When Sleep Stops Working: How Therapy Can Help with Sleep and Mental Health

Sleep comes up often in therapy, but rarely as the first concern. More often, people talk about feeling anxious, burned out, overwhelmed, or emotionally stuck. And as we begin to explore what’s happening in their day-to-day life, sleep quietly enters the picture—fragmented, unpredictable, or simply missing.

When sleep is disrupted, it affects more than just energy levels. It influences how we think, feel, and connect with others. Poor sleep can worsen anxiety, fuel depression, and make emotional regulation feel out of reach. It becomes harder to focus, harder to cope, and harder to feel like yourself.

Sleep problems aren’t always the main reason someone starts therapy, but they are almost always part of the story. And they’re almost always worth paying attention to.

The Connection Between Sleep and Mental Health

Sleep and mental health are deeply intertwined. One impacts the other in a cycle that can feel hard to break.

Anxiety makes it difficult to fall asleep. Depression can lead to oversleeping or waking up too early. Trauma can keep the nervous system in a state of hyperarousal, making it hard to feel safe enough to rest. Even when someone is physically exhausted, their mind might still feel wide awake.

Sometimes the sleep issues come first—persistent insomnia, restless legs, or fatigue that won’t go away—and emotional distress follows. Other times, sleep disruptions emerge as a symptom of an underlying mental health issue. In either case, therapy offers space to address both.

Insomnia and the Cycle of Sleeplessness

Insomnia is one of the most common sleep disorders we see in therapy. People describe lying in bed for hours, exhausted but unable to drift off. Others fall asleep quickly but wake in the early hours with racing thoughts and tension in their body. The harder they try to sleep, the more alert they feel.

Over time, the brain begins to associate the bed with stress instead of relaxation. Clients say they dread bedtime, not because they aren’t tired, but because they fear another night of trying and failing to rest.

Cognitive Behavioral Therapy for Insomnia (CBT-I) is one of the most effective treatments available. It doesn’t rely on medication. Instead, it focuses on reshaping thought patterns, adjusting sleep-related behaviors, and helping the body relearn how to rest. In therapy, we work together to reduce pressure around sleep and create a more compassionate, sustainable approach to rest.

Other Sleep Issues We Often See in Therapy

Not all sleep problems are insomnia. Here are a few others that commonly come up in our work:

Sleep Apnea

Clients who experience sleep apnea often feel tired no matter how long they’ve been in bed. While the diagnosis and treatment come from a medical provider, therapy can help clients cope with the emotional toll—frustration, shame, or overwhelm—that often comes with untreated apnea. Therapy can also support people in sticking with treatments like CPAP, which can take time to adjust to.

Restless Legs Syndrome and Nighttime Movement

An urge to move the legs at night or involuntary leg movements during sleep can make rest feel impossible. These sensations are more than physical discomfort—they take an emotional toll too. Therapy helps clients manage the frustration, rebuild a sense of calm, and explore relaxation techniques that support better sleep.

Nightmares, Night Terrors, and Sleepwalking

Trauma-related sleep disorders can include vivid nightmares, night terrors, or acting out dreams in a way that feels scary or confusing. Clients often come to therapy feeling ashamed or afraid of what happens when they’re asleep. We work gently and without judgment to make sense of these experiences and create a sense of safety at night.

Narcolepsy and Chronic Fatigue

Conditions like narcolepsy can be isolating. The unpredictability of sleep attacks or sudden muscle weakness can disrupt daily life and lead to feelings of shame or disconnection. In therapy, we focus on building resilience, exploring self-advocacy, and validating the emotional impact of living with a chronic condition.

What Therapy for Sleep Actually Looks Like

Therapy for sleep issues is rarely about offering generic advice or telling you to “just relax.” We slow down and look at what’s happening in your life, your body, and your internal world that might be getting in the way of rest.

Some of the strategies we may explore together include:

• Challenging anxious thoughts that show up at night

• Creating consistent sleep routines that support your body’s natural rhythm

• Using mindfulness and grounding techniques to settle the nervous system

• Exploring why bedtime might feel vulnerable or emotionally charged

• Processing trauma or unspoken grief that surfaces during the night

• Reducing pressure around sleep and letting go of perfectionism

The goal isn’t to control sleep. It’s to rebuild trust with your body and with rest itself.

Why Addressing Sleep in Therapy Matters

Sleep isn't just a physical process—it’s emotional. And when it breaks down, it can leave you feeling disconnected, ashamed, or exhausted in ways that are hard to explain.

You deserve support that sees the full picture. At Rust Wellness Group, we help clients explore the emotional, psychological, and relational layers of sleep difficulties—whether they’re tied to stress, trauma, anxiety, or something else entirely.

If you’re tired of feeling tired, Rust Wellness Group is here to support you, whenever you’re ready.