Insomnia and Sleep Issues
Insomnia is persistent difficulty falling asleep, staying asleep, or getting restful sleep, despite having the opportunity. Sleep and mental health feed each other: poor sleep can worsen anxiety, depression and stress, and those conditions can disrupt sleep, which sets up a cycle that psychological support can help break.
This page covers what insomnia tends to look like, what contributes to it, and how a structured, evidence-based approach called CBT-I can help.
What does insomnia look like?
Night-time
- Difficulty falling asleep, even when tired
- Waking frequently during the night, or waking too early and being unable to fall back asleep
- Lying awake worrying about not being able to sleep
Daytime & knock-on effects
- Daytime fatigue, difficulty concentrating, or irritability from poor sleep
- Anxiety or dread about bedtime, anticipating another poor night
- Relying on strategies like screens, alcohol or extended time in bed that may be maintaining the problem
Insomnia is generally considered clinically significant when it occurs at least three nights a week for three months or more and causes distress or affects daytime functioning, though addressing shorter-term sleep difficulty is still worthwhile.
What contributes to insomnia?
There’s rarely a single cause. It tends to develop from a mix of factors.
Psychological factors
Anxiety, depression and stress are among the most common contributors, and insomnia can also occur on its own.
Learned patterns
Over time, the bed and bedtime can become associated with wakefulness, frustration or worry rather than sleep, which reinforces the problem.
Habits & routine
Irregular sleep schedules, screen use before bed, or daytime napping can all contribute.
Life stress or major transitions
Insomnia often begins during a stressful period and can persist as a learned pattern even after the original stressor resolves.
Other health conditions
Some medical conditions and medications can affect sleep, which is worth discussing with a GP.
Insomnia frequently persists because of the anxiety and habits that build up around trying to sleep, which is exactly what structured psychological treatment addresses.
How is insomnia treated?
Cognitive behavioural therapy for insomnia (CBT-I)
A structured, short-term therapy considered the first-line treatment for chronic insomnia, and more effective for long-term improvement than medication alone.
Sleep restriction & stimulus control
Specific behavioural strategies used within CBT-I to rebuild a strong association between bed and sleep.
Addressing anxiety about sleep
Much of CBT-I focuses on reducing the worry and frustration that build up around not sleeping, which often perpetuates the problem.
Treating underlying conditions
Where insomnia is connected to anxiety, depression or another condition, addressing that condition is often an important part of resolving the sleep difficulty.
CBT-I has strong evidence and is generally recommended ahead of long-term reliance on sleep medication, which a GP can discuss with you if relevant.
When should I see a psychologist about insomnia?
You don’t need to wait until things feel unmanageable.
- Difficulty sleeping that’s persisted for more than a few weeks
- Sleep difficulty significantly affecting your mood, concentration or daily functioning
- Anxiety or dread specifically about sleep or bedtime
- Insomnia alongside symptoms of anxiety, depression or stress
A GP can set you up with a Mental Health Care Plan under Medicare’s Better Access scheme, which covers a rebate for a set number of psychology sessions each year.
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Get matched with a psychologistFrequently asked questions
Is insomnia a mental illness?
Insomnia is a recognised sleep disorder, and it can occur on its own or alongside another mental health condition. Either way, it’s a legitimate concern worth addressing directly, not something to just push through.
Do I need sleep medication to fix insomnia?
Not necessarily. CBT-I is generally recommended as a first-line treatment and has strong evidence for producing longer-lasting improvement than medication alone, though a GP can discuss whether medication is appropriate for your situation, particularly in the short term.
How long does CBT-I take to work?
CBT-I is usually a structured, short-term therapy, often delivered over a number of weeks, with many people noticing improvement within that timeframe, though this varies.
Can poor sleep cause anxiety and depression, or is it the other way around?
Both directions are well established. Poor sleep can worsen anxiety and depression, and those conditions can also disrupt sleep, which is part of why addressing both together often works best.
Do I need a GP referral to see a psychologist about insomnia?
No. A GP referral is only needed for a Medicare rebate through a Mental Health Care Plan, though seeing a GP first can be useful to rule out medical contributors to sleep difficulty.
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