Trouble Sleeping

What happens when you try to sleep?

You might recognise several of these:

• I’m tired but can’t switch off. Thoughts, worries or a feeling of being on alert keep me awake.
• My surroundings stop me settling. Noise, light, temperature or the feel of bedding becomes impossible to ignore.
• I keep waking. Sometimes it’s a nightmare; sometimes I’m simply wide awake again.
• My body clock runs late. I sleep better on my own schedule, but work or family life requires something different.
• I wake much too early. I cannot get back to sleep, even when I’m exhausted.
• I’ve slept, but I’m still exhausted. I may snore, gasp, experience restless legs or feel sleepy all day.

An important distinction: Are you unable to sleep despite feeling tired, or have you suddenly started needing very little sleep without feeling tired? The second pattern, particularly with unusually high energy or agitation, may be a sign of mania and warrants prompt assessment.

What might actually help?

One of the best-studied treatments for persistent insomnia is cognitive behavioural therapy for insomnia (CBT-I). It is a structured programme for improving sleep, not just advice to avoid screens or drink less coffee. Crucially, it has been studied in people with mental-health diagnoses too. The approach should be adapted to your circumstances, especially if you have bipolar disorder.

If you’re autistic and struggle to settle

Try: Identify the sensory experiences disturbing your sleep. Consider an autism-informed sleep therapist who can adapt CBT-I around light, noise, temperature, routines and other needs.

What happened in research? In a 2026 study of 163 autistic adults with insomnia, about 38 in 100 receiving a guided, autism-adapted online CBT-I programme improved meaningfully, compared with 11 in 100 receiving sleep education. Sleep benefits continued at follow-up, but the study did not show a clear improvement in everyday functioning. The particular programme, i-Sleep Autism, was tested in a research trial; we are not presenting it as a publicly available service (Spaargaren et al., SLEEP, 2026).

Find help: Search the CBT-I International Directory and ask about experience with autistic adults.

If PTSD or nightmares keep waking you

Try: Ask for CBT-I alongside your PTSD care. If nightmares are prominent, tell the clinician: these may need their own treatment rather than ordinary insomnia advice.

What happened in research? In a small trial of 45 people with PTSD and insomnia, about 41 in 100 receiving therapist-led CBT-I no longer met the insomnia threshold after treatment; none of those waiting for treatment reached that point. The results are promising but come from a small study (Talbot et al., SLEEP, 2014).

Free resource: The US Veterans Affairs Path to Better Sleep course offers practical insomnia lessons. It is not a replacement for trauma-focused care.

If you have bipolar disorder and sleep is becoming irregular

Try: Ask your bipolar-care team about CBT-I adapted for bipolar disorder and ways to protect a regular sleep schedule. Do not try intensive sleep restriction on your own.

What happened in research? In a pilot trial involving 58 people with bipolar I disorder and insomnia, about 5 in 100 who received adapted CBT-I had a manic or hypomanic relapse over the next six months, compared with 32 in 100 given sleep education. Sleep improved too. This is a small trial, not a guarantee of relapse prevention (Harvey et al., Journal of Consulting and Clinical Psychology, 2015).

Important: A sudden reduction in your need for sleep, especially with changes in energy, mood or behaviour, calls for prompt contact with your care team.

If depression or psychotic experiences are disrupting sleep

Try: Ask your clinician specifically about CBT-I, even if you already receive treatment for depression or psychosis. Sleep may need attention in its own right.

What happened in research? Across studies involving people with major depression and insomnia, an analysis estimated that about 32 in 100 improved meaningfully in depression symptoms with CBT-I, compared with 17 in 100 in comparison groups. Those numbers refer to depression response, not a percentage increase in sleep (Furukawa et al., Journal of Affective Disorders, 2024). In a separate small trial of people experiencing persistent hallucinations or delusions, 41 in 100 receiving CBT-I no longer met the insomnia threshold, compared with 4 in 100 receiving usual care (Freeman et al., The Lancet Psychiatry, 2015).

If you have ADHD and your natural sleep time is very late

Try: Ask whether you have a delayed body clock, rather than conventional insomnia. A clinician can review your schedule, medication timing and whether carefully timed treatment is appropriate.

What happened in research? In adults with ADHD and delayed sleep timing, carefully timed melatonin shifted a measured marker of the body clock earlier, but a later analysis found it did not reliably make people fall asleep earlier. A changed laboratory measurement is not automatically a better night of sleep (van Andel et al., Chronobiology International, 2021; Journal of Sleep Research, 2022).

Real programmes and resources

• CBT-I International Directory — Find sleep-focused therapists. Ask whether they have experience with your diagnosis; the listing alone does not verify specialist expertise.
• Sleepio by Big Health — Digital CBT-I for insomnia, with clinical evidence assessed by NICE. Availability depends on where you live. Its general insomnia results must not be assumed to apply equally to every psychiatric or neurodivergent group.
• Insomnia Coach — Free US Veterans Affairs self-help app. It is not the same as therapist-led CBT-I. Its provider advises people with bipolar disorder, epilepsy, sleep apnoea and some other conditions to consult a clinician before using it.
• Path to Better Sleep — Free online sleep education and insomnia self-management materials from the US Veterans Affairs.

One thing to do this week

For three nights, note when you tried to sleep, what kept you awake, when you woke, and how you felt the next day. You might notice a link with sensory discomfort, nightmares, a late body clock or medication timing. Choose one small next step that matches what you’ve noticed—or use your notes to ask for the right kind of help.

Seek medical assessment if sleep problems persist, you gasp or stop breathing in your sleep, you cannot stay awake safely in the daytime, or your need for sleep changes dramatically. Do not abruptly change prescribed medicines or deliberately restrict sleep without clinical guidance.