Behavioral Sleep Health: First-Line Moves for Insomnia

My first move is to understand the pattern before starting a full protocol. I want to know what their evenings look like, how long they stay awake, and whether stress or bedtime habits are keeping their body on alert.

One change I suggest within the first week is a consistent wind-down routine. I ask clients to stop screens 30 to 60 minutes before bed and do one calming activity at the same time each night, like reading, stretching, or slow breathing.

Before I touch any protocol, I ask one question: "What's happening in the hour before you get into bed?" Nine times out of ten, the answer tells me everything I need to know. Screens, work emails, doom scrolling, arguments with a partner. The problem isn't usually the sleep. It's what they're bringing to the pillow.

My first move is always stimulus control. I tell clients the bed is for sleep and sex only. No phones, no TV, no lying there problem-solving. If you can't fall asleep within 20 minutes, get up and sit in another room until you're drowsy. It sounds counterintuitive but it works because it breaks the association between the bed and frustration.

Most clients can implement that within a week. The ones who resist it are usually the same ones whose anxiety has colonized every room in the house. That tells me we've got bigger work to do.

Sleep disorders are typically not caused by mattresses.

Most people experience an ongoing cycle of fear or apprehension, which causes them to become hypervigilant and watch themselves (and others) while they are awake.

As long as you continue to be in this state of being 'on,' your brain will stay active.

The bed can then become a source of increased stress, especially when a person has a history of anxiety.

To eliminate the stress associated with monitoring, I often recommend that clients establish a "no-clock" rule.

By removing the ability to monitor, you eliminate one of the biggest sources of concern.

At this point, our focus shifts from sleep to relaxation.

Once we remove the pressure to produce results, we begin to lose some of the anxious thoughts that were preventing us from relaxing.

Our bodies know how to relax.

They need us to stop getting in the way.

Relaxation leads to sleep.

The first place to look when trying to help someone who has trouble falling asleep at night is their daily routines. The time they go to bed, what they do in the evening, light exposure, caffeine, and stress levels usually are a big part of the problem. An inconsistent bedtime or spending time scrolling on smartphones and exposing yourself to too much blue light late at night can leave the brain too alert to settle down for sleep. Sorting out these basics will often take care of many sleep problems on their own.

The best first step toward better sleep is setting a consistent wake-up time every single day, weekends included. It sounds simple, but it works — the body builds a pattern around that anchor and most people start to feel a difference within a week or two. It may take a few nights before falling asleep gets easier, but the tiredness that accumulates from waking at the same time each day eventually gets to a point where sleep comes naturally.

My first move is always to ask what they do in the 90 minutes before they get into bed, and the answer is almost always the same: phone in hand, sometimes work emails, sometimes social media, sometimes news. The single change I ask them to make before we talk about anything else is to remove the phone from the bedroom entirely. Not put it face down. Not set it to Do Not Disturb. Take it out of the room. "The bed has one job. The moment you give it a second job, it stops doing the first one well." Sleep onset difficulty is frequently a conditioning problem. The brain has learned to associate the bed with stimulation, decision-making, and low-grade anxiety. Retraining that association requires removing the cues that activate those states. This one change is harder than it sounds for most clients, which tells you something about the actual problem. The resistance to removing the phone is often the first real clinical data point.

Natalie Buchwald, LMHC, Founder & Clinical Director, Manhattan Mental Health Counseling (manhattanmentalhealthcounseling.com)