Responding to a patch of poor sleep
Recognise a personal pattern of poor sleep, recall useful responses and agree when to contact your clinician again.
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
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Responding to a patch of poor sleep
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A response agreed with your clinician
A poor patch is not proof that you have lost all progress.
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When to use ‘Responding to a patch of poor sleep’
‘Responding to a patch of poor sleep’ is an interactive cognitive behavioural therapy (CBT) worksheet, most often used in CBT for insomnia and sleep problems.
It is designed to be used within therapy rather than as a standalone self-help tool: a therapist introduces it, works through it collaboratively, and helps make sense of what it surfaces. You can preview the full worksheet above, then assign it digitally for clients to complete between sessions on any device or download it as a print-ready PDF.
How it works
Most people work through it in around 10 minutes. It centres on one focused exercise:
- A response agreed with your clinician: A poor patch is not proof that you have lost all progress.
Completed on the Formulate platform, your client's answers are saved automatically and shared straight back to you, so you can review them before the next session rather than waiting for a paper copy to come back.
The CBT approach behind it
In common with other CBT methods, ‘Responding to a patch of poor sleep’ works by putting clear, personalised coping steps in place for difficult moments. The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.
Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.
Evidence & sources
This worksheet is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- Morin, C. M., & Espie, C. A. (2003). Insomnia: A Clinical Guide to Assessment and Treatment. Kluwer Academic/Plenum Publishers.
- Perlis, M. L., Jungquist, C., Smith, M. T., & Posner, D. (2005). Cognitive Behavioral Treatment of Insomnia: A Session-by-Session Guide. Springer.
- Spielman, A. J., Caruso, L. S., & Glovinsky, P. B. (1987). A behavioral perspective on insomnia treatment. Psychiatric Clinics of North America, 10(4), 541-553.
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
- Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
- Samaritans: 116 123 — free, day or night, 365 days a year
- Shout: 85258 — text SHOUT, free, day or night
- SANEline: 0300 304 7000 — 4pm–10pm, every day
More Insomnia / Sleep worksheets
View all Insomnia / Sleep worksheets →Insomnia / Sleep
Insomnia formulation (Spielman's 3P model)
Map what made you vulnerable to poor sleep, what set it off, what keeps it going, and the cycle of poor sleep, using Spielman's 3P model.
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Sleep diary
Record each night's sleep: when you got into bed, fell asleep, woke in the night, woke for good and got up, plus daytime naps and how well you slept. Based on Spielman, Caruso and Glovinsky (1987) and Morin (2004): daily records of bed, sleep and wake times, night waking and naps.
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Sleep efficiency tracker
Work out and track your sleep efficiency (time asleep ÷ time in bed × 100), the main measure used to adjust the sleep window in sleep restriction. Based on Spielman, Caruso and Glovinsky (1987) and Morin (2004): a weekly log, with the window rules written out.
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Sleep window prescription and tracking
Set and track your agreed sleep window as part of sleep restriction therapy, with weekly changes based on sleep efficiency (how much of your time in bed you spend asleep). Based on Spielman, Caruso and Glovinsky (1987): sleep restriction with weekly changes by sleep efficiency; the record layout is added.
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Stimulus control plan
Six rules from CBT for insomnia that help your bed become linked with sleep again, with a weekly record of how well you followed them. Based on Morin (2004): the stimulus control rules, with a daily rule count, a hardest-rule note and a sleep rating added.
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Sleep hygiene assessment
Look at your everyday sleep habits, rate how helpful each one is for your sleep, and choose a few changes to try. Based on Morin (2004): sleep hygiene as one part of a wider approach to insomnia, with habits reviewed and changes planned.
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