Poor sleep affects everything. Therapy can help.

Sleep as a symptom, and sleep that keeps itself going

Poor sleep is often downstream of something else. When anxiety is high the body stays ready, and readiness is the opposite of sleep. When a loss is recent, the dark is where it finally gets your full attention. Depression tends to disturb both ends of the night. In cases like these, sleep is reporting on something, and the something is what the sessions are about.

Insomnia can also outlive whatever started it. The night shifts end, the exams finish, the illness passes, and the broken sleep stays. It helps to separate three things: what made you vulnerable to begin with, what set it off, and what keeps it going now. That last group is made of sensible responses — long hours lying in bed hoping, a lie-in on Saturday to catch up, an early bedtime to bank some extra, a drink to take the edge off. It is also the only group still available to change.

Which of these is in front of us changes the work. If your sleep broke seven weeks ago when your father died, treating it as a habit problem misses the point. If it broke four years ago during a bad stretch at work that ended long ago, the original cause is history and the habits that have grown up around the bed are the live issue. Most people are some of both, and the early sessions are largely about proportion.

What cognitive behavioural work for insomnia actually asks of you

It has three moving parts, and most of the work happens between appointments rather than in them. It is not relaxation training, and it is not the list of tips about screens and caffeine — that part is real but small, and you have almost certainly tried it.

Stimulus control rebuilds the link between the bed and sleep. In practice: the bed is for sleep and sex; when you are awake and frustrated you get up and go elsewhere until you are sleepy again; and you rise at the same time every morning, weekends included and especially after a bad night. Written down it looks trivial. At three in the morning in a cold house in February it is not.

Sleep scheduling, sometimes called sleep restriction, is the part people find hardest. You keep a simple record for a week or two, then we set a time-in-bed window close to what you are actually sleeping and hold it steady, widening it as sleep consolidates. The first fortnight usually brings more daytime sleepiness, not less, because you are deliberately building sleep pressure. If you drive for a living, operate machinery, have a history of seizures, or have ever been treated for bipolar disorder or mania, that trade-off is a conversation with your physician first, because short sleep destabilises some conditions — and sometimes it is not the right tool at all.

The third part is the thinking. Eight hours or tomorrow is finished. Awake since three, so the day is already lost. Those predictions get tested against your own record rather than argued with. Mohamad Shabib, Registered Psychotherapist (Qualifying) with the CRPO, has completed CBT for Trauma Levels 1 and 2; Alison Shaji, a Registered Clinical Counsellor with the BCACC who works with clients in British Columbia, is CBT-trained. Neither holds training in the structured insomnia protocol described above, so what happens here is cognitive behavioural work applied to your nights, alongside a referral for the protocol itself if that is what you want.

Where counselling stops and a physician starts

Counsellors do not diagnose, and nothing here is an assessment. We cannot tell you whether you have a sleep disorder, and several common causes of broken nights are medical ones that behavioural work will not touch: obstructive sleep apnoea, restless legs, thyroid problems, chronic pain, the effects of medication, the hormonal changes of perimenopause. If you snore heavily, have been told you stop breathing or gasp in your sleep, or wake unrefreshed no matter what you do, that belongs with your family doctor or a sleep clinic.

It is not either/or. You can sit on a waiting list for a sleep study and do behavioural work in the meantime; the two coexist often enough that settling one does not settle the other. We are glad to work alongside a physician. We do not advise on medication — starting it, changing it or coming off it is between you and whoever prescribes it.

What the first few weeks look like

The free consultation is fifteen to twenty minutes and needs no referral. The first full session is mostly history: what your nights actually look like, when they changed, what you have already tried and what happened. Then you keep that record for a week or two — paper is fine, filled in each morning from memory rather than by checking the clock in the night, which is the whole point.

Early appointments run weekly, because the sleep window gets reviewed weekly. Sessions are sixty minutes at $150. We run noon to nine Pacific, seven days a week, and nine in the evening on the coast is half past one in the morning in St. John's, which is no hour to sit and talk about sleep. Newfoundland clients tend to book at the front of the day instead: noon Pacific is half four in the afternoon there.