Why Your Sleep Hygiene Isn't Curing Your Insomnia (And What Actually Works)

Are you an anxious rule-follower with a death grip on life? You’re not alone. I’m a therapist, and I’ve found that the people who struggle most with insomnia are the ones trying the hardest to sleep. You've probably been told to improve your sleep hygiene, but if you're reading this, it likely didn't work.

There's a good reason for that, and it's not your fault. Unfortunately, a lot of misleading information about sleep is out there. In this post, we'll explore why that common advice fails and introduce you to CBT-I, the gold-standard treatment for insomnia that actually provides lasting relief.

The Big Misconception: Sleep Hygiene vs. Insomnia Treatment

Many therapists' first recommendation for any sleep complaint is sleep hygiene—the practice of having a bedroom and daily habits that are conducive to sleep. Before I became a sleep specialist, I did the same thing. But here’s the crucial distinction: sleep hygiene is preventive care, not treatment.

Think of it like dental health. Brushing and flossing are essential for preventing cavities, and everyone should do it. But if you already have a cavity, no amount of brushing will fix it. You need a targeted treatment from a dentist.

Insomnia is the cavity.

If you are a good sleeper who occasionally has a bad night, sleep hygiene might be all you need. But if you have a chronic sleep disorder like insomnia, you need a targeted treatment. For insomnia, that treatment is CBT-I (Cognitive Behavioral Therapy for Insomnia). Once we resolve the insomnia using CBT-I, we then put sleep hygiene practices in place to help prevent future issues—just like your dentist tells you to keep brushing after filling a cavity.

Clients often feel relieved when I tell them their sleep hygiene efforts didn't work because they were never going to. It means they aren’t broken, and they didn’t do anything wrong.

Are You Tired or Sleepy? Why This Simple Question Matters

To find the right path to better sleep, we first need to use the right words. I always make this distinction early on with my clients, as it helps point us toward the root of the problem.

• Sleepy is a high likelihood of falling asleep. Think heavy eyelids, head nodding, and lapses in concentration.

• Tired is fatigue, low energy, or a feeling of dragging through your day.

You can be tired without being sleepy. In fact, this is the classic description of insomnia: “tired but wired.”

This distinction is a critical diagnostic clue. If a client tells me they are constantly sleepy during the day, I start screening for disorders like sleep apnea or hypersomnias (like narcolepsy). If they report being tired but not sleepy, I immediately assess for insomnia. It's also possible to have both—a condition called COMISA (Comorbid Obstructive Sleep Apnea and Insomnia)—which requires treating both disorders.

Do You Really Need a Sleep Study for Insomnia?

A common question is whether a sleep study is necessary. The answer depends entirely on what we're looking for. A sleep study, or polysomnography, is an objective measurement of what’s happening in your body while you sleep—things like brain waves, breathing, heart rate, and muscle activity.

A sleep study is essential in these cases (not an exhaustive list):

• To diagnose sleep apnea: It measures if and how often you stop breathing.

• To diagnose narcolepsy: It measures how quickly you fall asleep and enter REM sleep.

However, a sleep study cannot tell you if you have insomnia.

One of the biggest drivers of insomnia is sleep effort—the act of striving or working hard to sleep. A sleep study can't measure that. Insomnia is a behavioral disorder, which is why it's diagnosed through a clinical interview and a detailed sleep diary, not a lab test. The same is true for nightmare disorder and most circadian rhythm disorders.

Why Your Insomnia Isn't Just a Symptom of Anxiety or Depression

Many people—therapists included—erroneously believe that sleep problems are always secondary to another issue, like anxiety or depression. The thinking is, "If we just treat the anxiety, the sleep will get better."

While a stressful event or anxiety can certainly trigger a few bad nights, once insomnia becomes chronic (occurring at least three nights a week for three months), it becomes its own independent disorder. It evolves from “I’m not sleeping because of X” to “I’m just not sleeping, and I don’t know why.”

In fact, the relationship often works in reverse. By effectively treating insomnia with CBT-I, we often see a client’s anxiety or depression symptoms resolve. Sleep is foundational to mental health, and directly addressing a sleep disorder is one of the most powerful interventions we can make.

Finding the Right Help: How to Find a CBT-I Specialist

Sleep is far more behavioral than most people realize, and therapists can play a critical role. But it’s essential to know when to offer sleep hygiene, when to refer to a physician for a medical evaluation, and when to refer to a behavioral sleep specialist like myself.

Because CBT-I is a short-term, focused treatment (often just 6-8 sessions), I often work adjunctively with a client’s primary therapist.

Take the Next Step

Insomnia is a treatable disorder, but it requires the right treatment. If you are tired of being "tired but wired" and ready to stop fighting for sleep, it may be time to move beyond sleep hygiene.

Go here to contact me to set up a free 15-minute phone consultation.