Insomnia: what to do when sleep tips are not enough

In short

• Long-term insomnia means trouble sleeping at least three nights a week for more than three months. CBT-I is its first-line treatment.
• Spending long stretches awake in bed tends to make insomnia worse, so CBT-I trains you to use the bed for sleep and to keep a steady wake time.
• CBT-I usually runs six to eight weeks and can be delivered in person, by phone or online.
• Sleeping pills carry real risks and are meant for short use. Research has not proven that melatonin works for insomnia.
• Insomnia can be a symptom of another condition, including sleep apnea, depression or pain, so a check-up matters.

Why insomnia becomes chronic

NHLBI defines chronic insomnia as trouble sleeping three or more nights a week for more than three months that is not fully explained by another health problem. Short-term insomnia, lasting days or weeks, often follows stress or a change in schedule or surroundings.

Once it settles in, other factors keep it going. Cleveland Clinic lists napping, irregular bedtimes, caffeine, and fear or anxiety about sleep as contributors. About half of people with chronic insomnia also have at least one other mental health condition. Anyone who has lain awake worrying about tomorrow knows the loop: the effort to sleep keeps the body alert.

CBT-I: what it includes

NHLBI describes CBT-I as a plan of six to eight weeks led by a doctor, nurse or therapist, and available in person, by phone or online. Cleveland Clinic calls it the first-line treatment for insomnia.

• Stimulus control: go to bed only when sleepy, get up if you cannot sleep, and use the bed only for sleep and sex. Cleveland Clinic adds getting up at the same time every day and avoiding daytime naps.
• Sleep restriction: time in bed is limited to a set amount and then lengthened as sleep improves. It targets the gap between how long you are in bed and how long you actually sleep.
• Cognitive work: it addresses anxious thoughts and beliefs about sleep, such as that one bad night will wreck the next day.
• Relaxation: methods that help you unwind and fall asleep faster.
• Sleep education: habits that support sleep, which are a background help, not the whole treatment.

What you can do while you arrange care

1. Keep a sleep diary.Write down when you go to bed, when you fall asleep, when you wake and when you get up. NHLBI notes that a provider may ask for one, and it makes your appointment more useful.
2. Fix your wake time.Get up at the same time every day, weekends included, and do not lie in after a bad night, as the NHS advises.
3. Go to bed when sleepy.If you cannot sleep, get up and do something calm in dim light, and go back to bed when you feel sleepy.
4. Protect the evening.The NHS suggests relaxing for at least an hour before bed, avoiding alcohol, tea and coffee in the six hours before bed, skipping large late meals and screens, and not exercising in the four hours before bed.
5. Be careful with sleep restriction.Cutting time in bed can leave you sleepier at first. Do it with a trained clinician, and do not drive when you are drowsy.

Sleeping pills and melatonin

NHLBI describes several classes of prescription sleep medicine and their risks: dizziness, confusion, interactions with other drugs, habit formation, and rare sleep-related activities such as walking, eating or driving while not fully awake. Benzodiazepines are used when other options fail and are limited to a few weeks. The NHS says sleeping pills are rarely prescribed, can cause serious side effects and dependence, and are usually given for at most a few days or weeks.

Pharmacy sleep aids, often antihistamines or herbal products, can cause drowsiness and may help for only one to two weeks, according to the NHS. Check with your provider before you take them, especially if you drive.

On melatonin, NHLBI states that research has not proven it to be an effective treatment for insomnia. NCCIH adds that guidelines from the American Academy of Sleep Medicine and the American College of Physicians do not recommend it for chronic insomnia because the evidence is too weak, and that the American College of Physicians strongly recommends CBT-I first. NCCIH rates its evidence as modest for jet lag and weak for shift work. In the United States melatonin is sold as a dietary supplement, and tests have found that many products do not contain the amount on the label. Keep melatonin, especially gummies, out of children's reach.

If you already take a sleep medicine, do not stop on your own. Ask your provider how to change it safely.

Other causes to rule out

The NHS lists conditions that can sit behind insomnia, and treating them often matters more than any sleep technique.

• Stress, anxiety or depression.
• Sleep apnea, restless legs syndrome and narcolepsy.
• An overactive thyroid, menopause, long-term pain, or conditions such as Parkinson's or Alzheimer's disease.
• Some medicines, alcohol, caffeine, nicotine or drugs.
• Jet lag and shift work.

When to see a doctor

Make an appointment if changing your sleep habits has not helped, if you have had trouble sleeping for months, or if insomnia makes it hard to cope with daily life, as the NHS advises. Also go if your symptoms get worse, or if a medicine causes side effects.

Tell your provider about loud snoring or pauses in breathing at night, an urge to move your legs in the evening, low mood or constant worry, or new medicines. Untreated long-term insomnia is linked in NHLBI's information to high blood pressure, coronary heart disease, diabetes and cancer, and it can make you dangerously sleepy at the wheel.

Red flags: if you cannot stay awake while driving or working in a way that puts people at risk, or you have thoughts of harming yourself, get help now. Call 911 in an emergency, or call or text 988.

How a provider checks

A provider asks about your sleep habits and may ask you to keep a sleep diary, as NHLBI describes. They review your medicines and other conditions, and can order a sleep study if sleep apnea or another sleep disorder is suspected.

These questions are worth bringing along:

• Could sleep apnea or restless legs syndrome be involved?
• Where can I get CBT-I in person or online?
• Is sleep restriction suitable for me?
• Could one of my medicines disturb my sleep?
• How do I safely cut down a sleep medicine that I have taken for a long time?

Questions and answers

Sources

1. NHLBI — Insomnia
2. NHLBI — Insomnia treatment
3. Cleveland Clinic — Insomnia
4. NCCIH — Melatonin: what you need to know
5. NHS — Insomnia
6. CDC — About sleep

Sources checked on 29 October 2026.