Why Can't I Sleep When I'm Exhausted?

Specialist CBT therapy for anxiety, OCD, depression and more in West London

Why can somebody feel exhausted all day and then lie awake at night? I’m Sanah Younis, a BABCP accredited CBT therapist at The Lyceum Clinic in West London, and it is a question I hear often. The answer is not automatically that a person is failing to relax or lacks enough tiredness. Sleep difficulties can involve worry, routine disruption, physical health, medication effects, shift work, pain, mood changes or other factors. A webpage cannot determine which of those matters most for one individual. For some people, bedtime gradually becomes associated with pressure. They notice a tired body but a mind that is scanning, calculating and predicting the consequences of another poor night. A racing heart, tense muscles, repetitive thoughts or checking the time can all feel alarming. The more somebody tries to force sleep, the more attention may be directed towards whether sleep is happening. That extra monitoring can itself be uncomfortable. It does not mean the person is weak, broken or responsible for every difficult night. It is useful to distinguish this from a diagnosis. Terms such as hyperarousal can describe a pattern of alertness, but they do not explain every sleep problem and they are not a conclusion that can safely be reached from a blog. If sleep has changed suddenly, if there are breathing pauses, heavy snoring, unusual movements, severe daytime sleepiness, marked mood change or other physical symptoms, medical review may be important. Psychological support can be part of the picture, but it should not replace appropriate medical assessment. In therapy, I often begin with the meaning that sleeplessness has acquired. For one person, the bed has become linked with worry about work. For another, it is the fear of being unable to cope tomorrow. For somebody else, the difficult part is the self criticism that arrives as soon as they wake. These are different starting points. An individual assessment can explore the pattern, relevant health information, safety, daily demands and what the person would like help with before deciding whether CBT based work or another next step is relevant. Where cognitive behavioural work is appropriate, it is collaborative rather than a challenge to complete alone. We may look at thoughts that increase pressure, routines that have become restrictive, or the cycle of checking, frustration and temporary attempts to gain control. Any practical strategy should be discussed in light of the person’s health, work, caring responsibilities and capacity. It should not be copied as a fixed self treatment plan from the internet. The goal is not to create another sleep scorecard. People sometimes ask whether a difficult night means that tomorrow is already lost. That prediction can be understandable, especially when sleep has been hard for some time. It can also make the night feel even more consequential. Part of the work may be to make room for uncertainty without turning every waking spell into evidence of failure. This is not a promise that sleep will quickly improve. It is a way of reducing the struggle around a problem that often becomes more distressing when it is treated as a personal test. If you are exhausted by day and wired at night, you do not have to decide on your own what it means. I offer online therapy and appointments in West London, including Chiswick, Ealing and the Richmond venue. You may also find the related sleep article at /blog/sleep is not a performance/ and the clinical guide at /guides/sleep/ useful. If you would like to discuss your own circumstances, you can arrange an initial conversation through /start/.