Chronic Insomnia: When Hypnotherapy Helps After CBT-I

If you have been sleeping badly for three months or longer, your nights or your prescriber may have already used the phrase chronic insomnia. It is not a soft label. It is a formal clinical category with specific criteria, a specific evidence-based first-line treatment, and a specific failure mode where roughly a quarter of clients get only partial response. If you are in that subset, the question is not whether to abandon CBT-I in favour of something else. It is what to layer on top, and in what order. This page is the honest map.

I am Danny M., RCH. I run Calgary Hypnosis Center. The broader sleep work and the research base are covered on the broader sleep hub. This page is the spoke for clients who already have a chronic-insomnia diagnosis and a real history with CBT-I or with the question of whether to try CBT-I. The audience here is exhausted, often dismissed, and frequently in their second or third year of bad sleep. Validation is not a substitute for honesty about sequencing, and false promises waste months you cannot afford.

Chronic insomnia is a distinct clinical category

Chronic insomnia has a formal definition and it is worth being precise about, because the precision matters for what comes next. The standard criteria are difficulty initiating sleep, difficulty maintaining sleep, or early-morning awakening with inability to return to sleep, occurring three or more nights per week, for three or more months, accompanied by daytime impairment such as fatigue, mood disturbance, cognitive difficulty, or functional impact at work or relationships. If those criteria are met, you are in the chronic insomnia diagnostic territory. If they are not, you are in acute insomnia, which often resolves on its own and which is a different conversation.

The distinction is not academic. Acute insomnia, the kind that follows a job loss, a health scare, a bereavement, or a major life transition, usually settles within a few weeks once the precipitating event resolves or the nervous system adjusts. Sleep restriction, behavioural intervention, or a brief course of medication can shorten the window, but most acute insomnia does not need a months-long treatment plan. Chronic insomnia is the version where the original precipitant has resolved, or has been there so long it no longer matters as the active driver, and the sleep disruption has become a self-sustaining pattern. Different beast, different treatment logic.

Population numbers give you the clinical context. Chronic insomnia affects roughly 10 to 15 percent of adults. It is significantly more common in women, in older adults, and in populations with chronic illness, chronic pain, depression, anxiety disorders, or shift work. The prevalence rises sharply through perimenopause and again in the seventh and eighth decades. Among clients with chronic medical conditions, the rate can climb to 40 percent or higher. None of this is reassurance. It is context, and it should land as: you are not the only one in this exact pattern, the field has worked out treatment paths that fit the pattern, and the path is not random.

Validating something that often gets dismissed: chronic insomnia is exhausting in a way that healthy sleepers cannot really model. The cognitive cost of running on fragmented sleep for months compounds. The mood cost compounds. The relational cost of being the person who is always tired or always anxious about sleep compounds. People whose only sleep complaint is a bad week or two tend to underestimate this and offer advice (try chamomile, try a sleep app, just relax) that is the wrong category of intervention entirely. If you have arrived here with that frustration baked in, that is reasonable. The advice on this page is at the right scale for the actual problem.

One framing point before we go further. This page is for clients with formally diagnosed chronic insomnia where CBT-I has failed, plateaued, or is not accessible. If you suspect you have chronic insomnia but have not been formally evaluated, the right next step is your GP or a sleep medicine consult, not a booking with me. An RCH does not diagnose insomnia. We work alongside the diagnosing clinician on the parts of the picture where suggestion and focused-attention work earn their place. That distinction is part of staying inside scope and it protects both your safety and the integrity of the work.

Why CBT-I is the evidence-based first-line

Cognitive behavioural therapy for insomnia, usually shortened to CBT-I, is the evidence-based first-line treatment for chronic insomnia in adults. That is not a marketing claim. It is the position of the American College of Physicians, the European Sleep Research Society, and most national specialty bodies that have published guidelines in the past decade. If you have chronic insomnia and you have not done CBT-I, the next step is CBT-I, not hypnotherapy. I will say that several times on this page because the sequencing matters and there is no shortage of websites willing to skip the order in favour of selling sessions.

CBT-I is built from five components, delivered together over six to eight sessions by a sleep psychologist, a registered psychotherapist with CBT-I training, a sleep medicine specialist with the protocol, or, increasingly, a structured digital program such as Sleepio or SHUTi. The components are stimulus control, sleep restriction, cognitive restructuring, sleep hygiene, and relaxation training. None of them is exotic. The combination is what produces the effect.

Stimulus control rebuilds the bed-as-sleep-cue association. The bed is for sleep and intimacy only. If you are not asleep within roughly twenty minutes, you get out of bed and only return when sleepy. Sleep restriction compresses your sleep window to slightly less than your average actual sleep time, increases sleep pressure, consolidates fragmented sleep into a tighter and more efficient block, and then gradually expands the window as sleep efficiency improves. Cognitive restructuring identifies and challenges the catastrophic thinking patterns that drive sleep anxiety. Sleep hygiene is the baseline of consistent wake time, light exposure, environment, stimulants, and alcohol. Relaxation training is body-based down-regulation.

The honest framing on effect sizes: CBT-I matches or exceeds sleep medication for chronic insomnia, with the major advantage that the gains are durable past the end of treatment whereas medication gains typically end when the medication does. The effects are visible on subjective sleep quality, sleep onset latency, wake-after-sleep-onset, total sleep time, and sleep efficiency. They are visible at follow-up six and twelve months later. Medication does not match that durability profile.

Access is the real-world problem. CBT-I waitlists in Canada are long. In some regions there is no trained CBT-I provider within reasonable distance. The sleep restriction phase is genuinely hard, and a portion of clients drop out during it because they did not have adequate scaffolding. The digital programs (Sleepio, SHUTi, others) reach a wider population but require a specific kind of self-directed engagement to complete the protocol. None of this changes the conclusion that CBT-I is first-line. It changes the conversation about what to do when first-line is not accessible or has not landed.

This is the place to be explicit about scope. I am a Registered Clinical Hypnotherapist. I am not a sleep psychologist and I am not a CBT-I provider, although CBT-I and clinical hypnotherapy share a number of behavioural and cognitive techniques. When a client comes to my practice without having tried CBT-I, my first move is usually to refer them to a sleep psychologist or to a digital CBT-I program, not to book them in for hypnotherapy sessions. That is what staying inside scope as complementary care looks like in practice.

Where hypnotherapy fits when CBT-I is not the answer

CBT-I is first-line. It is also not the right answer for everyone, and the realistic clinical question is rarely a head-to-head between CBT-I and hypnotherapy. It is sequencing. Where does each modality fit, in what order, for which version of chronic insomnia. Five scenarios cover most of the cases I see in practice.

The post-CBT-I plateau. A common presentation is someone who completed a full course of CBT-I, six to eight sessions with a sleep psychologist, did the homework, did the sleep restriction phase, and got real but partial improvement. Sleep is better than baseline. It is not where they need it to be. Roughly 25 to 30 percent of CBT-I responders fall into this partial-response group. The cognitive and behavioural layers landed. The somatic arousal layer or the meta-anxiety around sleep did not fully resolve. This is the strongest case for hypnotherapy as adjunct, because the residual is exactly the kind of conditioned arousal pattern that suggestion-based work targets directly.

CBT-I addressed mechanics, meta-anxiety remained. Related but slightly different. Sleep mechanics improved on every measurable dimension but the dread of bedtime, the catastrophic interpretation of any single bad night, and the sleep-anxiety meta-loop persist. The page on the meta-anxiety layer that often persists past CBT-I goes deeper on this loop, which is one of the most common reasons CBT-I gets close but not all the way.

CBT-I is not accessible. Long waitlists, geography, cost, no qualified provider. The honest framing here is that hypnotherapy is the realistic fallback when CBT-I is not on offer, with a clean safety profile, with some evidence (Chamine 2018, PMID 29952757), and with the caveat that the evidence base is smaller than for CBT-I. We are explicit at intake that this is a second-best access situation, and we re-evaluate access as time passes because waitlists move and digital options expand.

Sleep restriction is medically contraindicated. Sleep restriction, the CBT-I component that compresses your sleep window for several weeks, is not appropriate for everyone. Bipolar disorder where sleep loss can precipitate mood episodes, certain seizure disorders where sleep deprivation lowers threshold, untreated severe depression, certain pregnancy contexts, and chronic conditions where the cognitive cost of further fragmentation is unacceptable can all rule it out. In those cases, the rest of CBT-I can still be done, but the protocol is incomplete and a different layer of arousal-targeting work is reasonable. Hypnotherapy can fill that role.

Highly suggestible client where CBT-I structure did not fit. CBT-I is structured, behavioural, homework-heavy, and works with the cognitive layer. Highly suggestible clients sometimes respond more strongly to suggestion-based and imagery-based interventions than to behavioural protocols, and a portion of the partial-response CBT-I group lands here. We do a hypnotic responsiveness check at intake, and if a client screens as highly suggestible and CBT-I left them flat, the mechanism match for hypnotherapy is good.

Combined CBT-I and hypnotherapy. The clinically realistic frame for many chronic-insomnia clients is not either-or but both. CBT-I addresses the cognitive and behavioural layers that suggestion alone does not. Hypnotherapy addresses the somatic and meta-anxiety layers that CBT-I alone often does not. They are complementary, not competitive, and they can be sequenced or run in parallel with the sleep psychologist and the hypnotherapist coordinating on what each is targeting.

What the evidence says

Three studies anchor the evidence picture for hypnotherapy in chronic insomnia and the related arousal pattern. They sit at different levels of the pyramid and reading them together is the honest way to look at the field.

The first is Cordi 2014 (PMID 24882902). Researchers had healthy young women listen to a hypnotic-suggestion audio before sleep, measured polysomnography, and compared them to a control narrative audio. Among the highly suggestible participants, the active hypnotic audio produced 81 percent more slow-wave sleep among highly suggestible participants vs control. Slow-wave sleep is the deep, restorative stage tied to physical recovery, immune function, and memory consolidation, and it is the stage chronic insomnia clients most lose. Read the caveats carefully because they shape application. The participants were not diagnosed insomniacs. They were healthy young women. The effect was specific to high suggestibility, roughly the top 10 to 15 percent of adults on standardized scales. The 81 percent figure is comparison to control, not absolute baseline. The honest version is: hypnotic suggestion can shift sleep architecture toward more deep sleep, the effect is biggest in suggestible people, and translation to chronic insomnia clinical relief is a separate question.

That separate translation question is where Chamine 2018 (PMID 29952757) comes in, a systematic review of clinical trials evaluating hypnosis interventions for sleep outcomes. Of 24 included trials, 13 of 24 trials (54 percent) reported a sleep benefit from hypnosis-based intervention, including improvements in sleep onset latency, total sleep time, and subjective sleep quality. The remaining 11 did not show benefit. The authors flagged heterogeneity in protocols, populations, and outcome measures, and called for standardized hypnosis protocols and larger randomized controlled trials. The honest position from this review: there is a real signal, the effect is not universal, and the strongest case is for hypnotherapy as an adjunctive intervention rather than monotherapy for chronic insomnia.

The third anchor is Hammond 2010 (PMID 20183733), a review of hypnosis in the treatment of anxiety and stress-related disorders. Hammond concluded that hypnosis is an effective adjunctive intervention for generalized anxiety, situational anxiety, pre-procedural anxiety, and stress-related symptoms, with effect sizes comparable to other psychotherapeutic interventions. The relevance to chronic insomnia is direct: a substantial portion of chronic insomnia is held in place by exactly the stress and arousal patterns that Hammond identified as well-suited to hypnotic intervention. The page on the anxiety and chronic insomnia stack covers the comorbidity in more detail.

Putting these three together honestly: the research base for hypnotherapy in chronic insomnia is smaller than for CBT-I, but the mechanism alignment is good (Cordi 2014 on architecture, Hammond 2010 on the arousal pattern), and the adjunct positioning is well-supported (Chamine 2018). Direct head-to-head CBT-I versus hypnotherapy randomized controlled trial data is sparse. Clinical sequencing rather than competition is the realistic frame. CBT-I first, hypnotherapy as adjunct or alternative when CBT-I has failed, plateaued, or is not accessible. That is the position I take in my practice and the one supported by the evidence as it stands today.

Sleep medicine evaluation: when chronic insomnia is not just insomnia

A meaningful share of clients who present with chronic insomnia have something else going on beneath the sleep complaint. Treating that something else as plain insomnia, with CBT-I or hypnotherapy or both, is the wrong tool, sometimes a dangerous one, because it delays the right intervention. The sleep medicine workup gate is not optional for chronic insomnia that has not responded to first-line treatment. Five categories warrant explicit evaluation.

Sleep apnea. Obstructive sleep apnea is present in a significant minority of patients who present with chronic insomnia, and it is often missed because the dominant complaint is fatigue or fragmented sleep rather than the classic snoring and witnessed apnea. Untreated apnea raises cardiovascular risk and is independently associated with daytime cognitive impairment. Risk factors that should trigger evaluation include observed pauses in breathing, loud or chronic snoring, gasping or choking arousals, unrefreshing sleep despite full duration, morning headaches, daytime sleepiness disproportionate to total sleep time, hypertension that is hard to control, and certain anatomical features. The right tool is a sleep medicine consult with possible home sleep study or polysomnography, not more behavioural intervention.

Restless legs syndrome. RLS is a distinct neurological condition with its own diagnostic criteria: an urge to move the legs, usually accompanied by uncomfortable sensations, worse during periods of rest or inactivity, partially or totally relieved by movement, and worse in the evening or night. It needs medical management, often involving iron studies, dopamine agonists, alpha-2-delta ligands, or other targeted treatments under sleep medicine or neurology. Suggestion and behavioural work will not address the underlying dopaminergic mechanism.

Periodic limb movement disorder. Distinct from RLS, PLMD involves repetitive limb movements during sleep that fragment sleep architecture without the awake urge-to-move sensation. It is only diagnosable on a sleep study and is invisible to the patient because the movements happen during sleep. The fatigue and unrefreshing sleep are real and can be the dominant chronic-insomnia presentation, but the right evaluation is a sleep study, not a course of CBT-I.

Circadian rhythm disorders. Delayed sleep phase disorder, advanced sleep phase disorder, non-24-hour sleep-wake disorder, and shift work sleep disorder all present as insomnia but require targeted intervention with light therapy, chronotherapy, melatonin timing, and behavioural scheduling rather than standard insomnia treatment. The clue is usually the timing pattern: sleep is normal in duration and quality once it happens, but it happens at the wrong clock time. Treating a delayed sleep phase teen or twenty-something with sleep restriction targeting an 11 p.m. bedtime is the wrong protocol entirely.

Narcolepsy with disrupted nighttime sleep. Narcolepsy classically presents with excessive daytime sleepiness, but a substantial portion of patients also have disrupted, fragmented nighttime sleep that can be the chief complaint. It needs sleep medicine workup with polysomnography and a multiple sleep latency test, and treatment is medical. Behavioural and suggestion-based work is not the right starting point.

The general principle: chronic insomnia that has not responded to a full course of CBT-I, or that has features pointing to one of these categories, deserves a sleep medicine evaluation before further behavioural or hypnotherapy work. A 20-minute conversation with your GP about your sleep history, medications, apnea risk factors, and timing patterns is a small investment with significant downside protection. CHC requires that adult chronic-insomnia clients have either had a sleep medicine evaluation or commit to one in parallel before we treat the insomnia as a standalone presentation. That requirement is not paperwork. It is part of staying inside scope as a Registered Clinical Hypnotherapist.

What a hypnotherapy course for chronic insomnia looks like

The work has a fairly standard shape, with adjustments specifically for the chronic-insomnia presentation. Chronic insomnia courses tend to run longer than acute or subclinical sleep complaints because the conditioned arousal pattern has been entrenched longer and the meta-anxiety layer is heavier. Here is the realistic structure.

Intake, 60 to 90 minutes. Heavier than for acute presentations because the history is longer. We map your chronic-insomnia onset story, when it started and what changed, the sequence of prior treatments and their outcomes (with CBT-I outcome the single most important data point), current medication status (zopiclone, trazodone, low-dose mirtazapine or doxepin, melatonin, anything else), sleep medicine workup status and any results, current sleep architecture as best you can describe it, daytime functioning impact, and presence of comorbid anxiety, depression, chronic pain, perimenopause, or other conditions that could be driving or amplifying. We finish with a hypnotic responsiveness check and a clear treatment plan that names what we will work on, in what order, with what between-session practice, and what the criteria are for adjusting if it is not landing.

Sessions 1 to 2: foundational induction and somatic relaxation. The first two sessions establish the induction style your nervous system responds to (progressive relaxation, breath pacing, imagery, or a combination), build the basic somatic down-regulation skill, and produce the first personalized recording. Recording use is nightly. The reason these sessions come first is that chronic insomnia clients often arrive with a hyperaroused baseline that needs to come down before targeted suggestion work can land effectively.

Sessions 3 to 5: targeted suggestion work for the residual arousal pattern and meta-anxiety. Once the somatic baseline is more workable, we move to the suggestion content that targets your specific pattern. For most chronic-insomnia clients this includes work on the bedtime dread loop, the catastrophic interpretation of any single bad night, the conditioned association between bed and arousal, and the sleep-anxiety meta-loop that often sits on top of the actual sleep mechanics. Many clients in this phase also have a 3 a.m. wake-up pattern that is held in place by an early-morning cortisol spike amplified by chronic stress. The page on the cortisol-awakening pattern many chronic insomnia clients have covers that specific sub-pattern.

Sessions 6 to 8: integration with overall sleep approach and maintenance. The closing sessions integrate the gains with whatever else is in your sleep picture: CBT-I behaviours if you have done them, sleep hygiene baseline, medication taper if your physician has one underway, and any environmental or schedule factors. We build a maintenance plan that names how you will use the recordings going forward, what your tracking metrics are, and what would constitute a relapse warning that should bring you back for a booster.

Coordination with the rest of your care team. A chronic-insomnia client typically has a GP, possibly a sleep psychologist if CBT-I has been done, possibly a sleep medicine specialist, and possibly a psychiatrist or psychologist if mental health comorbidity is in the picture. With your consent, we coordinate. The CBT-I therapist needs to know what hypnotherapy is working on so we are not stepping on their cognitive and behavioural targets. The sleep medicine specialist needs to know if anything from sessions raises a red flag for further workup. The prescribing physician needs to know if a taper is part of the picture. Coordination is part of staying inside scope as adjunct care.

Typical course length. Six to ten sessions for chronic insomnia, on the longer side compared with acute presentations. Per-session fee is $220 CAD. Sessions are delivered virtually across Canada or in person in Calgary. Sessions are paid at time of service. A detailed receipt with the practitioner ARCH registration number is provided for any reimbursement attempt or HSA claim.

Realistic timelines and markers of progress. The first marker is rarely full nights of sleep. It is usually less catastrophic emotional response when a night is poor, then less middle-of-the-night anxiety, then shorter sleep onset, then fewer wake-ups, then deeper sleep. Most clients notice the catastrophic-response shift within two to three weeks. Sleep onset and wake-after-sleep-onset shifts usually appear by week four to six. Substantial change in total sleep time and sleep architecture, where it lands, usually shows up by week six to ten. Expecting immediate transformation is the most reliable way to undermine the work.

What to do this week

If you are in the chronic-insomnia category and trying to figure out the next move, here is the realistic week-one set. None of it requires booking with me. All of it makes whatever you eventually do more effective.

If you have not tried CBT-I, that is the next step, not hypnotherapy. Ask your GP for a sleep psychologist referral, or look up a digital program with evidence behind the protocol such as Sleepio or SHUTi. The waitlist for in-person CBT-I in many parts of Canada is months. Get on it now while you are reading this. The digital programs can start this week. Hypnotherapy can wait until you have tried first-line.

If you tried CBT-I but it was incomplete, do a complete course before assuming it failed. A single session of sleep hygiene advice or a few relaxation exercises is not CBT-I. CBT-I is six to eight sessions covering all five components, including a real sleep restriction phase that is genuinely uncomfortable for several weeks. If your prior course was under six weeks, did not include sleep restriction, or was delivered by someone without specific CBT-I training, the right move is a complete course before declaring it failed. The partial-response label only applies to a complete course.

If your sleep medicine workup has not happened, request it via your GP. Even a brief conversation about apnea risk factors, snoring or witnessed pauses, daytime sleepiness, RLS symptoms, and sleep timing patterns is worth ten minutes of your GP's time. If anything raises a flag, the next step is a sleep medicine consult and possibly a sleep study. Doing this in parallel with whatever else you are doing for sleep means you are not chasing the wrong target for months.

Track three numbers for two weeks. Subjective sleep quality on a one-to-ten scale, sleep onset latency in minutes, and total wake-after-sleep-onset in minutes. Add a fourth optional field for daytime functioning impact. Write them in your phone every morning. Two weeks of this data is worth more than two months of impressionistic memory when you eventually sit with a sleep psychologist, sleep medicine physician, or hypnotherapist. Chronic insomniacs are notoriously inaccurate about their own sleep. Tracking protects you from both underestimating progress and overestimating it.

Reduce caffeine after noon and alcohol within four hours of bed. These are not full sleep hygiene, and on their own they will not solve chronic insomnia. They are lower-bound housekeeping. Chronic insomnia clients often have rebound issues with both, where caffeine that did not affect sleep ten years ago now does, and where alcohol that helps onset disrupts the second half of the night. Eliminating these as variables makes whatever else you do more legible.

If you are on long-term sleep medication, schedule a conversation with your prescriber about a tapering plan. Long-term Z-drug use (zopiclone, zolpidem) and long-term benzodiazepine use for sleep have their own issues including tolerance, rebound insomnia on discontinuation, and cognitive effects. The conversation is not necessarily about stopping immediately. It is about whether the current plan is still appropriate, what the taper would look like if you decide to do it, and what supports you would want in place. Hypnotherapy can be one of those supports, but the taper itself is your physician territory.

If you want to start an intake that takes prior CBT-I outcome and sleep medicine workup status as primary inputs rather than afterthoughts, the chronic-insomnia-aware intake is the entry point. Initial CBT-I status is reviewed in detail before we book a treatment block.

Frequently asked questions

Should I try hypnotherapy or CBT-I first if I have never done either?

CBT-I first. Cognitive behavioural therapy for insomnia has the strongest evidence base of any chronic-insomnia treatment, with effect sizes that match or exceed sleep medication and durable results. The major specialty bodies recommend it as first-line. Hypnotherapy belongs in the picture if CBT-I is not accessible to you, if you have completed a full course and the meta-anxiety or arousal layer remains, or if specific CBT-I components like sleep restriction are medically contraindicated. If you have not tried CBT-I and it is available, that is the next step before booking hypnotherapy.

Can hypnotherapy replace long-term sleep medication?

It is not a direct substitute, and any decision to taper, change, or stop a sleep medication must be made with the prescribing physician. What hypnotherapy can do is support a medically supervised taper. Long-term Z-drug use (zopiclone, zolpidem) has its own set of issues including tolerance, rebound insomnia on discontinuation, and cognitive effects, and many people end up on these medications longer than the original prescription intended. Suggestion-based work targets the conditioned arousal that often keeps people dependent on the pill long after the original trigger has resolved. The taper itself is your physician territory. The arousal and meta-anxiety layer is where we work.

What if I am a low-suggestibility client, does hypnotherapy still work for chronic insomnia?

Hypnotic responsiveness sits on a spectrum. About 10 to 15 percent of adults are highly suggestible, the majority moderately suggestible, and roughly 10 to 15 percent are low. The Cordi 2014 (PMID 24882902) finding of 81 percent more slow-wave sleep among highly suggestible participants vs control specifically required high suggestibility. Moderately suggestible clients generally get good but smaller effects. Low-suggestibility clients sometimes get little benefit, and we screen for this in the first session so you do not invest months in something unlikely to land. If suggestibility is low, we refer back to CBT-I, sleep medicine, or another modality rather than running out the clock.

How is this different from sleep meditation apps?

Apps deliver the same recording to everyone. They cannot map your specific chronic-insomnia history, ask whether your wake-ups cluster at 3 a.m. or 5 a.m., adjust suggestion language to your hypnotic responsiveness, factor in your CBT-I outcome, or coordinate with your prescribing physician on a medication taper. They are useful as a relaxation tool. They are not a clinical intervention for chronic insomnia, and treating them as one is one of the most common reasons people arrive at hypnotherapy after a year of nightly app use with no durable change.

Will I always need maintenance after the initial course?

Most clients move from nightly recording use to a few times a week, then to occasional use during high-stress periods. A subset come back for a single booster session every six to twelve months if a life stressor reactivates the pattern. The skills are durable when the recordings remain available. For chronic insomnia specifically, where the pattern has been entrenched for months or years, periodic maintenance is more the rule than the exception. Plan for it rather than treating it as a relapse.

What if my chronic insomnia started after a specific event, like a loss, illness, or life change?

Onset events matter clinically. Acute insomnia triggered by a specific stressor often becomes chronic when the original sleep disruption gets reinforced into a conditioned arousal pattern even after the stressor resolves. The original event may need its own work, particularly if grief, trauma, or a chronic illness diagnosis is part of the picture. We map the onset story at intake. If the underlying event is unresolved, we either fold it into the hypnotherapy work or refer to a registered psychologist for the primary processing while we work the sleep layer in parallel.