Insomnia

What is it?

Insomnia is difficulty falling asleep, staying asleep, or waking too early, despite having the time and opportunity to sleep, and it becomes chronic when a few bad nights compound into a lasting change in your relationship with sleep and your bed.¹It is these changes that keep insomnia running, rather than the first nights of disturbed sleep.

Why could this be a problem?

Chronic insomnia isn’t just a problem during the night, unsurprisingly. It affects our concentration, mood, and decision-making the next day, and is linked to a higher risk of depression, anxiety, high blood pressure, and reduced immune function.2 It’s also self-perpetuating: the harder you try to force sleep, the more alert and anxious you become at bedtime, which just keeps the cycle going. It can feel like you are trapped in a vicious, inescapable cycle that slowly takes more and more away.

What can be done?

Cognitive Behavioural Therapy for Insomnia (CBT-I) is recommended as the first-line treatment for chronic insomnia by both the American College of Physicians and the American Academy of Sleep Medicine, ahead of sleeping tablets.3 It works by rebuilding the association between bed and sleep, adjusting time in bed to match your actual sleep need, and working through the anxious thoughts that build up around sleep. Most people see meaningful improvement within a short, structured course of sessions at our Cape Town practice, without medication.

Resources

 This self-screening tool is intended to help identify patterns worth discussing with a doctor; it is not a diagnosis and does not replace a full medical assessment.

FAQs

No. Most chronic insomnia responds well to structured, evidence-based treatment. It’s not a life sentence, even if you have lived with it for years.

This means that you could intervene in your sleep before a full insomnia disorder establishes. If you have more questions about this, you can contact us.

70-80% of patients experience improvements in their sleep, and many of these improvements are stable over time.4 It is more effective than medication and is designed to specifically help you achieve better sleep by targeting the factors that perpetuate insomnia.

Not usually, and not long-term. CBT-I outperforms medication over time, without the side effects or dependency risk.

Sleep hygiene helps around the edges but rarely resolves chronic insomnia on its own. CBT-I directly targets the mechanisms keeping the insomnia going.

The components of CBT-I might still be helpful, but we would manage both as inter-related problems. This might mean medication, such as an antidepressant, or general CBT skills. You will be treated as a holistic person, and not by what labels fit you.

CBT-I is the first-line treatment for insomnia in menopause and is effective.5 However, we will not be able to provide HRT (Hormone Replacement Therapy) through our clinic, but can refer you if it is something you wish to explore.

Yes, and it is a non-pharmacological (non-drug) treatment.6 This is important, as we try to avoid medications in pregnancy that might produce risks for the baby and/or the mother.

There are many other things that can disrupt your sleep, from nightmares to restless legs. Please contact us and let us know what has been disturbing your sleep, and we will get back to you as soon as possible.

References

  • American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014.
  • Fernandez-Mendoza J, Vgontzas AN. Insomnia and its impact on physical and mental health. Curr Psychiatry Rep. 2013 Dec;15(12):418. doi: 10.1007/s11920-013-0418-8. PMID: 24189774; PMCID: PMC3972485.
  • Buysse, D., Arnedt, J.T., Buenaver, L. et al. Combination treatment for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med 22, 56 (2026). https://doi.org/10.1007/s44470-025-00038-8
  • Muench A, Vargas I, Grandner MA, Ellis JG, Posner D, Bastien CH, Drummond SP, Perlis ML. We know CBT-I works, now what? Fac Rev. 2022 Feb 1;11:4. doi: 10.12703/r/11-4. PMID: 35156100; PMCID: PMC8808745.
  • Ntikoudi A, Owens DA, Spyrou A, Evangelou E, Vlachou E. The Effectiveness of Cognitive Behavioral Therapy on Insomnia Severity Among Menopausal Women: A Scoping Review. Life (Basel). 2024 Oct 31;14(11):1405. doi: 10.3390/life14111405. PMID: 39598203; PMCID: PMC11595697.
  • Manber R, Bei B, Simpson N, Asarnow L, Rangel E, Sit A, Lyell D. Cognitive Behavioral Therapy for Prenatal Insomnia: A Randomized Controlled Trial. Obstet Gynecol. 2019 May;133(5):911-919. doi: 10.1097/AOG.0000000000003216. PMID: 30969203; PMCID: PMC6485299.