBT-I therapist if:

• Insomnia has lasted >3 months

• You dread bedtime

• You lie awake thinking about sleep

• You feel exhausted but wired

• You’ve tried sleep hygiene with no improvement

• Fatigue is affecting your relationships, work, or mood

• You want to stop relying on medication

This is exactly what I help people with.

If You’re Ready to Sleep Again

I meet with clients across British Columbia through secure online therapy.
If chronic insomnia has been wearing you down, CBT-I and ACT can rebuild your sleep from the ground up.

Book a free consultation

If you want to learn more or see if we’re a good fit, you can book a free 15-minute consultation through my website.

Your nights can be different than they’ve been.
Your body still remembers how to sleep.
Sometimes, insomnia is just a pattern waiting for the right approach to unwind it.

Glossary

Sleep Drive:
Biological pressure to sleep that builds during wakefulness.

Conditioned Arousal:
Learned alertness triggered by the bed or nighttime.

Sleep Restriction:
Calibrating time in bed to strengthen sleep drive.

Stimulus Control:
Rebuilding the association between bed and sleep.

Sleep Effort:
Trying too hard to sleep, which increases arousal.

Defusion:
Stepping back from thoughts rather than fighting them.

Acceptance:
Allowing discomfort without struggle.

Values:
What matters to you that guides committed action.

Committed Action:
Doing what aligns with values, even when difficult.

This Guide Is Useful for People Asking

• “How do I fix chronic insomnia without medication?”

• “Is CBT-I effective?”

• “What therapist in BC treats insomnia?”

• “Why do I wake up at 3 AM every night?”

• “How does ACT help with sleep anxiety?”

• “What does insomnia treatment look like?”

• “Where can I find a CBT-I therapist in British Columbia?”