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Sleep Problems and Psychology: How the Mind Affects the Way We Rest

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Sleep is often thought of as a purely physical process — you close your eyes, your body rests, you wake up refreshed. But in truth, the way we sleep (and how well we sleep) is deeply intertwined with the workings of our mind. Psychological factors such as stress, anxiety, mood changes, and our beliefs about sleep can all disrupt rest — while understanding how the mind and brain operate during sleep can give us powerful tools to improve it.

In this article, we’ll explore what happens during sleep (especially REM sleep), how psychological processes can disrupt rest (especially in conditions like insomnia), and practical evidence-based strategies (such as Cognitive Behavioral Therapy for Insomnia or CBT-I) to sleep better — including insights on how to sleep better for a key population: expecting mothers dealing with pregnancy insomnia.

What Happens During Sleep: The Role of REM Sleep

When you go to sleep, your brain doesn’t just shut off. It moves through several distinct stages, oscillating between Non-REM (NREM) sleep (which includes light sleep and deep, slow-wave sleep) and REM sleep (where most dreaming happens).

Why REM Sleep Matters

  • REM sleep typically makes up about 20-25% of total sleep time in healthy adults.
  • During REM sleep, brain activity resembles wakefulness more than other sleep stages.
  • Research shows REM sleep plays key roles in emotional memory consolidation, creativity, and psychological regulation. For example, theta-oscillations during REM sleep link hippocampus and amygdala activity, supporting the “sleep to forget, sleep to remember” model (emotions get processed, memories get integrated).
  • Recent evidence suggests that reduced REM sleep correlates with greater risk of dementia: “for every 1% reduction in REM sleep, there was a 9% increase in dementia risk.” Harvard Health

When REM Goes Wrong

  • Disruptions of REM sleep (via deprivation or fragmentation) impair emotional memory processing and can interfere with mood regulation.
  • Given that psychological stress, anxiety, and depressive symptoms often disturb sleep architecture (including REM), this gives a mechanistic basis for how mental health affects rest.

Implications for “How to Sleep Better”

Because our brain is actively doing important work during sleep (not just “shutting off”), good sleep hygiene extends beyond “go to bed early”. It includes addressing mental-state variables: such as reducing pre-bed worrying, establishing relaxing routines, and protecting uninterrupted cycles of REM & NREM.

Practical tips:

  • Keep a regular sleep schedule to preserve the full sleep cycles.
  • Wind down mentally (journaling, mindfulness) to reduce arousal before bed.
  • Create a sleep-friendly environment: dark, cool, minimal interruptions.
  • Avoid late-night activities (e.g., work, heavy screen time) that keep the brain in “active” mode.

The Psychology Behind Insomnia

Insomnia isn’t simply “not sleeping”. It is a multifactorial phenomenon where psychological, behavioural and physiological processes interact.

What is Insomnia?

Insomnia disorder involves difficulty initiating or maintaining sleep, or early waking with inability to return to sleep, and daytime impairment. Psychological factors such as hyper-arousal (cognitive and physiological), dysfunctional beliefs about sleep (“I must get 8 hours or I’ll fail”), and maladaptive behaviours (e.g., staying in bed awake, napping) all play a role.

Why the Mind Matters

  • If you’re lying in bed worrying “I must sleep or I’ll be useless tomorrow”, that semantic loop triggers arousal (heart rate, cortisol), making sleep onset harder.
  • Over time, the bed can become associated with wakefulness rather than sleep (“conditioned arousal”), which is a behavioural learning process that CBT-I addresses.
  • Insomnia and mood disorders (anxiety, depression) often co-occur: treating insomnia with CBT-I can reduce risk of depression onset.

Evidence-Based Treatment: CBT-I

CBT-I is the frontline psychological treatment for chronic insomnia. Key elements include: stimulus control (using bed only for sleep/sex), sleep restriction (limiting time in bed to increase sleep drive), cognitive therapy (challenging unhelpful sleep beliefs), and relaxation training.

Supporting data:

  • A meta-analysis of 20 RCTs found average reductions in sleep latency (time to fall asleep) by ~19 minutes, and reduced wake after sleep onset by ~26 minutes.
  • Effects are maintained long-term: e.g., bibliotherapeutic CBT-I study found benefits up to 3-10 years later.
  • Digital/remote CBT-I shows strong outcomes too (e-CBT-I) for insomnia and comorbid anxiety/depression.
    Thus, when psychological factors are at the root of sleep problems, therapy offers a credible, non-medication path.

How to “Sleep Better” Psychologically

  • Keep a sleep diary to track patterns, beliefs, timing.
  • Challenge thoughts like “If I don’t sleep 8 hours I’ll be worthless” → reframe to “I’ll do my best; quality matters more than exact hours”.
  • Limit time in bed if you’re awake >20 minutes; get up and do something calming, then return.
  • Avoid unhelpful behaviours: excessive napping, heavy caffeine late day, working in bed.
  • Incorporate relaxation/meditation before bed to reduce arousal.
    If you’ve tried these consistently for 3+ months and still struggle, seek a psychologist trained in CBT-I.

Special Focus: Pregnancy and Insomnia

Pregnancy is a unique period where physiological, hormonal and psychological changes combine and often disrupt sleep.

Prevalence and Risk

  • A meta-analysis found overall prevalence of insomnia symptoms in the third trimester to be ~42.4% (95% CI: 32.9–52.5%) among ~8,800 women.
  • Other studies report rates ranging from ~44% to 73% during pregnancy.
  • Insomnia in pregnancy is not just a nuisance: it is independently associated with increased risk of severe maternal morbidity (SMM). For example, one large study found insomnia diagnosis during pregnancy predicted higher SMM even after adjusting for physical comorbidities.

Psychological Mechanisms

  • Expectant mothers face bodily discomfort (frequent nocturia, aches, hormonal shifts) and emotional changes (anticipation, anxiety, mood swings). These increase arousal, stress, and sleep fragmentation.
  • Poor sleep in pregnancy is linked to higher levels of anxiety, depression, and postpartum mood problems.

Safe Strategies for Better Rest During Pregnancy

  • Maintain a consistent bedtime routine — it helps anchor your mind despite physical changes.
  • Address physical comfort: supportive pillows, side-sleeping, avoiding heavy meals before bed, limiting fluid intake late evening.
  • Mind-based practices: gentle mindfulness, progressive muscle relaxation, prenatal yoga adapted for pregnancy. These reduce mental arousal.
  • Address worrying thoughts: pregnancy often brings big emotional changes—journaling, “worry time” earlier in the evening (e.g., allocate 15 minutes to reflect, then set aside) can help keep the mind calmer at bedtime.
  • If insomnia becomes chronic (3+ months) and is interfering with mood, daily function or pregnancy outcomes — consider seeking psychological support. A therapist trained in perinatal sleep issues can tailor CBT for pregnancy context.

When to Seek Professional Help

If you’re experiencing any of the following, it’s time to consider professional input (and for readers of your blog, this is where your service-offer comes in):

  • Sleep difficulty > 3 nights/week for ≥3 months.
  • Daytime impairment: fatigue, mood swings, concentration difficulties.
  • Sleep worries dominating evenings (for example, fear of “what if I don’t sleep?”).
  • Comorbid mental health symptoms: anxiety, depression, persistent rumination.
  • Pregnancy insomnia that persists despite good sleep habits and is increasing anxiety or interfering with daily life.

A psychologist trained in sleep disorders (and ideally CBT-I) can assess cognitive, behavioural and emotional contributors, and guide you through structured therapy — not just “good sleep tips” but targeted mental-health-informed work.

Takeaway: Resting the Mind to Rest the Body

Good sleep isn’t just about physical rest — it’s psychological rest. The brain continues working during sleep (especially REM), processing memories, emotions and integrations. When the mind is stressed, anxious or conditioned into poor sleep habits, the brain’s sleep architecture gets disrupted — and that creates a cycle of poor sleep → poor mood → worse sleep.

By recognising the psychological components of sleep — and applying evidence-based strategies like CBT-I, mindful routines, and sleep-mind hygiene — you give yourself a strong chance of breaking the cycle.

For those in special populations (like expectant mothers), the stakes are higher and so is the need for tailored support. But the same core insight holds: improving sleep means improving how your mind approaches rest.

If you are struggling despite good habits, an evidence-based psychological intervention may be the missing piece.

References

Blom, K., Jernelöv, S., Lindefors, N., & Kaldo, V. (2021). Very long-term outcome of cognitive behavioural therapy for insomnia through bibliotherapy: A 10-year follow-up of a randomized controlled trial. Cognitive Behaviour Therapy, 51(3), 225–240. https://doi.org/10.1080/16506073.2021.2009019

Cognitive Behavioral Therapy for Insomnia (CBT-I): An overview. (2023). Sleep Foundation. Retrieved October 19, 2025, from https://www.sleepfoundation.org/insomnia/treatment/cognitive-behavioral-therapy-insomnia

Cognitive-behavioral therapy for insomnia: An effective and safe treatment. (2019). National Center for Biotechnology Information (NCBI). https://pmc.ncbi.nlm.nih.gov/articles/PMC6796223/

Hashmi, A. M., Bhatia, S. K., & Ahmed, M. (2016). Insomnia during pregnancy: Diagnosis and rationale for treatment. Pakistan Journal of Medical Sciences, 32(5), 1193–1197. https://pmc.ncbi.nlm.nih.gov/articles/PMC5017073/

Harvard Health Publishing. (2020). REM sleep: What is it, why is it important, and how can you get more of it? Harvard Health Blog. https://www.health.harvard.edu/staying-healthy/rem-sleep-what-is-it-why-is-it-important-and-how-can-you-get-more-of-it

Okun, M. L., Schetter, C. D., & Glynn, L. M. (2018). Poor sleep quality is associated with preterm birth. Journal of Clinical Sleep Medicine, 14(5), 825–831. https://jcsm.aasm.org/doi/10.5664/jcsm.8248

Peever, J. (2016). The biology of REM sleep. National Center for Biotechnology Information (NCBI). https://pmc.ncbi.nlm.nih.gov/articles/PMC5846126/

Salari, N., Khazaie, H., Abolfathi, M., Vaisi-Raygani, A., & Shohaimi, S. (2021). A systematic review and meta-analysis of the prevalence of insomnia symptoms in late pregnancy. BMC Pregnancy and Childbirth, 21, 762. https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-03755-z

Siegel, J. M. (2011). REM sleep: A biological and psychological paradox. National Center for Biotechnology Information (NCBI). https://pmc.ncbi.nlm.nih.gov/articles/PMC3091378/

Sleep Foundation. (2023). Stages of sleep: REM and non-REM sleep. Sleep Foundation. https://www.sleepfoundation.org/stages-of-sleep/rem-sleep

Stanford Health Care. (n.d.). Cognitive Behavioral Therapy for Insomnia (CBT-I) procedures. Stanford Health Care. https://stanfordhealthcare.org/medical-treatments/c/cognitive-behavioral-therapy-insomnia/procedures.html

Walker, M. P., van der Helm, E., & Yoo, S. S. (2019). Dispatch: REM sleep—What is it good for? Current Biology, 29(14), R717–R719. https://www.sciencedirect.com/science/article/pii/S0960982219308012

Women’s Mental Health. (2022). Sleep problems during pregnancy: Why they matter. Massachusetts General Hospital Center for Women’s Mental Health. https://womensmentalhealth.org/posts/pregnancy-poor-sleep/

Yang, C., Chen, X., & Huang, Y. (2024). Evaluating the global prevalence of insomnia during pregnancy: A systematic review and meta-analysis. Frontiers in Psychiatry, 15, 11348333. https://pmc.ncbi.nlm.nih.gov/articles/PMC11348333/

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