Why Sleep Hygiene Isn’t Enough for Insomnia—and What to Do Instead. Part 2.

The late-afternoon sun filtered through the blinds, casting long stripes across the rug. Anna sank into the chair opposite me with a sharp exhale, her arms folded tight across her chest. Frustration clung to her like a second skin.

Anna: “I don’t get it. I’ve tried everything—melatonin, chamomile tea, cutting caffeine, going to bed earlier. For a whole week I forced myself to follow every sleep-hygiene rule I could find online. Nothing changed. Nothing worked.”

She shook her head, staring at the floor. “I must be broken. Normal people just… sleep.”

I waited a beat before leaning in. “You’re not broken, Anna. What you’re describing is insomnia—and insomnia isn’t just about the hours you don’t sleep at night. It’s a twenty-four–hour disorder.”

Her eyes flicked up, doubtful. “Twenty-four hours? What do you mean?”

“It shows up in the day too—the fatigue, the fogginess, the irritability. And sometimes, the problem isn’t the number of hours you’re actually sleeping, but the way your brain perceives it. People with insomnia often feel like they’ve slept less than they really have.”

Anna frowned, her arms tightening around her middle. “So… you’re saying I might not be as sleepless as I feel?”

“Exactly. Your worst nights stand out, and your brain latches onto them. But your body may still be sneaking in more rest than you realize. Insomnia isn’t just about sleep loss—it’s about the brain’s difficulty with managing the rhythm between wakefulness and rest.”

Her shoulders dropped, just a fraction, as she let the thought sink in.

The Roots of Insomnia

I picked up a notepad from the side table and drew three overlapping circles.

“It might help to think of insomnia through what we call the ‘3 Ps model.’ There are three layers that interact: predisposing factors, precipitating factors, and perpetuating factors.”

I tapped the first circle. “Predisposing factors are the things that make someone more vulnerable. For example, being a naturally light sleeper.”

The second circle. “Precipitating factors are the triggers—stressful events, a breakup, a health scare, losing a job. Something that knocks your sleep off balance.”

Finally, the third. “And perpetuating factors are the habits and thoughts that keep insomnia alive long after the trigger has passed.”

Anna leaned forward, studying the sketch. “Okay… let me try. Predisposing—I’ve always been a light sleeper. Precipitating—the big project at work last year, with all the late nights and deadlines. And perpetuating… well, now I lie in bed for hours hoping I’ll get drowsy. I keep checking the clock, calculating how little sleep I’ll get. Some mornings I even sleep in late to ‘catch up,’ which just throws me off more.”

She let out a shaky breath. “So I’m basically training myself to stay stuck.”

I shook my head gently. “Not intentionally. Those habits are your way of surviving the exhaustion, but yes—those are the patterns that fuel insomnia. And the good news is: they’re also the part we can change.”

Why Sleep Hygiene Isn’t Enough

Anna’s brow furrowed. “But I’ve done all the sleep hygiene things. I cut out coffee. I keep my bedroom dark and cool. I even bought blackout curtains. Shouldn’t that have helped?”

I set the pen down. “Sleep hygiene can support healthy sleep, but it’s rarely enough to treat chronic insomnia. Think of it like brushing your teeth—it’s good for prevention, but it won’t cure a cavity that’s already there.”

Her lips twitched into a humorless smile. “So all this time I’ve been obsessing over the wrong things.”

“Not wrong—just incomplete. Sleep hygiene is helpful, but it doesn’t address the deeper issue: the habits and thought patterns that perpetuate insomnia. Sometimes, it even backfires. People get so focused on perfect routines that they add more pressure to sleep, which makes the problem worse.”

Anna slumped back in her chair. “That’s exactly me. I’ve been turning bedtime into some kind of test. No matter how carefully I follow the rules, I still lie there wide awake.”

“And that’s the trap. The goal isn’t perfection—it’s relearning how to let sleep happen naturally, without all the pressure.”

A New Tool: The Sleep Log

I turned my tablet around so Anna could see the screen. A clean, simple app was open—just a few boxes to tap each morning.

Therapist: “This is where we start: a sleep log. Each day, you’ll record when you went to bed, how long it took to fall asleep, how many times you woke up, and when you got up in the morning.”

Anna leaned forward, cautious. “That’s it? I thought you were going to hand me a giant chart.”

I shook my head. “No charts. Just a couple of taps on your phone. It’ll take less than two minutes.”

She frowned. “But why? I already know my sleep is a mess. Do I really need to track it to see that?”

“That’s a fair question,” I said. “But here’s the thing: without the log, we’re flying blind. It’s like trying to get in shape without knowing which muscles you’re using—or trying to treat a cavity without seeing where it is. The log gives us the data we need to guide everything else. It tells us whether the strategies we try are working, where the trouble spots really are, and how your sleep shifts over time.”

Anna tapped the screen skeptically. “So this is… the foundation.”

“Exactly. Every other step in therapy builds on this. The sleep log shows us not just how bad nights feel, but how the whole pattern unfolds—how you fall asleep, when you wake, how long you stay in bed. Without that map, we wouldn’t know what’s helping and what’s not.”

She sat back, considering. “So it’s less about keeping score, more about finding direction.”

“That’s right. This isn’t about judgment. It’s about discovery. Over the next few weeks, the log will become the lens we use to understand your insomnia and the ruler we use to measure progress.”

Anna nodded slowly, her resistance softening. “Okay. Two minutes a day. I can do that.”

Setting Expectations

Anna slid the tablet back toward me, her fingers drumming lightly on the armrest. “So if I do this—if I track everything—how long before I actually start sleeping again?”

I leaned back, giving the question the weight it deserved. “That’s the hardest part, Anna. Insomnia therapy isn’t instant. Most people start noticing changes in two to four weeks, but it usually takes six to ten weeks for the full treatment to really take hold.”

Her eyebrows shot up. “Six to ten weeks? That still feels like forever.”

“It feels long now,” I agreed. “But think of it like physical therapy. If you injured your knee, you wouldn’t expect to walk pain-free after one stretch. You’d expect weeks of gradual progress—small steps that build strength. This is the same. In the first few weeks, you’ll start to notice early shifts. Over time, those shifts add up to lasting change.”

Anna sank deeper into the chair, chewing on the thought. “So I’m not supposed to expect instant results.”

“Right. Some nights may still be rough in the beginning. But those aren’t failures—they’re part of the process. What matters is the bigger picture. The sleep log will help us see that, so you don’t get lost in the ups and downs of a single night.”

Her shoulders relaxed a little, the tension giving way to something softer—acceptance, maybe even relief. “Okay. Two to four weeks for small changes. Six to ten for the real thing. I can hang on if it means there’s a path forward.”

“And there is,” I said gently. “Tonight isn’t about fixing your sleep. It’s about preparing for the work ahead—setting the stage so your body and mind can relearn what they already know how to do.”

Anna nodded, a faint smile flickering at the corners of her mouth. For the first time, her exhaustion didn’t feel like defeat. It felt like the start of a journey.

Therapist Commentary

Insomnia isn’t just about losing sleep at night—it’s a 24-hour disorder shaped by biology, stress, and the habits that keep it alive. Using the 3 Ps model, we can see how insomnia develops:

• Predisposing factors (like being a light sleeper) set the stage.

• Precipitating factors (stressful events or disruptions) trigger the problem.

• Perpetuating factors (clock-watching, irregular schedules, “catch-up” sleep) keep it going.

Treatment focuses on breaking those perpetuating patterns. That’s why sleep logs are essential: they reveal the real patterns behind insomnia and help us measure whether therapy is working. Most people notice early improvements in 2–4 weeks, with full treatment effects by 6–10 weeks. It’s not about quick fixes—it’s about steady, lasting change.