When sleep becomes unpredictable, daily life can feel more demanding. Fatigue reduces patience and clarity, and many adults find themselves caught between exhaustion and a rising sense of pressure to “sleep well”. In this episode of The Choice Space, Dr Lee David speaks with occupational therapist and CBT-i specialist Louise Berger to explore how adult sleep works, why it becomes difficult and the small choices that genuinely help nights become steadier.
The conversation begins with what sleep provides. Sleep is a period of significant repair – a time when the brain consolidates memory, processes emotion and supports cognitive function. The body restores hormonal balance, strengthens immunity and repairs tissue. When sleep is disrupted by insomnia or prolonged night-time wakefulness, people often feel the effect across mood, concentration and overall wellbeing. Understanding these processes removes the idea of personal failure. Difficulties with sleep are common, particularly during periods of stress, change or emotional strain.
A central theme in the episode is the role of arousal and worry. Night-time waking is a normal part of human sleep, yet many adults respond to it with alarm. Louise explains that the brain operates differently overnight – the prefrontal cortex, responsible for reasoning and perspective, is less active, while the emotional systems remain alert. This combination gives night-time worries a stronger pull and often leads people into a cycle of “trying” to sleep, which increases wakefulness. Recognising this pattern helps reduce anxiety and encourages a more compassionate response to being awake.
The discussion moves into the principles of CBT-i, the leading evidence-based treatment for chronic insomnia. Key components include strengthening sleep pressure, rebuilding the association between bed and sleep and reducing behaviours that unintentionally keep the sleep system activated. Maintaining a consistent wake time, limiting long periods awake in bed and creating a calmer transition into the evening are simple but powerful ways to support improvement. These approaches are grounded in research and routinely help people regain confidence in their sleep.
The episode also explores common assumptions about technology and sleep. Recent reviews suggest that while bright light can influence the body clock, the specific impact of blue light is smaller than often portrayed. More important are the behaviours surrounding technology use – the type of content people engage with, the timing of exposure and the way devices can displace natural wind-down time. Choosing calmer content, reducing notifications and keeping lighting low are practical ways to support the sleep system without rigid rules.
Stress is another important factor. Periods of high stress commonly lead to short-term sleep disruption, yet sleep usually recovers once the stressor settles. Persistent insomnia often develops not from the stress itself, but from the understandable attempts people make to compensate – going to bed early, lying in, reducing activity or worrying about sleep. These behaviours reduce sleep pressure and reinforce the cycle. Keeping daytime routines steady and maintaining meaningful activity helps protect sleep during difficult periods.
Throughout the discussion runs a clear message: sleep improves when pressure reduces and when people feel supported rather than judged. There is no perfect routine or universal target. What matters is creating conditions that allow the body to rest, easing the threat response and building small habits that support the sleep system over time. Sleep is personal, variable and responsive to change.
Choice Space Takeaways
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Consistent wake times strengthen the sleep–wake rhythm.
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Reducing pressure around sleep helps the body settle more naturally.
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Technology affects sleep mainly through content and timing, not just light.
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Behavioural shifts have more impact than strict routines.
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Night-time thinking is influenced by the brain’s reduced reasoning – keep decisions for the day.
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Supporting overall wellbeing during the day helps nights become steadier.
About the guest
Louise Berger is an Occupational Therapist specialising in sleep and leads the Insomnia Clinic at the Royal Surrey County Hospital – one of the few NHS services in the UK dedicated to insomnia treatment. She focuses on turning sleep science into practical support, delivering training, mentoring and public speaking, and contributing to national guidance to improve access to effective care. Alongside her NHS work she offers private sleep coaching, lectures on the University West England Sleep Medicine course, is a trustee for the British Society of Pharmacy Sleep Services and sits on the communications committee for the British Sleep Society. You can connect with Louise on LinkedIn or contact her directly at lo***************@****on.me
References
CBTi – JAMA Psychiatry 2024;81(4):357-365
Blue light – Sleep Med Rev 2024;76:101933
