The leaders who come to me about sleep are rarely tired in the evening. They are tired at four in the afternoon and alert at three in the morning, which tells me the problem is not the bed. It is that the day never ended.Dr. Prerna Kohli

You fall asleep easily enough, often in front of a screen, sometimes with a drink. Then, somewhere between two and four, you are awake, fully awake, and the day is back: the conversation you handled badly, the number that did not reconcile, the client who went quiet, tomorrow's board call rehearsed for the fifth time. You check the phone because you are awake anyway. By the time sleep returns, the alarm is close.

Most senior people I see have tried to fix this as a sleep problem. Better pillows, a sleep tracker, magnesium, a stricter bedtime, a holiday that worked for four nights. When the pattern keeps coming back, I look at both sides: the sleep itself and what the working day has left unresolved. Work stress is often the bigger part, but I do not assume it is the only cause. If this has been your pattern for weeks or months, you can start with an individual consultation; within the usual ethical and legal limits, nobody at work hears it from me.

Can't sleep because of work stress: what is actually happening

Sleep needs a nervous system that believes it is safe to stop watching. Work stress keeps part of that system on duty. The heart rate stays a little higher, the mind keeps scanning for what is unfinished, and the body treats the night as a pause in the shift rather than the end of it. Psychologists call this hyperarousal: being too switched on, mentally and physically, to let sleep take over.

That is why the pattern so often looks like this: exhausted in the afternoon, wired in the evening, asleep through sheer depletion, then awake in the small hours when the deepest sleep is over and the lighter sleep that follows is easy to break. The first thought on waking is usually about work, and the mind, once it has hold of something unfinished, does not let go easily. Lie there long enough and the bed itself starts to feel like the place where you worry.

None of this means something is wrong with you. It means a system built to keep you alert under pressure has stopped knowing when the pressure ends. In my practice persistent work rumination is a common part of the picture in senior clients, though I check the sleep pattern and possible medical causes before assuming it explains the waking.

Why leaders can't switch off

Leaders struggle to switch off because the work has no clear end, decisions stay unfinished and other people's livelihoods stay with them at night. In my practice the same few drivers come up again and again, and most people recognise two or three at once.

• The day never closes. There is no last task, only a pile that stops when you do. Without a clear ending, the mind carries the open items into the night and keeps sorting them.
• The phone on the pillow. Messages, markets, the group chat with the other directors. Every check tells the brain the shift is still on, and the light and the content are both alerting at exactly the wrong hour.
• The only quiet hour. For many leaders the late night is the one time nobody needs anything, so it becomes thinking time. The thinking does not stop at the bedroom door.
• Other people's livelihoods. When salaries, a family's money or a factory's orders depend on your judgement, the stakes do not reset at night. In my practice this weight is heaviest for owners, and the least talked about.
• Time zones. Calls with the US in the evening, with Asia at dawn. Sleep gets cut from both ends, and the body never settles on a rhythm.
• Alcohol as the off switch. Alcohol can make you feel sleepy sooner, but it tends to fragment the second half of the night, which is exactly when many of my clients wake and cannot get back. If the drinking itself has started to worry you, that deserves its own attention.
• The belief that worrying is working. Many senior people quietly believe that if they stop thinking about the problem, something will slip. The night-time replay feels like diligence. It is usually just repetition.

When poor sleep becomes insomnia

A few bad nights before a deal closes is ordinary. The concern is when the pattern stays after the pressure passes. Chronic insomnia generally means trouble falling asleep, staying asleep or waking too early at least three nights a week for three months, despite a real chance to sleep, with the days affected: irritability, poor concentration, a shorter fuse with your team and your family. By then the sleeplessness has often taken on a life of its own, kept going by the habits and fears that grew around it, even if the original work stress has eased.

The signs themselves are set out in the seven signs of insomnia. This page is about the cause, and in my practice the cause for senior people is very often the one in the title: a working mind that will not stand down.

Sleep problems also travel with other conditions. Broken sleep is a common feature of burnout and of depression, and early waking with low mood deserves an assessment rather than a sleep routine. Burnout or depression explains how to tell them apart, and executive burnout treatment covers what the work involves when exhaustion is the larger story.

When to see a doctor first

Some sleep problems are medical, and a psychologist is not the right first stop. See your doctor if any of these apply:

• Loud snoring, gasping or pauses in breathing that a partner has noticed, or waking unrefreshed even after a full night. These can point to sleep apnoea, which needs medical assessment.
• Physical symptoms at night such as chest discomfort, palpitations or breathlessness. New, severe or unexplained symptoms need prompt medical evaluation, and sudden or severe ones mean contacting your local emergency services.
• New medication, or a change in dose, around the time the sleep changed. Some medicines affect sleep, and only your doctor can review them.
• Sleeping pills. Whether to start, continue or stop any sleep medication is a decision for your doctor. As a psychologist I do not prescribe, and I work alongside whatever medical care you have.

What helps, starting this week

Start by giving the working day a clear ending and limiting night-time checking. These steps are not a cure for settled insomnia, and they are not tips for falling asleep faster; those are collected here. They are aimed at the work stress side, at giving the day a proper ending.

1. Close the day on paper. Twenty minutes before you stop work, write down what is open, what you will do about each item and when. The mind lets go more easily of what it knows has been parked somewhere safe.
2. Set a hard stop for work messages, and tell the few people who matter. Where you can, charge the phone outside the bedroom. If your role truly needs you reachable at night, agree what counts as an emergency and let everything else wait.
3. Give the late hour a different job. If night is your only quiet time, move the thinking earlier: a protected half hour in the afternoon for the problems that will otherwise arrive at 3 am.
4. Keep a steady waking time on working days and weekends, even after a bad night. A steady morning anchors the body clock better than chasing lost sleep; if you are very sleepy during the day, do not drive or do safety-critical work, and talk to your doctor.
5. Do not wrestle with wakefulness in bed. If you have been lying awake for what feels like a long while, get up, go somewhere dim and quiet, do something calm, and return when sleepy. The bed should mean sleep, not the night shift.
6. Be honest about the drink. If you drink every day or heavily, speak to your doctor before cutting down, because stopping suddenly can be dangerous. Where your doctor says it is safe, notice what happens to the second half of your night when you cut back.

If these are enough, keep them. They cannot tell you whether your sleep needs medical review, structured insomnia treatment or work on the beliefs that make switching off feel risky; that is what an individual consultation sorts out.

The treatment that works on it

For chronic insomnia, the first-line treatment is psychological, not a pill. Current sleep-medicine guidance, including the American Academy of Sleep Medicine's, strongly recommends cognitive behavioural therapy for insomnia, CBT-I, for adults with chronic insomnia, with any medication decisions left to a doctor. CBT-I is a structured approach: it works on the timing of sleep, the link between the bed and wakefulness, and the beliefs and worries that keep the mind on duty at night. In trials it helps people fall asleep faster and spend less of the night awake, and in my practice it is among the most reliably useful work I do with senior clients.

With leaders, the sleep work rarely stands on its own. A tracker can show you that you woke at three; it cannot explore why a board meeting or the fear of letting go follows you into bed. Properly designed digital CBT-I can help insomnia, and what I add is the individual assessment of your sleep and the responsibilities underneath it. In my practice the work runs on two tracks at once. One is CBT-I, the sleep-specific part. The other is the work stress underneath: the belief that switching off is dangerous, the habit of carrying everyone's problems as your own, the role that has swallowed the rest of your life, and, where it is there, the low mood or anxiety that broken sleep both causes and hides. In my experience the two often need to move together, and we review sleep and daytime functioning as we go, adjusting if the gains do not last.

Sessions run online from anywhere in the world or in person in Gurugram, between 9:00 AM and 8:00 PM Indian time, seven days a week, so the work can continue through travel and heavy months. Nothing about it needs to be announced at work.

If your nights look like his, you do not have to wait for a crisis or a holiday that never comes. We can start with what is keeping you awake and what would help, alone and in confidence. Book a first session or message me on WhatsApp.