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.

Overcome insomnia for good with Dawn's CBT-I program

There are several reasons physicians recommend CBT-I as the go-to treatment for insomnia. It helps your body return to natural sleep without the use of pills, it addresses the underlying problems causing insomnia, the results are lasting so that you can end the cycle of sleeplessness, and it has been 

Dawn Health’s online CBT-I program is grounded in the same evidence-based practices used during in-person CBT-I and is equally effective. CBT-I online makes sleep therapy more convenient, accessible, and affordable, so it is easy to get started and take the first steps toward consistent, restful sleep right away.

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.

CBT for Insomnia: A Complete Guide to CBT-I | Dawn Health

Cognitive Behavioral Therapy for Insomnia (CBT-I)

Sleep is becoming increasingly harder to come by, as the constant stress of the modern world has diminished both the quality and quantity of sleep. COVID-19 has only made things worse. Thus, people are turning to medications in the hope of a 

But traditional psychopharmacological treatment for insomnia (sleep medications) are a delicate balancing act because of addiction and tolerance issues. As a result, doctors prefer antidepressants with sedative properties to treat insomnia. Mirtazapine is classified as one such antidepressant.

 is approved to treat major depression, obsessive-compulsive disorder, and various anxiety disorders. Additionally, it is often prescribed 'off-label' for insomnia. Initially launched under the brand name Remeron, it is still sold as such even though other generic versions of the drug are available.

Mirtazapine works on the Central Nervous System (CNS) as an antidepressant. It increases the concentration of particular chemical messengers (called neurotransmitters) in the brain, such as 

. These neurotransmitters are important contributors for an uplift in mood.

 suggests Mirtazapine is effective in treating depression-related insomnia. For instance, in a 

, Mirtazapine was given to 28 male patients with depression, suicidal ideation, and insomnia symptoms. Six individuals dropped out due to side effects, but twenty-two of them showed significant improvement or complete remission of both sleeplessness and suicidal ideation.

To understand how Mirtazapine helps with sleep, it is essential to grasp the effect of depression on sleep. Sleep is broadly divided into 

- Rapid Eye Movement (REM) sleep and non-rapid eye-movement (NREM). We all need a certain amount of sleep time in 

 to feel fully rested. Depression is associated with adversely impacting these phases as studies show 

of people with depression have increased REM sleep density and decreased latency to enter REM sleep. In other words, affected patients spend more time in REM sleep and less in slow-wave sleep. This has a negative effect on overall sleep quality.

 REM sleep. It also improves sleep continuity and duration due to its anti-histaminergic properties. Thus, the end result is deeper sleep.

However, the effects of Mirtazapine, much like other sleeping medications, are short-lived. This is because they function by keeping hyperarousal at bay. Unfortunately, the body adapts rapidly to the drug and its sedative effect, and after a few months, the effects are notably lowered (though some still benefit from what is known as 

Mirtazapine Side Effects Related to Sleep

Mirtazapine use is associated with several side effects. These can range from weight gain, headaches, and dry mouth to feeling ill. In addition, Mirtazapine can also cause several sleep-specific side effects.

Interestingly, some of the more prevalent side effects of Mirtazapine are sleep disorders such as Restless Leg Syndrome (RLS) and Periodic Limb Movements (PLM). In fact, studies show up to 

 of Mirtazapine users can experience RLS and PLM, respectively.

 is a well-known symptom of Mirtazapine discontinuation. Yes, you read that right! While Mirtazapine may help you sleep in the short term, changing the dose or discontinuing the medication can negatively affect your sleep. This is why it is important to consult your doctor before beginning, modifying, or discontinuing a medication. Starting, changing, or terminating a pharmaceutical regimen on your own can have serious consequences.

Due to Mirtazapine's sedating properties, approximately 

 of users experience daytime drowsiness. This is particularly worrying for patients suffering from depression which itself causes sleepiness and exhaustion. Mirtazapine can make this situation worse.

Although rare, sudden Mitrazapine discontinuation can cause 

People who have trouble sleeping frequently turn to medications first. Unfortunately, they are unaware of safer, more effective therapies. For instance, changing your 

 can help you sleep better over time. Sleep habits support a reliable and predictable pattern for your mind and body.

You can prepare for a restful night of quality sleep by relaxing before bed. A warm bath or a relaxing massage are excellent options. It's also a good idea to make your surroundings conducive for sleep. Set your thermostat to the optimal temperature and remove all unnecessary distractions. You can even experiment with different sleeping positions to see what works best.

Furthermore, what you do during the day has a significant impact on how well you sleep. Although long naps can disrupt your sleep schedule, consider taking shorter naps or simply resting. Exercising during the day may also help you relax and sleep.

If you still have trouble sleeping, your doctor may prescribe cognitive behavioral therapy (CBT-I) for your insomnia.

Why CBT-I May Be The Best Cure For Insomnia

 is an evidence-based and clinically proven approach for treating sleep disorders.

Two forces govern sleep: Sleep drive and mental arousal (wake drive). These two drives operate independently but must work together for optimal sleep. Your sleep drive is typically strongest at bedtime. Your wake drive is your state of alertness. Understandably, it is easier to fall asleep when your sleep drive is high, and your wake drive is low.

CBT-I provides a comprehensive plan that strengthens your sleep drive and teaches you to calm your mind. It is highly effective, with research showing it helps up to 

 achieve healthy and restorative sleep. Further, unlike sleeping pills and antidepressants which are only helpful for as long as you take them, the results are long-lasting.

 and begin your journey to a medication-free restful night’s sleep, visit our 

Mirtazapine may be prescribed to you for depression-related insomnia. Before you begin, or if you are weaning off, learn about side effects related to sleep.

Mirtazapine for Sleep: Side Effects & Alternative Insomnia Treatments | Dawn Health

Mirtazapine for Sleep: Uses, Side Effects & Alternative Insomnia Treatments

Change is inevitable; sometimes change can be advantageous, sometimes inconvenient, but change will always be unavoidable. Similarly, for better or for worse, seasonal change can affect one's sleep.

Fortunately, the human body can adjust and adapt. Thus, although outside factors, such as the weather may influence sleep, the disruption is usually short-lived. In some instances, however, a more chronic insomnia may develop.

Read on to learn how this happens and what you can do about it.

 is defined as any or all of the following;  trouble falling asleep, staying asleep, waking too early, or feeling tired during the day. Acute insomnia or short-term insomnia can last for a few days or a few weeks. It can often typically be connected to a number of external factors, such as the weather or 

, it is a completely normal response to change. Chronic insomnia is when you have trouble sleeping more nights than not for at least 3 days out of 7 for at least 3 months or longer. If left untreated, insomnia can adversely affect health.

Bodies prefer to follow a predictable pattern of wake time and sleep time each day. These rhythms are largely regulated by our sleep drive and our circadian rhythm. Our sleep drive and circadian rhythm must line up with each other throughout the days and nights to support our body in falling asleep, staying asleep, and waking up. Our sleep drive is regulated by the quantity and quality of your sleep. Think of it like your hunger drive -- the more you eat, the fuller you get; likewise, the more you sleep, the more rest you get. Your circadian rhythm is your body’s internal clock that regulates many different bodily processes including your sleep and wake schedule.

 naturally runs a bit longer than 24 hours, and therefore relies on sunlight and temperature, to keep it in alignment with our days and nights.  Light exposure also influences the body’s production of the hormone melatonin. Melatonin serves as a 

. The body produces the hormone melatonin when sunlight levels drop.The body needs sunlight to make 

 of the hormone serotonin. Lower serotonin levels lead to 

 and are associated with greater daytime drowsiness and feelings of 

Research shows the ideal temperature for sleep is between 

. Indoor temperatures can fluctuate as the weather changes and this can create a less-than-ideal environment for sleep.

Finally, let’s not forget the challenges we all face in maintaining healthy 

 during the winter months. It is not always easy to go out for a run in freezing temperatures. Temptations such as sugar-filled holiday meals, late-night partying, and drinking can also impact our sleep.

This is why weather changes can have an impact on our sleep. When days become shorter, so does our exposure to natural sunlight, the strongest circadian rhythm adjustment tool. This change in light exposure not only impacts our circadian rhythm but also the timing of our melatonin production and our production of vitamin D. It also impacts our sleep environment and our ability to make healthy lifestyle choices that promote healthy sleep patterns.

 in sleep are common, whether they are directly responsible for chronic insomnia is debatable. For instance, a 

 on 43,045 participants in Norway found no evidence for seasonal insomnia. This is significant because Norway experiences 

The 3P model is a widely accepted model that offers an explanation of what causes chronic insomnia. In this model, the onset of sleep difficulties is typically due to a precipitating factor (P #1) or a trigger, which could be a number of factors, and in this discussion, it's the seasonal changes in the weather. These changes interact with other factors that were already there, known as predisposing factors (P #2). Quite simply, what we have and what life gives us leads to the start of sleep problems. What differentiates insomnia that resolves versus insomnia that is chronic is how we learn to respond to our sleep challenges. Not being able to sleep often becomes stressful and becomes a source of anger and frustration. The more we try to sleep and become activated, the more difficult it becomes to sleep. This influences our thoughts and behaviors, often leading to attempts that are meant to “fix” the sleep problem but end up making it worse. These thoughts, feelings, and behavior become perpetuating factors (P #3) that maintain sleep disruption.

Like the name of the model, all three Ps (predisposing, precipitating, and perpetuating) factors create the insomnia spiral.  Seasonal changes impact our sleep, interact with other factors (such as pain or hormones), and lead to worrying about sleep and trying to manage our lack of sleep. This, in turn, increases physical activation, worry and stress, creating a vicious struggle with insomnia.

How To Sleep Better Regardless of The Weather

Evident from our discussion, seasonal change can certainly cause short-term sleep disturbances. However, when these seasonal changes lead to a more chronic insomnia pattern, this is a result of not just the seasonal changes, but what pre-existing challenges we had before the sleep problems and how we try to fix these sleep problems.   Fortunately, 

cognitive behavioral therapy for insomnia (CBT-I)

 behavioral insomnia. It focuses directly on the link between our thoughts, behaviors, and habits.

Sleep in any season is possible by addressing emotions and challenging our thoughts related to insomnia, and changing your habits with CBT-I.

To get more information about seasonal sleep changes and use 

Whether seasonal insomnia has a direct impact on chronic insomnia is debatable. Read about the facts and how to sleep better regardless of the weather. 

Seasonal Insomnia: Fact or Fiction? | Dawn Health

Seasonal Insomnia: Fact or Fiction?

Sleep is essential as it helps you rest and recover so you can function at your best. Unfortunately, while sleep comes easy to some, many struggle every night when their head hits the pillow.

The term insomnia is often used to refer to 

, but learning about the specific subtypes of insomnia can increase your ability to address these problems.

Read on to learn more about a common type of insomnia known as Sleep-maintenance Insomnia.

 is defined as any or all of the following;  trouble falling asleep, staying asleep, waking too early, or feeling tired during the day. The constellation of symptoms that you struggle with will impact which treatments work best.

The term sleep maintenance insomnia, also known as middle insomnia, refers to the challenge of staying asleep throughout an entire night. This is defined as waking up during the middle of the night and finding it hard to fall back to sleep once you do wake up. This type of awakening can happen multiple times throughout the night, leading to 

The main symptom and indicator of sleep maintenance insomnia is waking up during the middle of the night and having a hard time going back to sleep. Other symptoms are sleep anxiety, daytime sleepiness, inability to concentrate, headaches, and irritable mood.

. In addition to the long, frustrating sleepless nights, it also can affect both mental and physical health.

 consequences include the inability to function and perform. It lowers reaction time which means routine tasks such as driving become unsafe. Further, 

 of the heart, mind, and hormonal system. 

 are also common in patients with persistent insomnia.

What Can Cause Sleep-Maintenance Insomnia?

Waking up during the night is normal; most of us do. However, we do expect to have the ability to fall back to sleep fairly quickly. So if you find yourself waking up and having difficulty going back to sleep, for at least three out of seven nights per week, for three months or more, you are likely struggling with sleep-maintenance insomnia.

 that may be creating this frustrating cycle such as:

such as pain, breathing or digestive problems, hormones, or a full bladder

 such as  stress, anxiety or other psychological concerns (mood disorders)

 such as your sleep schedule, caffeine, nicotine, or alcohol intake, or technology habits

Sleep-maintenance insomnia, like other forms of insomnia, is 

. such as exercising regularly and establishing a relaxing bedtime routine. Resisting daytime naps and going to bed only when sleepy is also recommended, as is avoiding stimulants such as caffeine before bed.

Sleep-maintenance insomnia often develops because we have taught our brains to respond to natural wake-ups with hyperarousal. We worry about being awake during the middle of the night. To unlearn this and train your brain not to be afraid, we can use a user-friendly behavioral techniques from CBT-I such as stimulus control.

 therapy that directly addresses the link between thoughts, behaviors, and habits. It enables you to form healthier habits and cope with stress and the negative thoughts associated with insomnia. These, as discussed earlier, are the common causes of a chronic sleep=maintenance insomnia pattern.

To get more information about sleep-maintenance insomnia and use 

 to treat your sleep-maintenance insomnia, 

Sleep-maintenance insomnia, also known as middle insomnia, is a common form of insomnia. Read more about what it is, what can cause it, and how to treat it.

Sleep Maintenance/Middle Insomnia: Causes, Symptoms, Treatment | Dawn Health

Sleep Maintenance/Middle Insomnia: Causes, Symptoms, Treatment

The emergence of the COV-SARS-2 virus has changed everything. From work to simple everyday activities such as food shopping, nothing is the same.

While some effects of COVID are apparent, others are not. This is why it's easy to overlook the influence of COVID on sleep.

Read on to learn more about how COVID can affect your sleep and what you can do about it.

 is defined as any or all of the following;  trouble falling asleep, staying asleep, waking too early, or feeling tired during the day. Acute insomnia or short-term insomnia can last for a few days or a few weeks. Chronic insomnia is when you have trouble sleeping three or more nights out of seven for three months or longer.

 if you see yourself in these statements:

You struggle to fall asleep, even though you feel sleepy when you go to bed, and often stay awake 30 minutes or longer before you fall asleep,

You wake up during the night and struggle for 10-15 minutes or more to fall back to sleep,

You wake up earlier than you would like to and cannot fall back to sleep

You feel tired and unable to focus during the day,

You can't nap even though you are tired and try to do so.

 or “Coronasomnia” describes sleeping problems caused by COVID. This is not to say that insomnia is a symptom of COVID, because it's not! COVID does, however, directly and indirectly influence sleep.

, can affect your body’s ability to have restorative sleep. The blocked nasal passages, difficulty breathing, fever spikes, and chills, etc. interfere with the body’s ability to go into the deeper stages of sleep. Fortunately, for patients that recover, these are short-lived.

Since this pandemic is a source of stress and 

,  insomnia even affects those not diagnosed with COVID. In fact, the incidence of depression and anxiety has more than 

 over the last year. This correlates with the rising 'insomnia levels' worldwide as everyone’s constant stress causes 

, which prevents the body from relaxing for sleep. A study estimates 

 of the population is currently struggling with insomnia - a 

Additionally, spending most of the time indoors and irregular work routines disrupts the 

 is the body's internal clock responsible for physical, mental, and behavioral changes.  This means the body produces the hormone that 

The negative impact of insomnia on health is well-documented. Short term, it affects mood and the ability to function and perform. In the long run, it 

 for heart, brain, and endocrine system diseases. 

 such as anxiety and depression are also common in patients with 

Importantly, insomnia weakens the immune system increasing susceptibility to infections such as COVID-19. This creates a 

 – COVID can lead to insomnia which in turn can create a higher susceptibility to catching viruses such as COVID.

Insomnia is entirely treatable. A variety of treatment options exist, from lifestyle modifications to sleeping pills. Not all treatments are equally effective, though.

Cognitive Behavioral Therapy for insomnia (CBT-I)

 that addresses underlying issues such as stress causing insomnia. It is a form of talking therapy that focuses directly on the link between thoughts, behaviors, and habits.

CBT-I is so effective because COVID insomnia, like many other forms of insomnia, is thought to be perpetuated long after your body heals due to your associated thought patterns and subsequent behaviors. Thus, by challenging unhelpful beliefs, and changing your habits, CBT-I can help you sleep better.

To learn more about CBT-I and how it can treat your COVID insomnia, visit 

The pandemic has affected the way that we sleep in numerous ways, whether you have COVID or not. Looking past being sick, COVID has caused stress and anxiety. 

COVID Insomnia | Can COVID Cause Insomnia? | Dawn Health

COVID and insomnia: Can COVID cause insomnia?

Sleep deprivation is an unavoidable part of becoming a mother. Caring for an infant isn't easy. Coupled with abrupt changes in hormone levels, sleep is often a distant reality. Thus, it is normal for moms to suffer a drop in energy and mood in the first few weeks after giving birth.

, sleep troubles begin even earlier -- during pregnancy. Research shows that up to 

 of pregnant women have trouble sleeping, with 

 suffering from insomnia during their first trimester. Are you one of these women? If so, don't worry. This is completely normal and can happen to anyone. 

Read on to learn more about pregnancy insomnia and what you can do to treat it.

 is defined as one or more of the following:  falling asleep, staying asleep, waking too early, or feeling tired during the day. These symptoms occur even when you give your body the opportunity for sleep (as opposed to the symptoms associated with sleep deprivation). 

The following questions are a good way to help you recognize if you have insomnia.

Do you find yourself struggling to sleep? Even if you do sleep, do you wake up several times during the night? Do you wake up earlier than you would like to in the morning? Are you tired during the day and find it difficult to focus? Do you feel tired but unable to nap?

If you are able to answer “yes” to any of these questions, and this has been your experience for more days than not for at least one month, you are likely experiencing insomnia.

Wondering why you're struggling to sleep during early pregnancy? Learn how changes to your body are causing insomnia, and how to deal with pregnancy insomnia.