I can't fall asleep, my thoughts won't switch off — what to do

You lie down, turn off the light — and instead of sleep, a stream of thoughts begins: conversations you should have handled differently, tomorrow's tasks, old mistakes. This is one of the most common concerns, and there is a specific explanation for it.

Why it happens in the evening

During the day the brain is busy with external tasks that occupy attention. When you lie down, external stimuli disappear, and the freed-up attention returns to unresolved internal matters. Anxiety doesn't "appear" in the evening — it simply becomes noticeable, because nothing else is competing for your attention.

The second factor is physiology. Anxious thoughts keep the nervous system's arousal level elevated, while falling asleep requires that level to drop. A vicious circle forms: thoughts prevent sleep, and the anxiety caused by sleep deprivation intensifies the thoughts the following evening.

Why "just don't think about it" doesn't work

Trying to suppress a thought usually backfires: to check whether you are thinking about something, the brain has to return to it. That is why fighting thoughts directly tends to worsen insomnia rather than relieve it.

What works according to the evidence

Cognitive behavioural therapy for insomnia (CBT-I) is recognised by the American College of Physicians as the first-line approach for chronic insomnia — ahead of medication. Its main components:

• Limiting time in bed. The bed should be associated with sleep, not with lying awake in thought. If you haven't fallen asleep within 15–20 minutes, it is better to get up and return when drowsiness appears.
• Working with thoughts before bed, not in bed. A designated "worry time" 2–3 hours before sleep: write down what is circling in your head, and a plan for tomorrow.
• Reducing physiological arousal. Breathing techniques with equal phases lower nervous system activation.

When to see a specialist

If sleep difficulties last more than a month, affect your ability to function, or come with persistent daytime anxiety — this is no longer "just insomnia", but a state worth working on deliberately.

Will sleeping pills help? Decisions about medication are made by a doctor. Clinical guidelines recommend trying CBT for insomnia first, since its effects persist after the work ends, unlike medication.

How long does it take to see changes? Under CBT-I protocols, first changes are usually noticeable within a few weeks of regular practice.

See also: Anxiety Disorders: How CBT Helps · I keep replaying conversations and mistakes in my head — how to stop · I wake up with anxiety for no reason — why it happens and what to do · How to know it's time to see a psychologist — 7 signs

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