REFERENCE · CO-OCCURRING CONDITION

Insomnia and Sleep Difficulties Alongside FND

This page covers: Persistent difficulty getting to sleep, staying asleep or returning to sleep, with daytime effects.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
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For the Person With FND

Understanding why sleep becomes difficult

Insomnia means trouble sleeping despite an adequate opportunity to sleep, with effects during the day. A person can feel exhausted and still be unable to sleep. Over time, bed can become associated with wakefulness, frustration or trying hard to make sleep happen. This is one treatable pattern, not the explanation for every sleep disorder. [1]

Sleep problems are frequently reported in FND studies, although the studies differ considerably. Poor sleep can make concentration, pain and everyday rehabilitation harder; discomfort and symptoms can in turn interrupt sleep. The overlap with FND principles is that attention, arousal and learned associations can affect automatic processes without conscious choice. Evidence that treating insomnia directly improves FND remains limited. [1][2]

Recovery and treatment options

Multicomponent CBT-I: cognitive behavioural therapy for insomnia combines several methods to improve sleep regulation and reduce patterns that keep a person awake. It is a first-line evidence-based treatment, not simply advice to be more relaxed. [1] [Research-supported guideline recommendation]
Rebuild the bed–sleep connection: stimulus control is the part of CBT-I that helps bed become a cue for sleep rather than prolonged wakefulness. The usual advice must be adapted if getting out of bed is unsafe, painful or exhausting; a therapist can find a workable alternative. [1] [Guideline-based practice; individualized adaptation]
Adjust sleep timing with clinical guidance: a stable schedule and, where appropriate, carefully managed time in bed can help consolidate sleep. “Sleep restriction” is a technical CBT-I method, not a do-it-yourself instruction to deprive yourself of sleep. It needs particular care with severe daytime sleepiness, falls, bipolar disorder or seizure vulnerability. [1] [Guideline-based practice; safety adaptation required]
Reduce the struggle around sleep: CBT-I can address clock-watching and catastrophic expectations about the coming day; relaxation may help some people settle. The aim is to make sleep easier, not to blame someone for worrying when they are exhausted. [1] [Guideline-based practice]
Make the surroundings and routine supportive: address light, noise, caffeine timing and comfort in ways the person can manage. These measures can support treatment, but sleep hygiene alone is not an adequate treatment for chronic insomnia. [1] [Guideline-based practice]

If a night goes badly: use the agreed plan, allow necessary daytime support and avoid treating the night as a failed recovery exercise. Loud snoring with breathing pauses, restless legs or marked daytime sleepiness may need a separate sleep assessment. Medication and pain review may also help; do not stop prescribed sleep medicines abruptly. [1][2]

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
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For Family, Friends, and Other Supporters

Protect a workable sleep routine without policing it. Help reduce household noise or morning demands when asked. “You would sleep if you were tired enough” is particularly unhelpful to someone who is already exhausted.

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
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For Clinicians and the Care Team

Differentiate insomnia from sleep-disordered breathing, circadian problems, movement-related sleep disturbance and medication effects. Offer adapted CBT-I and coordinate it with fatigue and seizure care. Avoid rigid instructions that increase fall risk or conflict with a PEM management plan. The FND sleep literature is heterogeneous and does not establish a single FND-specific sleep disorder. [1][2][3]

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —

Research and Sources

Evidence reviewed: September 23, 2026. The strongest treatment evidence here is for adults with chronic insomnia, not FND-specific trials. FND sleep studies mainly establish association and burden; individualized adaptations should not be presented as separately proven interventions.

Technique labels describe the evidence for the named condition. A treatment working does not confirm an FND diagnosis or prove a shared mechanism.

No.	Source and stable record	What it supports and limits	Figure
1	Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021;17:255–262. doi:10.5664/jcsm.8986. FND-CIT-0207	Adult insomnia guideline: strong recommendation for multicomponent CBT-I; sleep hygiene alone is insufficient. Application in complex FND requires individual adaptation.	—
2	Kannan S, Dutta A, Das A. Sleep disorders in functional neurological disorder—a systematic review and meta-analysis. Neurological Sciences. 2025;46(4):1573–1580. https://doi.org/10.1007/s10072-024-07931-9 FND-CIT-0073	FND sleep systematic review; association and burden, not proof that insomnia treatment resolves FND.	—
3	National Institute for Health and Care Excellence. Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management. NG206. Recommendations. Accessed September 23, 2026. FND-CIT-0206	ME/CFS guideline: energy management is not a cure; fixed incremental exercise programmes are not recommended. Does not establish the cause or treatment of all FND-associated fatigue.	—

For the Person With FND
For Family, Friends, and Other Supporters
For Clinicians and the Care Team
Research and Sources —