Sleeping badly is not only tiredness

People who sleep badly rarely talk about sleep. They talk about the following day: concentration that will not hold, irritability that shows up around five, the feeling of running on reserves that are not there.

Three different forms

• Not falling asleep. You go to bed tired and thinking switches on exactly there. An hour, sometimes two, with a mind clearer than it was all afternoon.
• Waking in the middle. Typically between three and half past four. You fall asleep again shortly before the alarm, which is the cruellest part.
• Sleeping without rest. The hours are there, the morning is not. This form should always be raised with a doctor too, because some causes are physical.

The circle that forms

After a few weeks the problem is no longer only sleep. It is the bed, which has become the place where you lie awake. It is the evening, which starts to feel frightening around nine. It is the arithmetic you do at quarter to two: if I fall asleep now, five are left.

Sleep is one of the few things you cannot get by trying to get it. The harder you chase it, the more you switch on the alert system that should be switching off. The effort of trying is already part of the problem.

What I usually suggest first

There are simple measures worth trying for a fortnight before concluding anything: a constant waking time including at weekends, getting out of bed if you are still awake after twenty minutes, no afternoon naps, and a clean separation between the bed and any screen. They work better than they sound, but they rarely suffice on their own.

What three in the morning is saying

The part that matters most in my work is what arrives in those hours, because it is almost never random. In the daytime the day covers things; at night nothing covers them, and back comes whatever was left hanging: the postponed conversation, the decision not taken, the conflict that cannot be named without consequences.

Treating insomnia as a technical problem works for a while. Understanding what those nights are talking about lasts longer, and is often the first thing that shifts.