Acceptance & Commitment Therapy for insomnia

Published On: November 5, 2023
Published By: London Sleep Coach

If you’ve suffered from insomnia then you’ll be aware of how much suffering it can cause. The word ‘suffering’ may sound a bit strong, but that’s really what insomnia causes in all sorts of ways. As humans it’s our natural instinct to try to reduce our suffering and get relief from it, therefore most people will try many different things to help solve the issue.

For insomnia this results in trying all sorts of different strategies to help our sleep and reduce the difficult feelings that come with poor sleep. The chances are most insomniacs have already tried or come across using the following strategies to help them sleep:

  • Sleep hygiene advice
  • Different supplements and sleep related gadgets
  • Relaxation techniques (e.g. breathing exercises & meditation)
  • Sleeping pills (prescribed & over the counter)
  • Trying to tough it out and stay positive
  • Using alcohol and or recreational drugs (e.g. cannabis)
  • Distraction techniques (e.g. listening to things)
  • Sticking to strict rules (e.g. getting out of bed if you can’t sleep)

If you’re currently using any of these strategies and they’re working for you and helping you to sleep and live the life you want, then perfect. You can probably stop reading this article right now. However, what if they’re not working?

I suspect you’re reading this article because you’ve tried some of them, maybe even most of them, and they aren’t working. Perhaps some are giving short term relief but don’t seem to be offering a long term solution. Or maybe they do work to an extent, but aren’t helping you to live the life you want and seem to be restricting you.

The chances are you want to sleep like a good sleeper does: typically sleeping well and without having to rely on any pills, remedies or rigid rules. In either case, I have another alternative option that you might be interested in.

ACT Introduction

Acceptance and Commitment Therapy (ACT) is a type of psychological therapy that was created by a man called Steven Hayes back in the 1980s. It’s a powerful therapy that’s been used to help people with all sorts of problems.

There’s a great deal of scientific evidence to support the effectiveness of ACT and there have been more than 3000 scientific studies and over 1000 carefully randomised controlled trials completed on it. Among the 400 or so different types of psychological therapies available, ACT stands out as one of the most effective. It comes in second place, right behind the traditional CBT, in having the most proof that it works.

What’s really exciting is that ACT is really good at helping people with insomnia. Whether the sleep problems are short-term or chronic, ACT can be very effective. Organisations such as the UK’s National Institute of Health and Care Excellence (NICE) and the US’s Department of Health and Human Services (HSS) give it their stamp of approval for insomnia.

But here’s something to point out early: ACT is not a magic cure for insomnia. People can be complicated, and so can sleep, so no therapy can be perfect all the time. If anyone tells you they’ve got a perfect solution for insomnia, then they’re either lying to you or deluded. No such thing exists.

ACT also needs to be done the right way and whilst it’s simple and straightforward in nature, it’s not enough to just read about it or watch videos on it. Much like most therapies, to get the best results you need to have genuine conversations with others who know what it’s like and get personalised help in a real heart-to-heart conversation with someone trained in ACT.

How ACT helps you sleep

People can struggle to sleep and suffer from insomnia for a multitude of reasons, which are explained in more detail in my article what causes insomnia. However, often a core reason is because of experiencing anxiety, stress, worry and other negative thoughts and feelings at night, which keeps people alert and awake.

Everyone experiences difficult thoughts and feelings at night sometimes, such as anxiety, stress and worry etc. Whilst for many this doesn’t happen too often, or at least their sleep doesn’t suffer regularly, for others difficult thoughts and feelings can routinely disrupt sleep and lead to chronic insomnia.

As humans our natural instinct is to think the solution to insomnia is to get rid of these negative thoughts and feelings keeping us awake at night. On the surface this makes sense; if you can relax at night you should be able to sleep. Hence people try various methods to relax to help them fall asleep. But typically they don’t get good results and still struggle with sleep. What if trying to relax at night might not be the best answer?

ACT teaches us a different way. Instead of trying to stop these thoughts or push these feelings away, ACT helps us to handle them in an accepting way. By not trying to stop or struggle with difficult thoughts and feelings at night, we don’t let them have so much control over us and thus they affect our sleep less.

Through using simple tools and strategies based on mindfulness, self-compassion and values based living, we can reach a point where negative thoughts and feelings may still happen at night, but they don’t stop us from sleeping or pursuing the life we want in the daytime.

Paradoxically ACT isn’t about focusing on getting a good night’s sleep. The likelihood is you’ve probably already been trying to get a good night’s sleep, doing your best and trying everything, but how’s that going?

ACT is about taking control of our lives, despite current difficulty sleeping. It’s about working towards not letting sleep troubles or the worries that come with them define who we are or how we should live. It helps us to be in charge of our own actions, rather than letting insomnia rule our lives. Coincidentally this also helps the sleep issues dissipate too.

Acceptance at night

In ACT, Acceptance means being willing to feel whatever thoughts and feelings bubble up inside us at night, even if they’re bad ones and seem to keep us awake. Here’s why that’s important, especially for those experiencing insomnia:

Our brains have evolved to be a built-in worry machine, always on the lookout for dangers and what to do about them. This system is what’s helped humans survive throughout history. We inherently worry about what might cause us harm, even if the threat is minimal and not an actual physical threat.

Automatically our brains work on the basis of ‘better safe than sorry’. From a survival perspective worrying about something is more likely to keep you safe, than forgetting and relaxing about it. Your brain is a pro at spotting possible threats and trying to figure out how to deal with them.

When it comes to insomnia, the brain treats being unable to sleep as a threat. It perceives the lack of sleep as a threat to you because insomnia makes you feel bad and affects your ability to perform at your best in daily life. The word ‘threat’ might sound a bit strong, as a bad night itself won’t physically harm you, but your brain still becomes hypervigilant because of it. Therefore it starts to worry more and more about this problem and what to do about it. The more it worries, the harder it becomes to fall asleep, creating even more worry and so on. It can be like a snowball rolling down a hill, getting bigger and bigger.

In the image below you’ll see some typical worrying thoughts that we experience at night when we can’t sleep. These thoughts are often along a theme of either trying to predict what will happen (often in an anxious way), ruminating over what’s already happened or of general hopelessness. For most people suffering from insomnia you can almost predict these thoughts will pop up at night, when the ‘worry machine’ seems to be most active.

Most of us, instead of being open to and sitting with these hard thoughts and feelings, naturally want to escape them. We instinctively want to get rid of the uncomfortable feelings of anxiety, worry and stress etc, and find a quick fix to help us fall asleep. We might turn to using sleep aids or other strategies to find relief and help us do this. But in the long run, these solutions might not work and might even make things worse.

Don’t feel bad if any of this sounds like you, as experiencing these difficult thoughts and feelings is a completely normal human reaction. In a type of psychotherapy called Compassion Focused Therapy, amongst others, it’s said that humans have “tricky brains,” which have evolved to become easily threatened, stressed and filled with fear and worry. This has served us well in the past to help keep us safe and alive, but has its problems, especially in 21st century life.

In response to insomnia this hard wired threat response also kicks in, manifesting itself typically as worry, anxiety and panic etc. So when we get worried, anxious or fearful about insomnia, that’s normal and to be expected. Therefore the anxiety, worry and stress that we experience from insomnia isn’t because we’re malfunctioning, but because our brains are functioning as they’ve evolved to.

The strange thing is, the secret to a good night’s sleep is often the opposite of what we think. Instead of trying to get rid or get a grip of those tough thoughts and feelings, we should lean towards trying to accept them. Initially we may think of insomnia as a problem to overcome, fix and struggle with. However, it’s actually okay and possible to open up to being awake at night and to allow the feelings this brings to happen without struggling or battling with them, even if it’s uncomfortable.

ACT helps us to not hide from the things that keep us awake and not miss out on life because of insomnia. Embracing the feelings this brings might be a little scary, but can be helped through using tools based on mindfulness for insomnia and self-compassion for insomnia. This leads to a more fulfilling life and is a way of living that reflects who we truly are and what we value. Coincidentally also leading to better sleep.

Commitment to your values

In ACT, commitment is all about focusing on what’s truly important in life and going after it, even when sleep is a challenge. Here’s a flavour of what this entails:

Think of the things that mean the most to you, like family, friends, your job or your passions. These are likely the things that you value in life most and want to be the best version of yourself for. Interestingly though, despite what you might instinctively think, sleeping itself isn’t actually something that you value in life. We think we value a good night’s sleep, but actually good quality sleep just helps us to enjoy doing the things that we really value and love in our daily lives more.

The easiest way to portray this is to give you the following analogy. If I could wave my magic wand and make you feel like you’d had the best night’s sleep, feeling fully refreshed and well in yourself, but having only slept for three hours each night, would you be happy with that? If the answer is yes then you’ll begin to appreciate that it’s not the quantity of sleep that we value, but how it makes us feel and able to do the other things in life.

However, importantly you can still pursue what you value in life and try to be the sort of person you want to be despite sleeping badly. The opposite also applies, you can sleep fantastically and not be living a life true to your values. Even though there’s no question that insomnia makes life harder, hopefully you’re getting a sense that you can still try to be the kind of parent, partner, friend or colleague in life despite it. ACT helps to give you the tools and skills you need to do this, despite the difficult thoughts and feelings that can get in the way.

It’s important to note, committing to our values doesn’t always mean we should force ourselves to push through our day after sleepless nights with sheer willpower. The goal isn’t to grit our teeth and bear it, but rather to approach the issue with mindfulness, compassion and kindness towards ourself. There’s a big difference between tolerance and acceptance, and ACT always aims towards the latter.

By staying true to your values and letting them guide you, you can take control of your life again. You won’t be held back as much by the negative thoughts and feelings that insomnia brings. Instead of letting sleep problems push you away from life, focusing on what you treasure most will pull you back in and help you to live more fully.

The ACT Choice Point

Let’s look at a helpful tool from ACT called ‘the choice point’ to help you understand a bit more about how ACT can practically help your sleep, especially if anxiety, stress, worry, hyperarousal or panic is keeping you awake at night.

Picture this: you’re lying in bed, worrying about something, getting stressed about it and you can’t fall asleep. Perhaps you’re getting anxious about not falling asleep itself and what might happen if you don’t. You’re stuck in a cycle of negative thoughts that keep whirring around in your mind. Or maybe you’re feeling consumed and wrapped up in difficult feelings of anxiety, frustration or panic. This is where the choice point tool comes into play.

When difficult thoughts and feelings arise within us at night, bad ones that keep us awake (e.g. anxiety), there’s a choice we can make. Importantly firstly we need to recognise that we can’t stop these thoughts and feelings arising in the first place. As I’ve already mentioned, it’s expected that when struggling with insomnia, feeling somewhat anxious, stressed and worried at night is a normal reaction. Whatever you try, negative thoughts and feelings will usually find a way to reappear at night.

However, what we do have is more control over how we respond to these thoughts and feelings when they show up. We have a choice over how much we let these thoughts and feelings influence our behaviours in life. We have the ability to not let difficult feelings bother us as much or stop us from doing the things most important to us.

Getting Hooked:

When a worrisome thought pops up, such as “I’ll never sleep tonight,” “I won’t cope tomorrow if I don’t’ sleep,” or “why can’t I sleep?” Our natural tendency is to focus our attention on them, to let them grab us and hook us in. These thoughts might then carry us away and cause us to get lost in them, resulting in us spending lots of time dwelling on them. Sometimes these racing thoughts can keep us up for hours.

When you get consumed by these thoughts, you’re getting ‘hooked.’ You become more bothered, anxious and stressed and less relaxed, making sleep less likely. Getting ‘hooked’ by these negative thoughts tends to spiral into more negative thinking, causing you to get even more lost in your thoughts. This tends to perpetuate feelings such as anxiety too, making you feel even less relaxed and less likely to sleep.

Importantly ‘getting hooked’ by difficult thoughts and feelings is normal, natural and to be expected. It happens to us all, myself included, and we will never not get ‘hooked’ at times. However, using skills learnt through ACT, we can start to notice and realise when we do get ‘hooked’.

Unhooking Yourself:

When we notice we’ve been hooked we then have a choice. Instead of getting carried away or lost in these thoughts and feelings, you can ‘unhook’ yourself. You can create some distance between you and them, getting to see them for all that they really are, simply thoughts and feelings. You can recognise these troubling thoughts and feelings as temporary, something you don’t need to struggle with, get wrapped up in or let control your actions.

So how do you ‘unhook’ yourself? It might sound a bit abstract, but it can be simple with the right tools, although it’s not always easy. ACT provides specific techniques, often based on mindfulness exercises, that you can learn to help you let go of these thoughts and feelings and not get so wrapped up or consumed by them. It might sound easier said than done, but with practice, it becomes more doable.

On the choice point diagram, you’ll see the phrases “away from sleep” and “towards sleep.” But let’s look at what replacing them with “away from your values” and “towards your values” means.

Think about a time when you had a negative sleep related thought like “I won’t be able to do that important thing tomorrow because I’ll be too tired.” This thought might ‘hook’ you and make you feel stuck, leading you to cancel what you originally wanted to do or take part in. In other words, you’re moving away from what you value because you’re letting that unhelpful thought around sleep control your behaviour.

But what if you could ‘unhook’ yourself from that thought? Recognise the thought for all that it is, just words and images popping up in your head, and something that you don’t have to buy into and can let go. It’s about still going ahead and to do that important thing tomorrow which you value, despite the negative thoughts insomnia brings. You might still feel tired or worried, but that hasn’t stopped you focusing your attention on what’s truly important to you.

So, in reality, you have more control than you might think over how much a problem like insomnia affects your life. I’m not suggesting it’s easy, but you can learn to not be so held back by the negative thoughts and feelings that insomnia causes. If this all sounds great, but not something you think you’ll be able to do, that’s understandable and normal and ACT is there to help you make it more accessible and easier.

The ACT Hexaflex

The diagram below is called the ACT Hexaflex, which is a model designed to represent the six different core principles that ACT covers to help people. I’ve adjusted the descriptions of each principle to give you an idea of how they link to sleep and insomnia, as ACT can be used for many different issues.

Don’t be put off if you think the diagram and jargon looks a bit complicated, which admittedly it does. Rest assured that ACT is both relatively simple and straightforward to apply. You’ll never need to understand what the bits of the diagram all mean to get the benefits of ACT to help you sleep and overcome insomnia. But I’ve included it as some may find it useful.

There’s also a few things to bear in mind about the Hexaflex. Firstly it’s just a model. It can’t get even close to fully capturing how the different ACT principles and tools can help you in reality, but it’s an overview. Secondly, not everyone’s sleep troubles are the same. Your insomnia might be different from someone else’s. So, the Hexaflex may need to be tailored to fit your unique situation. Some parts of it might be more relevant to you than others and some parts might not apply to you, and that’s okay.

Struggling with sleep?

I can help you to resolve your difficulty sleeping using Acceptance & Commitment Therapy (ACT).

ACT is an approach that is:

  • Drug and gimmick free
  • Clinically proven and endorsed by NICE
  • A long term solution
  • Tailored to your specific issue
  • Simple and straightforward

Complete my free online course to find out more about how ACT can help.

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