Sleep as a Foundation

If we work together, I’m probably going to ask about your sleep, and I’ll likely ask more than once. Not because sleep fixes everything, and not because I expect it to be good or consistent. I ask because when sleep is persistently off, it becomes much harder to work on anything else. Insight does not land the same way, emotions can feel sharper than usual or oddly flattened, and coping requires more effort even when you understand what is happening.

When sleep is disrupted, most people are operating in some form of damage control. There is less flexibility, less emotional range, and less capacity for learning or reflection. Therapy can still be helpful under these conditions, but the work is often slower and heavier. That is why sleep comes up so often in my work, not as a solution, but as a foundation that supports everything else we are trying to do.

When Sleep Problems Are Especially Frustrating

Many people think of sleep problems as difficulty falling asleep. That is certainly part of it, but waking during the night is just as common and often more distressing. Both difficulty falling asleep and waking during the night can be influenced by many factors, including:

• stress and chronic worry

• unprocessed emotion or grief

• illness, pain, or medication effects

• hormonal changes

• anxiety about sleep itself

When things finally get quiet, the mind often ramps up rather than settling. Thoughts feel louder, the body feels less at ease, and people describe feeling strangely alert. They are not rested, but not sleepy either, caught in an uncomfortable state of wakefulness that can feel hard to escape.

This is one reason sleep problems are so discouraging. People are exhausted from the day and expecting rest, only to find themselves more awake once they finally lie down.

A Counterintuitive Recommendation

One of the most common sleep-related suggestions I make is also one people often find surprising. If you are lying in bed awake and frustrated, it is often better to get up for a short period of time rather than staying in bed trying to force sleep.

This can sound backwards. After all, the goal is sleep, so leaving the bed can feel like giving up. The reasoning has to do with how the brain learns associations over time. It links places with states. When the bed becomes a place where you lie awake, watch the clock, scroll, or worry about the next day, it can begin to cue alertness rather than rest.

Getting up briefly, in low light and doing something neutral, helps protect the bed as a place for sleep and sex. The goal is not to make yourself sleep, but to reduce pressure and allow the brain to relearn what the bed is for.

What to Do Instead of Tossing and Turning

I am realistic about the fact that phones are part of most people’s lives, and pretending otherwise is rarely helpful. At the same time, bright light and emotionally stimulating content tend to make settling harder, particularly late at night. When people ask what to do instead of lying awake in bed, I usually suggest activities that are low light, mildly engaging, and not emotionally activating.

Some examples include:

• reading something familiar or intentionally a little boring

• simple handwork like knitting or crocheting

• doodling or coloring

• listening to calming music or an audiobook

• sitting quietly with a cup of herbal tea

• gentle stretching

• using lamp light instead of overhead lighting

The point is not to make yourself sleep. It is to give your mind and body something low demand to rest against until sleepiness returns on its own.

A Note About Alcohol and Night Waking

Alcohol often comes up in conversations about sleep because it can make falling asleep easier, which is part of why it is so tempting. At the same time, it tends to disrupt sleep later in the night, making early or middle-of-the-night waking more likely.

I mention this not to moralize, but because people are often confused by the pattern. They fall asleep quickly and then wake hours later feeling alert and uncomfortable, unsure why this keeps happening. Simply understanding that this is a common effect of alcohol can be relieving and can help people make more informed choices about how they want to approach sleep.

Why Routine Still Matters, Even for Adults

We tend to accept without question that children benefit from a bedtime routine. Bath, pajamas, book, lights out. The repetition helps their brains recognize what is coming next. Adults are not fundamentally different in this way, even though we often expect ourselves to be.

A bedtime routine for adults does not need to be elaborate. It might include:

• switching to softer lighting for the last part of the evening

• doing hygiene tasks in the same order

• changing into sleep clothes

• saying goodnight to others in the house

• turning off lights in roughly the same sequence

When evenings are unpredictable or overstimulating, the mind often stays in problem-solving mode. A familiar sequence helps orient the nervous system toward winding down. Routine is not about control, but about orientation.

Where Therapy Fits In

Therapy can help with both difficulty falling asleep and waking during the night, though not always in direct or obvious ways. Sometimes the work involves lowering overall tension so settling becomes easier. Sometimes it involves addressing what surfaces when things finally slow down. At other times, it is about grief, trauma, chronic stress, or illness that keeps the body in a state of alertness.

As those underlying factors begin to shift, sleep often changes as well. When sleep improves even a little, other work tends to become more possible. Emotions feel more manageable, insight sticks more easily, and change requires less effort overall.

Why I Keep Asking About Sleep

I do not ask about sleep because I expect it to be perfect or because I think it should be easy. I ask because when sleep is consistently off, everything else has to work harder. When sleep is better supported, even imperfectly, there is more room for growth, reflection, and relief.

That is why sleep keeps coming up in my work. Not as a cure-all, but as a foundation that quietly supports the rest of the process.

Haley Speer is a Licensed Clinical Social Worker (LCSW) providing psychotherapy via telehealth for adults licensed in New York, North Carolina, South Carolina, Tennessee, Florida, Arkansas, and Kentucky.