How it develops
The standard model has three stages. Predisposing factors — genetic sensitivity to arousal, a family history, a tendency toward worry. Precipitating factors — the thing that started it: a stressful period, illness, a new baby, a job change. Perpetuating factors — the behaviours adopted in response, which outlive the trigger and keep the problem running.
The third stage is where treatment lives. Most people try to fix the precipitating factor long after it has gone.
The perpetuating factors
- Extended time in bed, which fragments sleep and dilutes pressure.
- Irregular wake times, which destabilise the circadian rhythm.
- Napping, which discharges sleep pressure.
- Effort and monitoring — trying to sleep, checking the clock, tracking devices.
- Catastrophic beliefs about sleep's consequences.
- Alcohol used as a sedative.
What treats it
CBT-I is the recommended first-line treatment, ahead of medication, in both American and European guidelines. It combines:
- Stimulus control
- Sleep restriction
- Cognitive restructuring of sleep beliefs
- Sleep hygiene education
- Relaxation training
Effect sizes are substantial and durable: reduced severity, faster onset, better efficiency, and gains that persist 6 to 12 months after treatment ends. Around 40% reach remission.
Medication works faster and is appropriate in some circumstances, particularly short-term and alongside behavioural work. Discuss it with a doctor rather than self-medicating, and see CBT-I versus sleeping pills.
Ruling out the lookalikes
Before assuming ordinary insomnia, exclude:
- Sleep apnoea — snoring, observed pauses, morning headache, dry mouth.
- Restless legs syndrome — urge to move, worse at rest, relieved by movement.
- Circadian rhythm disorder — you sleep fine, just at the wrong clock time.
- Depression and anxiety disorders.
- Medication effects — beta blockers, some antidepressants, corticosteroids, decongestants.
Where body-based work fits
CBT-I addresses schedule, association and belief. It does not directly address the somatic arousal that many chronic insomniacs carry — the background muscular effort that keeps the nervous system at a low level of alert. That is the gap Feldenkrais work fills, and it sits naturally in the relaxation-training component. See the bedtime routine.
Realistic expectations
CBT-I is six to eight weeks, with improvement usually visible by weeks two to three. It is not a cure in the sense that you will never have a bad night again — the goal is that bad nights stop turning into bad months.