A Guide for EMDR Therapists to Address Insomnia Effectively

March 9-15 is Sleep Awareness Week, a time to raise awareness on the importance of sleep on our overall health. We turned to EMDRIA members Abby Neuberg and Holly Forman-Patel to share more about using EMDR therapy with issues around sleep.

Understanding Insomnia: A Guide for EMDR Therapists to Address Insomnia Effectively

Guest Blog Post by Abby Neuberg, LMFT, LPCC and Holly Forman-Patel, LMFT, LPCC

EMDR clinicians often find themselves stumped when working with clients struggling with insomnia. While EMDR therapy has proven highly effective for addressing trauma, anxiety, and related conditions, insomnia presents unique challenges that require a nuanced approach. Many therapists struggle to grasp the full picture of how insomnia develops, persists, and impacts a client’s overall well-being. This article aims to provide essential information about insomnia, common mistakes in EMDR therapy related to sleep issues, and strategies to address this complex condition effectively.

Insomnia vs. poor sleep: What’s the difference?

Insomnia is more than just an occasional bad night’s sleep. It’s a persistent disorder that affects the ability to fall asleep, stay asleep, or feel rested despite adequate opportunity for sleep. Poor sleep, on the other hand, might result from temporary factors like stress, a late night, or an uncomfortable sleeping environment. Insomnia, by contrast, is a chronic condition that disrupts daily functioning and often involves underlying psychological or physiological factors.

It is important to refer a client to a doctor for a sleep study if underlying parasomnias like sleep apnea, restless leg syndrome, or sleepwalking are suspected. Parasomnias are best treated by a medical doctor who is a sleep specialist. Sleep apnea can be a serious or deadly issue when untreated

Insomnia: What it is and what it isn’t

First, it’s important to understand what insomnia is and how it differs from other sleep disturbances. Insomnia is a 24-hour disorder, not something you can necessarily observe during a single sleep study unless it’s directly caused by parasomnia.

Treating insomnia requires a comprehensive assessment that goes beyond the night’s sleep. Some of the key factors to evaluate include:

Chronotype: Are you naturally more of a night owl or an early bird?
Sleep Hygiene: How healthy are your sleep habits?
Daily Anxiety Management: How do you manage stress throughout the day?
Routine Consistency: Are you able to maintain a reasonably structured 24-hour schedule?
Substance Use: Do caffeine or other substances interfere with your ability to fall or stay asleep?

When and why did insomnia start?

A crucial step in addressing insomnia is understanding its origin. When did it start? Was it triggered by a specific event or series of events? Common correlations include trauma, loss, health issues, or changes in life circumstances. This is where EMDR Therapy can be very helpful in processing the events leading up to and surrounding the insomnia along with the triggers.

How insomnia works: The cycle of anxiety and arousal

For many people, the experience of insomnia is both physiological and psychological. A typical scenario might look like this:

You wake up in the middle of the night—perhaps due to noise, discomfort, or needing to use the bathroom.
Almost immediately, a thought arises: “Oh no, I’m awake, and I won’t be able to go back to sleep.”
This thought triggers a subtle but powerful adrenaline response, which keeps you awake.
As you lie in bed trying to will yourself to sleep, the anxiety builds, further conditioning your body to associate being in bed with wakefulness.

This cycle happens so quickly and subtly that most people don’t even realize it is anxiety-based. But for those with a history of trauma or chronic anxiety, this process can easily disrupt their sleep.

Using a beliefs questionnaire, such as the Dysfunctional Beliefs and Attitudes About Sleep Scale (DBAS), can be a helpful tool to uncover subtle, unhelpful beliefs about sleep that may be contributing to insomnia. These beliefs often revolve around fears of not sleeping or the consequences of poor sleep, which can create a vicious cycle of anxiety and wakefulness. These beliefs can be addressed in the EMDR process, including where they were first learned and situations (which may not only be related to sleep) that trigger the beliefs.

Time in bed matters

One of the most effective strategies for insomnia is reconditioning the body’s association with the bed. People with insomnia often spend too much time in bed, either working, relaxing, or simply lying awake. Over time, this conditions the body to view the bed as a place of activity or stress rather than rest.

To break this cycle, using sleep compression techniques may be helpful. This involves:

Maintaining a consistent sleep and wake schedule.
Only going to bed when you are truly tired (when your eyes are shutting, and your head is nodding).
Avoiding lying awake in bed for more than 20 minutes. If you are not asleep by then, get up and do something boring until you feel sleepy again.

Think of it like training a baby to sleep in their crib, it is about creating consistent and healthy sleep associations.

Additional factors to consider

Beyond behavioral strategies, it is important to assess other potential contributors to insomnia:

ADHD: Some individuals with ADHD find their minds crave stimulation to wind down, which can interfere with sleep.
Hormonal Changes: Life stages like perimenopause or menopause can significantly impact sleep patterns.
Medication Side Effects: Certain medications may disrupt sleep; it is worth discussing with a doctor.
OCD: Obsessive-compulsive tendencies can cause intrusive thoughts or rituals that delay sleep.
Bipolar Disorder: Sleep patterns can be severely affected during manic or depressive episodes.
Untreated Anxiety or Depression: Generalized anxiety or depressive disorders are common underlying causes of insomnia.
Grief, Work, or Family-Related Stress: Temporary situations that might increase levels of stress and anxiety in an individual can impede falling or staying asleep.