Can't sleep after trauma or shift work? How CBT-I helps when sleep hygiene doesn't

When sleep stops coming easily

Most of us have the occasional restless night. But for some people, broken sleep stretches into weeks or months: lying awake with a racing mind, waking through the night, or waking far too early and never feeling rested. Over time this affects mood, concentration, physical health and overall quality of life.

Two groups are especially prone to it: people who've experienced trauma, and people who work shifts, often the same people, in frontline and emergency roles.

Why trauma and shift work disrupt sleep

After trauma, the nervous system can stay 'switched on', making it hard to wind down and stay asleep, and nightmares are common. Shift work adds another layer: working against the body's internal clock makes consistent, restorative sleep genuinely difficult.

Why sleep hygiene often isn't enough

Tips like avoiding screens and cutting caffeine ('sleep hygiene') can help a little, but for persistent insomnia they're rarely enough on their own. That's because chronic insomnia is usually maintained by deeper patterns, the associations, thoughts and behaviours that build up around sleep over time.

What CBT-I is and why it works

Cognitive Behavioural Therapy for Insomnia (CBT-I) is recommended in Australian and international guidelines as the first-line treatment for chronic insomnia, often more effective than medication, because it targets the root causes rather than just the symptoms. It usually involves:

1. A consistent sleep-wake routine
2. Stimulus control, relearning to associate bed with sleep
3. Sleep restriction, matching time in bed to actual sleep, then gradually extending it
4. Challenging the anxious thoughts that fuel wakefulness
5. Relaxation and wind-down strategies

Adapting CBT-I for shift workers

A standard sleep schedule isn't realistic when your hours change. A good clinician will tailor CBT-I to your roster, using strategies like sleep timing around shifts, strategic light exposure and a sleep diary to find what works for your life.

When to seek help

If sleep difficulties have lasted more than three nights a week for three months or more, it's worth getting support. A psychologist trained in CBT-I can tailor an approach to your situation and help you get your rest, and yourself, back.