Cognitive Model of Insomnia
Harvey; Espie (2002) · Insomnia
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
Harvey's cognitive model (2002) and Espie's psychobiological inhibition model (2002) explain why poor sleep persists after whatever caused it has passed: worry, monitoring and well-meant efforts to sleep raise arousal and weaken the body's own sleep rhythm.
Cognitive Model of Insomnia
Harvey; Espie (2002)
Poor Sleep
Disturbed sleep — trouble falling asleep, waking in the night, or unrefreshing sleep. In Harvey's cognitive model the deficit is often overestimated, as attention and worry distort how sleep and daytime tiredness are perceived.
Daytime Fatigue & Worry
Daytime tiredness together with excessive, negatively-toned thinking about sleep and its consequences ('I won't cope', 'I must get eight hours') — worry, rumination and clock-watching that raise arousal.
Compensatory Behaviours
Safety behaviours and counterproductive efforts — napping, extra caffeine, going to bed early, lying in, using screens in bed, and 'trying hard' to sleep. Effortful attempts to sleep paradoxically increase arousal and inhibit sleep's natural automaticity (the attention–intention–effort pathway).
Perpetuating Factors
Perpetuating factors that keep insomnia going after the original trigger has passed — conditioned arousal (the bed becomes a cue for wakefulness and worry), an irregular sleep–wake schedule, and reduced homeostatic sleep drive from extra time in bed and napping.
Selective Monitoring & Misperception
Selective attention, monitoring and misperception (Harvey's cognitive maintainer) — scanning the body and the day for signs of poor sleep and tiredness, and clock-watching at night. This sharpens awareness of, and overestimates, the deficit — so sleep is perceived as worse than it is, feeding back into the cycle.
The published model, shown for reference. Switch to “Blank” to see the empty template you complete with a client.
Understanding the model
Most of us sleep badly now and then. Sometimes, though, a run of poor nights turns into ongoing insomnia — and what keeps it going is often different from what set it off. This model shows the cycle that maintains it.
After some bad nights, it's natural to worry about sleep and about coping the next day. But worrying and watching the clock keep the mind and body switched on and alert — the opposite of what sleep needs. We also tend to monitor closely for signs of tiredness, which makes us notice them more.
To cope, people understandably try things that seem to help: napping, extra coffee, going to bed early, lying in, or staying in bed trying hard to drop off. Trying to force sleep tends to backfire, because sleep comes most easily when we stop chasing it.
Over time these habits weaken the body's natural sleep rhythm and turn the bed into a place linked with being awake and worrying rather than sleeping. So poor sleep continues — and the worry, monitoring and habits that were meant to fix it are keeping it going.
Questions therapists ask about this model.
Frequently asked questions
What maintains insomnia once it has started?
Usually not what started it. After a run of bad nights, worry about sleep and about coping tomorrow keeps mind and body alert, and watching closely for signs of tiredness makes them easier to notice. Understandable habits follow — napping, extra caffeine, early nights, lying in, trying hard to drop off — and effort tends to backfire, while extra time in bed weakens sleep drive and turns the bed into a place associated with being awake.
How does it relate to Spielman's 3P model?
Spielman, Caruso and Glovinsky (1987) separated predisposing, precipitating and perpetuating factors in insomnia. This formulation sits in the third group: it maps what keeps poor sleep going once whatever set it off has passed. Within that group, Harvey (2002) explains the part played by worry, selective monitoring and misperception of sleep, and Espie and colleagues (2006) describe the attention–intention–effort pathway, in which the effort to sleep gets in the way of sleep itself.
What does the model not cover?
It describes what keeps insomnia going rather than what distinguishes it from other sleep disorders, which have their own causes and are identified in their own right. It also carries an implication worth knowing: because attention and worry shape what the client notices, their sense of how badly they slept is itself partly a product of the cycle.
Worksheets and reading for this model
Using this model in session — for therapists
How to introduce the model, guided-discovery questions, treatment targets and a behavioural experiment are available to signed-in therapists.
References
- Harvey, A. G. (2002). A cognitive model of insomnia. Behaviour Research and Therapy, 40(8), 869–893.
- Espie, C. A. (2002). Insomnia: Conceptual issues in the development, persistence, and treatment of sleep disorder in adults. Annual Review of Psychology, 53, 215–243.
- 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.
- Espie, C. A., Broomfield, N. M., MacMahon, K. M. A., Macphee, L. M., & Taylor, L. M. (2006). The attention–intention–effort pathway in the development of psychophysiologic insomnia: A theoretical review. Sleep Medicine Reviews, 10(4), 215–245.
This diagram is a reconstruction of the published model for clinical and educational use, grounded in the sources above.
Cite this page (APA 7)
Vermani, T. (2026). Cognitive Model of Insomnia. Formulate. https://formulatetools.co.uk/tools/formulation/insomnia-cognitive-model
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