Is there a contradiction in the message of Cognitive Behavioral Therapy for Insomnia (CBTI)? Many people start CBTI due to worry about not getting enough sleep. The media is filled with scary messages that sleeping less than 7 hours a night increases the risk of a host of physical and mental problems. These concerns often motivate people to seek out CBTI and buy the SomniSkills Workbook.
Yet, the cognitive restructuring component of CBTI teaches people to challenge and reduce their worries about sleeping too little. When talking to people about sleep, I often find myself trying to reduce their concerns about sleeping too little. That may seem odd coming from a person who co-authored a book about how to sleep better. It’s like the author of an exercise book telling their audience to stop worrying about not getting enough exercise.
How can we make sense of this apparent inconsistency? The most obvious reason is that worrying about not getting enough sleep is rarely, if ever, helpful! Think about your personal experiences with sleeping. Do you have any evidence that worrying has ever helped you sleep better? If you are one of the few people who find worrying helpful, then I urge you to continue doing it. For those who agree that worrying is not useful, focus instead on more effective strategies to improve your sleep. Objective scientific evidence strongly supports the various techniques recommended in the SomniSkills Workbook. I urge you to go with what the evidence says. If you do tend to worry, let those worries motivate you to follow the recommendations of every respected medical organization, which is to use the techniques of CBTI. And please focus on the Cognitive Therapy section of the SomniSkills Workbook.
In a recent New York Times article,1 Dr. Chris Winter, a neurologist and sleep medicine specialist for several professional sports teams, said “the problem isn’t so much a lack of sleep. It’s our expectation of what we think will happen if we don’t get enough sleep.” He shares the story of a San Francisco Giants baseball player who told him “My twin babies were up vomiting all night, and I didn’t get any sleep. I can’t play like this.” He played anyway and hit two home runs in a game for the first time in his career. This anecdote captures a central theme of CBTI. Our expectations about the effect of “insufficient” sleep rather than the actual amount of sleep influence how we feel and behave the following day.
Worry about “insufficient” sleep often centers around how you will feel and perform the next day. The baseball player’s experience shows that fears about the effects of poor sleep on performance often don’t come true. The Cognitive Therapy component of CBTI will help you examine your specific fears about what will happen if you don’t get enough sleep. You will be guided to test those specific negative expectations. First, you will write down your feared outcomes. Then you will assess what actually happens if you don’t get enough sleep. That way you will look at the actual data. In many cases, like the baseball player, your fears will not come to pass. And if your sleep does adversely affect you, be precise about the extent to which that happened. To what extent was performance or mood actually affected? How bad was it really? Exactly how much of the day was sub-par?
There is solid research supporting the proposition that your expectations about at how well you sleep, rather than how you actually sleep, affect how you will feel and perform the following day. Several experiments found that the perception of how well a person slept, rather than how well they actually slept, determined how they felt and performed the following day.2,3,4 So if you find yourself worrying about “insufficient” sleep ruining your day, keep this research in mind.
The CBTI cognitive restructuring also encourages you to ask yourself: So, what if? What if you do not perform or feel your best during some parts of the next day? What if you make a mistake or find yourself struggling in some situations? Is that really a catastrophe? Human beings cannot always perform at their highest level even after a good night’s sleep. You are a human being. Therefore, you cannot always perform at your highest level.
Please also pay attention to days after you slept well. Do those days always go perfectly? Probably not. There is a natural tendency to blame a poor night’s sleep for a “bad” day. But we all have “bad” days even after sleeping well. Did you ever say, “today was a bad day, it must have been because I slept well last night”? How we feel and perform on a day-to-day basis varies, sometimes quite a bit. Parts of some days go well, while parts of other days do not. Sleep may play a role, but sleep is not always the culprit.
After reading this article, I hope you understand why advocates of CBTI may urge you not to worry about getting enough sleep. Sleeping a “sufficient” amount certainly has advantages. But it will not prevent all the problems in your life. Nor will sleeping an “insufficient” amount of sleep cause all your problems. It is better to temper one’s expectations about both the negative and the positive effects of sleep.
- Devlin, E. (2025, June 19). I’ve had a hard time sleeping. So I asked an expert who works with elite athletes for advice. The New York Times.
- Semler CN, Harvey AG. Misperception of sleep can adversely affect daytime functioning in insomnia. Behavior Res Ther. 2005 Jul;43(7):843-56. doi: 10.1016/j.brat.2004.06.016. PMID: 15896282.
- Gavriloff D, Sheaves B, Juss A, Espie CA, Miller CB, Kyle SD. Sham sleep feedback delivered via actigraphy biases daytime symptom reports in people with insomnia: Implications for insomnia disorder and wearable devices. J Sleep Res. 2018 Dec;27(6):e12726. doi: 10.1111/jsr.12726. Epub 2018 Jul 10. PMID: 29989248.
- Rahman SA, Rood D, Trent N, Solet J, Langer EJ, Lockley SW. Manipulating sleep duration perception changes cognitive performance – An exploratory analysis. J Psychosomatic Res. 2020 May;132:109992. doi: 10.1016/j.jpsychores.2020.109992. Epub 2020 Mar 4. PMID: 32172039; PMCID: PMC7568839.