What you brought with you
Stable traits that were true before you ever slept badly. They set how easily the problem could start. On their own they sit below the line — plenty of people have all of these and sleep fine.
What started it
The trigger. It pushes the total above the line and your sleep breaks — which is a normal response to a hard event. Then it fades. Watch it fade on the figure while the sleep problem doesn't.
What's keeping it going
Every one of these was a reasonable response to a bad night. Together they are now the mechanism. They start switched on — turn off any that aren't you, or that you'd be willing to change, and watch the figure.
Perpetuating factors I recognise
What's still in play for you
Built from what you left switched on above. Copy or print it and take it to an appointment.
Self-described perpetuating factors, from the 3P model of insomnia (Spielman, Caruso & Glovinsky, 1987). A self-description, not a diagnosis.
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Before you tell me you've tried everything
"I tried sleep hygiene and it didn't work."
That's the expected result, and it isn't your failure. Sleep hygiene — dark room, no screens, cool temperature, regular times — is a set of conditions that make sleep easier to have. It isn't the treatment for insomnia that has become self-sustaining.
In CBT for insomnia, the components that target these maintaining mechanisms directly are behavioural: stimulus control (what the bed is allowed to be used for) and reducing time in bed to match your actual sleep ability. Both are counterintuitive — they involve spending less time in bed when you're already exhausted — and both are difficult to apply correctly alone, which is why they're usually done with a practitioner.
Where this model stops
When a medical review comes first
This page describes one pattern. Some sleep problems have a physical cause that behavioural work won't touch. Talk to your GP before anything else if you have:
- Loud snoring, or someone has seen you stop breathing in your sleep
- Sleep that doesn't refresh you even when you get enough hours
- Creeping, crawling or restless sensations in your legs at night
- Acting out dreams — shouting, punching, getting out of bed
- Falling asleep suddenly during the day, without warning
- Significant pain
- New or worsening physical symptoms
Reducing time in bed is not a do-it-yourself exercise
This page deliberately doesn't tell you how many hours to spend in bed. Time in bed is here as a mechanism to understand, not a number to set yourself.
Reducing it increases daytime sleepiness before it improves sleep. That's how it works, and it's why it needs supervision. It isn't suitable, or needs specialist oversight, if you:
- have bipolar disorder — sleep loss can trigger episodes
- have a seizure disorder — sleep loss lowers the seizure threshold
- have untreated sleep apnoea
- have a parasomnia, such as sleepwalking or night terrors
- drive or operate machinery for work
Medication
Don't change or stop any sleep or sedative medication based on this page. That conversation belongs with whoever prescribed it. Stopping some sleep medications abruptly is unsafe.
Insomnia, depression and anxiety
Persistent insomnia often occurs alongside depression and anxiety. It's often assumed the sleep will sort itself out once the mood lifts, so it gets left until last. Insomnia is worth addressing in its own right, and can be worked on at the same time.
If the third layer looks like yours, that's the layer a first appointment would work on. You can read what actually happens in a first session, or send a message to arrange one.