The Intimate Relationship Between Exercise and Sleep

Quality sleep and optimal workouts are interdependent — you can’t have one without the other. People who are struggling with good sleep can get more physical activity as a way to improve their shut-eye. Likewise, those who are looking to improve their fitness levels can boost recovery by getting a good night’s rest. Consistent healthy sleep patterns will help your body to recover, conserve energy, repair the muscles used during exercise, and support the production of growth hormones.

Your sleep is controlled, in part, by your body’s internal clock, called your 

. This cycle senses and responds to external cues such as light, diet, and even exercise. Your circadian rhythm uses these cues to maintain a predictable pattern of wake time and sleep time.

A structure in your brain called the suprachiasmatic nucleus (SCN) uses this information from your environment to send out signals to the rest of your body, controlling different processes such as hormone levels, metabolism, and feelings of sleepiness.1 When you are more active, get lots of exposure to bright light early on, and eat during the day (rather than right before bed), you are confirming to your biological clock that it is daytime. This sets up the capacity for your body to more easily recognize that it is time to sleep once nighttime comes around.

Exercise has been shown to boost levels of adenosine, a brain chemical that increases your sleep drive — your need for sleep.

 When you first wake up, adenosine levels in your brain are low. The longer you are awake, the more your adenosine levels rise and the sleepier you get.

 Exercise can help strengthen this process by encouraging your cells to make more adenosine, reinforcing your innate biological urge for sleep later on.

Researchers have conducted dozens of studies that link physical activity and sleep.

 These studies have found that a consistent exercise program can:

Make it easier for you to fall asleep faster

Help you sleep for longer lengths of time without interruption

Increase the amount of time you spend in deeper stages of sleep

Reduce your time spent lying in bed awake

Studies have reported improvements in sleep with both aerobic exercise, such as jogging or swimming, and resistance training, such as bodyweight exercises or lifting weights. Additionally, multiple studies have found that people may get the most sleep benefits when they exercise in the mornings.4

Why is Sleep Important for Improving Exercise?

People with poor sleep tend to be less active than those who regularly experience healthy sleep. For example, athletes tend to 

 than those who don’t get much physical activity.

Sleep does several important things for people who are trying to increase their overall level of fitness. Quality sleep can:

. Sleep is a time for your body to rest and repair its tissues, including resting the heart, which helps you feel your best the next day.6 People who don’t get enough sleep on a regular basis are 1.7 times more likely to become injured.

. Not getting enough sleep can hinder your muscle strength, deplete your fuel stores, make you slower, decrease your endurance, and cause you to fatigue more quickly. Some studies have even studied specific competitions and found that the athletes who got the best sleep were likely to place the highest!

. Your circadian rhythm helps control your metabolism. Poor sleep decreases your glucose tolerance — your fat cells can’t use sugar for fuel as effectively as they should.

 In the long term, this can increase your risk of obesity and diabetes.

Ensure your body has enough growth hormone

. A chronic lack of sleep reduces the amount of growth hormone that your body makes.

 This molecule is what helps muscles grow bigger and stronger.

Many studies show why sleep is important for fitness and athletic performance. Aim for at least 7-8 hours for optimal results!

Improving sleep in the long run with CBT-I

You may be able to improve your sleep with some 

, such as avoiding caffeine in the afternoons and evenings, steering clear of alcohol, finishing meals several hours before bedtime, and keeping your bedroom cool and dark.

In some cases, these tips aren’t enough to reverse your sleeping troubles, and some personalized guidance may be needed. To learn more about how to improve your specific situation and to work with a sleep coach, fill out this simple 

National Institute on Alcohol Abuse and Alcoholism. Overview of Circadian Rhythms. 

https://pubs.niaaa.nih.gov/publications/arh25-2/85-93.htm

Dworak, M., Diel, P., Voss, S., Hollmann, W., & Strüder, H. K. (2007). Intense exercise increases adenosine concentrations in rat brain: implications for a homeostatic sleep drive. Neuroscience, 150(4), 789–795. 

https://doi.org/10.1016/j.neuroscience.2007.09.062

Bjorness, T. E., & Greene, R. W. (2009). Adenosine and sleep. Current neuropharmacology, 7(3), 238–245. 

https://doi.org/10.2174/157015909789152182

Dolezal, B. A., Neufeld, E. V., Boland, D. M., Martin, J. L., & Cooper, C. B. (2017). Interrelationship between Sleep and Exercise: A Systematic Review. Advances in preventive medicine, 2017, 1364387. 

Watson A. M. (2017). Sleep and Athletic Performance. Current sports medicine reports, 16(6), 413–418. 

https://doi.org/10.1249/JSR.0000000000000418

MedlinePlus. (2021, October 18). Healthy Sleep. 

https://medlineplus.gov/healthysleep.html

Huang, K., & Ihm, J. (2021). Sleep and Injury Risk. Current sports medicine reports, 20(6), 286–290. 

https://doi.org/10.1249/JSR.0000000000000849

Broussard, J. L., Ehrmann, D. A., Van Cauter, E., Tasali, E., & Brady, M. J. (2012). Impaired insulin signaling in human adipocytes after experimental sleep restriction: a randomized, crossover study. Annals of internal medicine, 157(8), 549–557. 

https://doi.org/10.7326/0003-4819-157-8-201210160-00005

Sharma, S., & Kavuru, M. (2010). Sleep and metabolism: an overview. International journal of endocrinology, 2010, 270832. 

The relationship between exercise and sleep is more complex than you may think. Learn all about why working out helps you sleep better, and vice versa.

Exercise and Sleep: How Exercise Improves Sleep | Dawn Health

How Does Good Sleep Improve Exercise? 

At any given time, a delicate balance between two opposing systems governs our body and mind. The sympathetic system is the body’s threat detection system that prepares your body to respond to any threat, while the parasympathetic system calms the body and mind and induces a state of relaxation.

When the balance tilts in favor of the sympathetic system, hyperarousal ensues.

Read on to learn what hyperarousal is, its symptoms and causes, how it affects your sleep, and what you can do about it.

Hyperarousal is a state in which you are more alert or vigilant. Usually, hyperarousal is caused by the brain detecting a threat and entering fight-or-flight mode. The cause can be a real external threat or an internal fear or anxiety.

The level of hyperarousal one may experience varies greatly, along with the level of distress and dysfunction it causes. One of the most extreme examples is Post-Traumatic Stress Disorder (PTSD). For most, hyperarousal manifests itself as a subtle sense of unease that you might not even be aware of, but can still disrupt your sleep.

Hyperarousal can manifest itself through a variety of symptoms, 

Why Is It Hard To Fall Asleep in a State of Hyperarousal?

Sleep requires the body and mind to relax. It is predominantly a parasympathetic activity. But, in a hyperaroused state, the sympathetic system 

 the parasympathetic one and prevents your body from falling asleep. This makes evolutionary sense because sleeping when there is an imminent threat significantly lowers your chances of survival, and when in a hyperaroused state, your brain is convinced there is an imminent threat. This leads to 

Hyperarousal insomnia is a psychological condition. It is a mental state that triggers the body to react to thoughts and emotions as though they are threats that need to be addressed and keeps your body at high alert.

Being constantly on high alert can cause rapid, anxious thoughts to occur at night as well as less restorative sleep throughout your sleep cycle. Further, inadequate sleep can then lead to more stress, turning it into a self-propagating cycle.

If stress is keeping you up at night, you are not alone. According to the National Sleep Foundation Survey, 

 have trouble sleeping due to stress every month. Even though you may have been struggling to sleep, you do not have to. Practical, simple treatments for hyperarousal insomnia exist.

Cognitive behavioral therapy for hyperarousal insomnia (CBT-I) directly addresses our thoughts and behaviors. It is a type of 

 that focuses on the idea that how we think, our habits, and our emotions are all linked and influence one another. We can ease mental suffering by challenging our inaccurate thoughts about threats, challenging our habits, and accepting our feelings. CBT-I allows us to do that and more.

Learn more about CBT-I Treatment for Hyperarousal Insomnia

To get more information about hyperarousal insomnia and use 

Don't Let Hyperarousal Keep You From Sleep

What is hyperarousal, what are the symptoms of hyperarousal insomnia, and how do you treat it? Learn about hyperarousal insomnia and CBT-I treatment. 

Learn Symptoms & Treatment of Hyperarousal Insomnia

Hyperarousal and how it can cause insomnia

When it comes to getting a good night’s rest, it’s not enough to focus on quantity — it’s also important to consider your sleep quality. The best restorative rest is a complex dance of different sleep stages that shift and expand throughout the night.

Your body moves through four sleep stages each night. As you leave one stage and enter the next, you experience changes in brain activity as well as body processes like breathing and heart rate.

One sleep cycle occurs when you progress through all of the sleep stages. This cycle can range from 70 to 90 minutes. Each night, you complete about four to six sleep cycles, which on average takes about 8 hours.

The conversation around sleep cycles is complicated by the fact that the numbering of stages has changed in the past few years. Two of the NREM stages (Stages 3 and 4) were combined into one stage and thus, the numbering is different depending on when the information was published. Suffice it to say that there are currently three stages in NREM sleep and one stage in REM sleep. NREM sleep dominates the first half of the night and REM dominates the second half of the night.

The first three sleep stages are non-rapid eye movement (NREM) sleep. Your sleep progresses from light to deep sleep and then back up again. You sleep the most deeply during the last stages of NREM sleep (Stage 3).

When you fall asleep, your brain slips into the first stage of sleep, which lasts just a few minutes. During this stage, your breaths and heartbeat start to slow. Your muscles become more relaxed, but they may wake you if they suddenly jerk or twitch.

As your body further relaxes and slows, you enter stage 2 of the sleep cycle. Your brain activity diminishes, but occasionally has quick spurts of activity called sleep spindles, which help refresh your brain and process new memories.

Stage 3 sleep is deep sleep that provides quality rest for your mind and body. During this time, your heart rate and breathing become very slow, and your body heals. It becomes more difficult for external disturbances to awaken you when you are in stage 3 sleep.

These stages are followed by rapid eye movement (REM) sleep, which is the sleep stage during which you have dreams.

 REM sleep stages build on themselves and get longer each cycle.

The brain becomes very active during the REM sleep stage. Most of your muscles are completely relaxed, but your eye muscles rapidly contract, making your eyes move in multiple directions. Your brain also becomes much more active, leading to vivid dreams.

Altogether, the different stages of sleep lead to many important effects within the mind and body, including: 

Releasing hormones necessary for growth and fertility

When you don’t get enough sleep, it can take a big toll. A lack of sleep can affect your mental health, making it harder to think or focus, putting you in a worse mood, and leading to bigger problems like anxiety or depression. People who don’t sleep enough also have a higher risk of developing high blood pressure, heart disease, diabetes, and kidney disease.

Sleep disorders such as sleep apnea often involve disturbances to the normal sleep cycle. In people with sleep apnea, breathing problems kick in during deep sleep stages, disrupting the stage and making a person fall back into the lighter stages of sleep, where breathing is easier.

 Apnea is a medical condition that is different from insomnia so consult your doctor if you think you have apnea.

Improve Sleep by Focusing on Sleep Cycle Length

Being able to sufficiently move through each of the stages will help you feel better rested. For example, if you are consistently woken during deep stage 3 sleep, you will notice the effects on the way your body feels rested and your mind feels focused.

Practice good sleep hygiene to help reduce unexpected awakenings in the middle of a key sleep stage. Sleep hygiene includes any behaviors and habits that help you promote healthy sleep patterns. Good sleep hygiene can involve:

Ensuring your sleeping area is as comfortable, quiet, and dark as possible

Going to bed and waking up at the same time every day

Getting in consistent physical activity during the day

Eating any large meals earlier in the day, several hours before you go to bed

Avoiding alcohol and caffeine, especially in the evenings

Try Cognitive Behavioral Therapy for Insomnia (CBT-I) Today!

When a good night’s sleep is difficult, treatments like cognitive behavioral therapy for insomnia (CBT-I) can help. CBT-I is a form of talking therapy that addresses the root cause of your sleep problems by helping you understand and change your attitude towards sleep. Scientific research has found this treatment to be effective and safe — unlike sleep medications, CBT-I can better address long-term sleep problems and doesn’t lead to addiction or uncomfortable side effects.

Interested in learning more about CBT-I? Get started with a 

 to help us better understand where you’re at on your journey to better sleep.

Patel, A. K., Reddy, V., & Araujo, J. F. (2021). Physiology, Sleep Stages. In 

National Institute of Neurological Disorders and Stroke. (2019, August 13). 

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Understanding-Sleep

Schönauer, M., & Pöhlchen, D. (2018). Sleep spindles. 

(19), R1129–R1130. https://doi.org/10.1016/j.cub.2018.07.035

Centers for Disease Control and Prevention. (2016, July 15). 

https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.html

Insomnia Treatment: Cognitive Behavioral Therapy Instead of Sleeping Pills

https://www.mayoclinic.org/diseases-conditions/insomnia/in-depth/insomnia-treatment/art-20046677

Curious about what a sleep cycle is, and the various stages of sleep cycles? Here's everything to know about sleep cycles, including why they're important.

Everything to Know About Sleep Cycles

 million Americans struggle with sleep? Even the soundest sleepers have bad nights. No matter who you are or what your background is, you will have nights where your sleep is 

So, if you're reading this, chances are you are hoping melatonin can 'fix' your sleep. You're not alone; the use of melatonin supplements among adults has 

 from 0.6% in 2007 to 1.3% in 2012, with 3.065 million adults reporting taking melatonin within the past month.

Thus, you may have questions such as: Does melatonin work? If so, how? Is it safe?

Melatonin is a hormone that your body produces naturally, but you can also get synthetic melatonin as a supplement.

The pineal gland (in both humans and animals) secretes natural melatonin in response to darkness. Thus, it serves as a critical component of the body's 24-hour internal clock − 

 − which regulates crucial functions such as sleep, temperature, and the basal metabolic rate.

In other words, the body produces melatonin as a signal for your body to prepare to sleep when the sun sets.

Melatonin supplementation seeks to emulate this effect with mixed results. 

 show melatonin works short-term for conditions such as jet lag and delayed sleep-wake phase disorder. However, the American Academy of Sleep Medicine and American College of Physicians does not recommend its use for chronic insomnia due to limited evidence and the risk of negative side effects.

Is It Safe To Take Melatonin Every Night?

In general, low doses of melatonin, between 1 and 10 mg, are safe with few side effects.

If you continue to take melatonin every night − without addressing the cause of your sleeping trouble − your body will adapt. Over time you’ll need to raise the dose of melatonin to achieve the same effect. This can lead to 

What’s more, melatonin supplements can interact with 

Lastly, please avoid strenuous labor such as operating any heavy machinery within five hours of taking melatonin. It causes 

People that struggle with insomnia tend to turn to supplements and medications first because they are unaware of safer, better options.

The first thing you should try when you are struggling with sleep is waking up at the same time every day. Having a fixed wake-up time will adjust your natural melatonin production and increase your chances of sleeping great the next night.

Your doctor may prescribe cognitive behavioral therapy (CBT-I). It is a proven, recommended, and safe sleep therapy for many forms of insomnia.

The truth is that there is little evidence that melatonin will help you with insomnia.

That is why the American College of Physicians recommends CBT-I, which addresses the true cause of insomnia: thoughts, behaviors, and emotions.

The research backs up this recommendation with up to 

 of participants reporting remarkable improvements − more so than 

, but the results are also long-lasting and free from side effects.

Dawn’s evidence-based CBT-I can help you sleep without relying on supplements and medications. Visit our 

Melatonin is a widely common sleep aid. Learn how it works, why it's a short-term solution, what its long-term side effects are and its alternatives.

Is Melatonin Bad for You?

For years, Cognitive Behavioral Therapy (CBT) has been the gold standard for treating 

. Cognitive Behavioral Therapy techniques for insomnia (known as CBT-I) have been proven to work in numerous clinical trials, are equally effective with medication in the short term and more effective than medication in the long term.

The American Academy for Sleep Medicine, the American College of Physicians, and the European Sleep Research Society all recommend CBT for insomnia (CBT-I) as the first-line treatment.

What is Cognitive Behavioral Therapy (CBT)?

CBT is a form of therapy that was initially developed as a treatment for depression. The Cognitive in CBT refers to mental activity, such as thoughts, beliefs, memories, images or values. The behavioral part includes all the things we do on a daily basis. This can be things you do with others or things you do alone.

Both behavioral and cognitive therapies saw their beginnings when providers like Aaron T. Beck sought more effective remedies for challenging patterns of thoughts and behaviors. Though there are strong roots in both types of work, the research shows that combining the two provides the most effective results. And so, cognitive behavioral therapy was born.

A core principle in CBT is that our emotional reactions and behaviors are influenced by how we think about ourselves, others, and the world around us. Humans have a great capacity for thinking, but that requires time and energy. Our minds are wired to be efficient and so frequently we engage in  mental shortcuts and react to events that happen without giving them much thought. These mental shortcuts, known as heuristics, can save time but often omit relevant information and lead to inaccurate assumptions. These types of errors are called cognitive biases and often lead us to interpret and process information inaccurately.

If you ask two people to give a presentation on something they are both knowledgeable about, you might get two different reactions. One is hesitant and suggests someone else. The other immediately and enthusiastically agrees. It's the exact same situation. So why do they react so differently?

CBT explains that this difference in emotional reactions and behaviors comes from different ways of thinking about the situation. Perhaps, one thinks he might start to shake and others will notice, while the other one thinks that this is a good opportunity to share his knowledge.

Changing what you do is often the most powerful way of changing how you think and feel about something. This is because the new information, based on the actual experience, requires your mind to challenge its own assumptions. The behavioral part in CBT is about intentionally engaging in new behaviors and learning so these new experiences can inform your cognitive assumptions.

If you always avoid giving presentations because you fear they will be a failure, you will never experience a successful one that can challenge your assumption. Your negative thoughts about yourself in that situation will be very difficult, if not impossible, to change. A common unhelpful and distorted belief that people often have when speaking to a crowd is that they will get anxious, start to shake, and the audience will see that as a sign of weakness.

To target the cognition that shaking is a sign of weakness, CBT uses something called a behavioral experiment. In these kinds of experiments, the goal is to get real experiences about what happens 

 you shake (or not), if other people notice (or not) and if others notice, if they react negatively to shaking (or not). A typical behavioral experiment might be to videotape yourself talking in front of a crowd. When viewing the video afterward, try to notice the level of shaking and what reaction the group had to this shaking. Most likely, you will see that the amount of shaking and/or judging is less than what your mind thought it would be. Also, even if you did shake, and people did or did not notice, you have the experience of being able to manage it and still do your presentation.

The CBT triangle (putting it all together)

Therapy involves changing how you feel about something

. Whether it is to achieve a goal or to stop being anxious or sad — it's all about changing emotions. Now, this is hard to do directly. We have little control over our emotions; they will pop up whether you like it or not. CBT aims to change how you feel about something through our thoughts (cognitions) and behaviors.

CBT has been used by thousands of therapists and millions of patients from all over the world since the 1960s. Since then, different CBT approaches have been developed for a wide range of problems, and research has repeatedly shown its effectiveness. It’s common to talk about CBT as a specific kind of therapy, but in reality there are many models of cognitive behavioral therapies.

One of these models is CBT for insomnia, which this guide is mainly about.

CBT helps with unhelpful thinking and behavior, but how it is used to treat 

 isn’t always immediately obvious. To illustrate how insomnia is caused by cognitions and how CBT can help you sleep, let’s use two fictional people who represent two different ways of experiencing sleep. Meet George, who has insomnia and Susan, who doesn’t.

George has 

. Over the years he’s had many sleepless nights, spent tossing and turning and waiting for sleep. George's insomnia has been getting worse lately and he frequently wakes up in the middle of the night and can't get back to sleep. For the last couple of months, he hasn’t been getting more than 4 or 5 hours of sleep each night.

Susan has always been a good sleeper. She always falls asleep within fifteen minutes of going to bed and wakes up feeling refreshed. Susan doesn’t really think much about sleep, it’s just something that happens when she goes to bed.

Why does George have insomnia and not Susan?

What may not be obvious but separates George from Susan, is that they have very different beliefs about sleep. They experience precisely the same situation each night; they both go to bed and try to sleep. Yet their thoughts and feelings in this situation are very different.

George worries that it's going to be another night of sleeplessness and that he will be dead tired at work the following day. He thinks about 

how a lack of sleep might damage his body

 and wonders if he will ever sleep well again. The minute his head hits the pillow, he's wide awake. His mind races and he starts feeling anxious and upset. He's exhausted but can't seem to fall asleep. After spending quite a bit of time unsuccessfully trying to sleep, he pulls out his phone and listens to a podcast to distract himself. He finally falls asleep a few hours before he has to get up for work.

Susan goes to bed and doesn't think much about it at all. She is fast asleep fifteen minutes after she turns off the lights.

George’s sleep problems started when the company he was working for experienced financial trouble and had to downsize. He worried about losing his job and not being able to afford rent. George found that he became preoccupied with thoughts of worry most of the day and even more as nighttime approached and it was time to sleep. He tried, as most do when facing problems in life, to think his way out of it. After a while, George noticed that his sleep was getting worse. It frequently took a long time to fall asleep, and he often woke up multiple times every night.

Fortunately, George didn’t lose his job. The company is now doing fine, and he doesn’t worry about it anymore, but he’s still struggling with sleep.

George’s story is typical when it comes to insomnia. It's common that some initial stressful life event sets it off, but the problems persist even when the stressor has resolved. It is notable that the event that causes insomnia in the first place varies, but when insomnia has been established, people unknowingly continue to behave and think in certain patterns that interfere with sleep.

CBT-I does not concern itself much with what initially caused George's insomnia. Instead, it focuses on the thoughts, feelings, and behaviors that maintain it. In George's case, we can see a pattern of him worrying a lot about sleep and the consequences of not getting enough. After a while, he starts to associate the bed with feelings of frustration and anxiety.

When George's thoughts constantly revolve around sleep and the consequences of him not getting enough, his mind will interpret this as a threat. 

 doesn't make the distinction between thinking about a threat or actually experiencing one. It does what it’s supposed to do and tells the body to get prepared for the threat.

When the brain signals the body to get ready, the body reacts immediately. It goes into a state of arousal where the main goal is to be prepared to handle anything. Arousal is, in many ways, a state that is the opposite of sleeping. Your heart beats a little faster, your breathing starts to increase in frequency. Pupils dilate, and you are more vigilant. Because the brain believes you are in danger, you go into a mild form of fight-or-flight mode where your senses are heightened, and muscles are ready to spring into action.

The most convincing and compelling way of learning that a previously held belief is false is experiencing the opposite. George has the view that he has to put in a lot of effort to get to sleep. A goal of cognitive behavioral therapy for insomnia is going to sleep without thinking or worrying too much about it. We want George to be more like Susan and experience falling asleep without effort, and as a result, learn that he can fall asleep easily without thinking too much about it. To help people get this valuable experience, CBT for insomnia offers up a wide variety of tools; the two most effective behavioral interventions are  sleep restriction and stimulus control. Sleep restriction and stimulus control aims to get you to experience what it's like to sleep without worrying about it. You gain confidence in your body's ability to go to sleep on its own without you having to think about it all.

When people who struggle with sleep hear about 

 the first time, they immediately think it's counterintuitive. Why should you restrict your sleep when you want more of it?

To answer this question, we need to learn about sleep drive. Sleep drive is the force that makes you sleepy when you have been awake for a long time. One of the measures of your sleep drive is a hormone called adenosine. The moment you wake up in the morning, the body starts producing adenosine. When the brain detects high enough levels, it starts shutting off wake-promoting areas in the brain, and you get sleepy. The longer you stay awake, the more adenosine the body produces, and your sleep drive increases.

The name sleep restriction is a bit misleading, and it could just as well have been called time-in-bed restriction or sleep consolidation. Sleep restriction is, in essence, spending less time in bed to increase the sleep drive. When starting with sleep restriction, you determine how much sleep you have been getting in total for the last week. If you have been getting an average of about 7 hours of sleep each night, you get an initial 7 hour window of time to sleep. This means that if you have to get up at 8 am each morning, you shouldn't try to sleep before 1 am. The 7 hours between 1 am and 8 am is called your sleep window. Whether you sleep or not in your window is not important, at least in the beginning. What is important is that you do not sleep outside of your sleep window.

It's important to note that sleep restriction isn't meant as something you should do for the rest of your life. It also gets a little easier as you progress. Your sleep window will increase when you stop spending so much time trying to sleep.

As previously mentioned, behavioral changes that lead to new experiences are amongst the most powerful methods for bringing about change in cognitions. By restricting your time in bed and building your sleep drive, you will strengthen the forces that make you sleep, so they are stronger than the forces that keep you awake.

Many people who suffer from insomnia report that they have a much easier time falling asleep on their couch, for example, than in their bed. This can be explained with something called classical conditioning, which is the way that all brains develop connections through experience.

Conditioning is a form of learning that happens through associating one thing to another. An example of being conditioned is when you hear a particular song at the same time you are having a good time. The next time you hear the song, the song makes you happy, in part, because you associate the song with a good time.

When we have regular problems falling asleep and or staying asleep, we begin to associate the bed and trying to sleep with negative emotions. We get frustrated, angry, sad and anxious about not sleeping. We toss and turn, and despite being tired, we can't get to sleep. The bed and bedroom can become associated with negative feelings.

CBT for insomnia uses stimulus control to break the negative association between trying to sleep and negative feelings. stimulus control works by having a set of guidelines or rules for sleep.

The bed should only be used for sleeping (and sex).

Don't stay in bed outside of your sleep window.

If you can't sleep, get out of bed for a while and try again later.

"Avoid caffeine, take a shower, have a bedtime routine, and get to bed at the same time each night."

 Sound familiar? Chances are high that you have heard advice like this before if you've been having trouble sleeping.

A common misconception about CBT for insomnia is that its advice about sleep that you have heard before. Sleep hygiene recommendations like the above ones aren't necessarily harmful on their own and can be beneficial in some situations. There is, however, little evidence that sleep hygiene alone helps people with insomnia.

A problem with sleep hygiene advice is that it gives you the impression that sleep is something you can control if you try harder. If this were the case, insomnia probably wouldn’t exist.

CBT for insomnia involves making behavioral changes too, but with a very different intent. Here the interventions are designed to help you experience sleep by setting your body up to return to its innate ability.

Additional tools used in CBT for insomnia

Stimulus Control alone or in conjunction with sleep restriction is an essential aspect of CBT for insomnia because they directly target your sleep drive and daily patterns around sleep. There are also cognitive techniques that are helpful. Research shows a sleep program that involves both a behavioral component and a cognitive component have the most optimal impact on insomnia.

Brains are wired to take shortcuts in our thinking. Taking shortcuts and thinking fast is mostly a good thing in most situations as it makes us more efficient. If we had to think things through and make an effort to be conscious of every thought, in every situation, we wouldn't have much time for anything else.

However, there are times when thinking fast, and jumping to conclusions can become unhelpful. Thoughts are influenced by how we feel and the things we have experienced in the past. We are susceptible to something called cognitive biases – which is just another word for relying more on the story in our heads than the information unfolding in front of us. There are a lot of different cognitive biases, and they share the common challenge of  how we see the world. One such example is confirmation bias – the tendency to filter information and only notice what confirms what we already believe to be true.

It turns out, the more that we struggle with insomnia, the more likely we are to have cognitive distortions about sleep. As we’ve discussed, these distortions perpetuate insomnia. To help us slow down and put ourselves in a position to actually do something about these biases and skewed thinking, we can use several tools including cognitive restructuring, cognitive defusion, and designated worry time..

We have already learned that worrying about sleep is a factor that sustains insomnia. But for many with insomnia, worry isn't just limited to sleep, and a general approach for handling worry might be beneficial.

Cognitive restructuring is a technique involving identifying thoughts in a situation, what emotions follow these thoughts, and how strong these emotions are. By writing them down as sentences, we force our minds to slow down enough to catch our biased way of thinking. Like sleep, worry can't really be controlled. You can't stop thoughts from popping up in your head. But you can change how you react to them.

Changing how you respond to thoughts is known as cognitive defusion. This can initially sound like a strange concept, but you already react to some thoughts differently than others. You have thousands of thoughts every day. Some you don't pay much attention to, and some you dwell on. We all tend to think some thoughts are more important than others and require attention. But they are all essentially the same thing – just thoughts.

Usually, we don't notice ourselves responding to worry, and most of the time, this just happens automatically. To pause and start making active choices when it comes to individual thoughts, we need to train our ability to take a bird's-eye perspective on our thoughts. Typically mindfulness is used for this, but also specific attention training exercises where you, for example, train your mind to switch your attention with sounds.

The idea is that you need to become aware of worry to do something about it. There are several ways you can directly respond to worry - the most straightforward way to start is by postponing worry to a specific time. This is known as designated worry time (DWT).This works by noticing thoughts of worry during the day and writing them down. Instead of engaging with these thoughts right away, you practice delaying the response to a planned "worry time."

In your worry time, you go through your list of worries during the day and decide how you want to respond. If the worry is something you can do something about, you use the time to make a plan. If it's the kind of worry that you can't do something about (most of them are), then you don't do anything about it. Just let them exist without engaging with them.

What is CBT-I? Learn all about cognitive behavioral therapy, how it treats insomnia, theCBT triangle, and more with Dawn’s guide to CBT for insomnia.