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It’s heavenly to drift softly into slumber at bedtime—but that doesn’t always happen, and for some people, falling asleep is a nightmare. We asked sleep medicine physicians Nancy Collop at the Emory Sleep Center and Hitendra Patel at the Wellstar Sleep Program about insomnia and what to do about it. Here’s a summary of their advice.
I’m so tired. Why can’t I fall asleep?
Sleep is actually a complicated process. First comes sleepiness, which is a physiological need, like thirst or hunger. Different regions of the brain work together, releasing brain chemicals and hormones that shut down wakefulness, relax muscles, and stimulate sleep. Stress, pain, discomfort, or even late-night eating, drinking, and TV-watching, can interfere with those steps.
How many hours of sleep should I be getting?
Adults need at least seven hours of sleep each night, according to the American Academy of Sleep Medicine. Calculate your latest healthy bedtime by counting back from the time you plan to wake in the morning. Regularly getting less than seven hours of sleep has been associated with health problems, including diabetes, obesity, heart disease, hypertension, and depression.
How do I know if I need treatment for insomnia?
Insomnia is considered a chronic sleep disorder if it happens three or more times a week for three months. Sleep hygiene can help with shorter bouts of insomnia: going to bed and waking at the same time every day; avoiding electronics, late-night eating, and alcohol consumption before bedtime; and using deep breathing or other relaxation techniques. If insomnia continues, talk to your primary care provider or seek help from a sleep medicine physician or a behavioral sleep specialist.
Can’t I just take a sleeping pill?
Nineteen drugs are approved to treat insomnia, but they aren’t magic pills. Many of them can cause daytime drowsiness, and studies show they have only a small effect on how quickly people fall asleep. That may be because the drugs target just one of many sleep pathways in the brain. The American Academy of Sleep Medicine recommends sleeping pills for short-term use—for example, if you’re having trouble sleeping during a stressful time. Cognitive behavioral therapy for insomnia (CBT-I) is the preferred long-term treatment.
Does melatonin help?
It depends. Melatonin is a hormone your brain releases to promote sleep. It is triggered by the light-dark cycle, so bright morning light triggers alertness and dim light before bedtime helps ease you into sleep. Short-term use of a melatonin supplement, taken 30 minutes to an hour before bedtime, can help adjust a lag in that body clock, known as the circadian rhythm.
I don’t have any problem falling asleep, but I wake in the night and can’t get back to sleep.
Frequent wakening during the night can be a sign of sleep apnea. You may get up and go to the bathroom, but problems with breathing during sleep might be what caused the awakening. “Most of the time, treating the apnea fixes the issue,” says Patel. Alcohol also can cause sleep disruption, so you should avoid drinking before bedtime. Being unable to fall back asleep after wakening in the night is a form of insomnia, so if it’s a chronic problem, you should seek help from a sleep center or therapist trained in CBT-I.
What do sleep doctors want people to know about insomnia?
You are making your problem worse by worrying about it. Almost everyone has a bad night here and there, but anxiety about sleep contributes to insomnia. “Your body really wants to sleep,” says Collop. “So, just try to let it do what it wants to do and don’t stress about it.”
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This article appears in our January 2024 issue.
