Chronic insomnia and pre-sleep tension

For ten years he had been waking at two and staying awake until close to morning. The more he tried to sleep, the more anxious he became. Gradually he had started sleeping on the sofa, where the thought 'this is not the bed' gave him false reassurance.

Work started by redefining the bed: the bedroom only for sleep, and leaving it if a long night ensues. Despite his resistance at first, this produced the largest change.

We then worked on the mental tension before sleep — thoughts full of work worry and the day's replay — and wrote a stable schedule for waking times.

By the third month sleep had reached five and a half hours and, more importantly, he had lost the feeling of being tired all day. By month five he was at six and a half hours and no longer slept on the sofa.