Figure 1. Example of Sleep Diary To keep on the same schedule, it's important to not oversleep the next night.
This guide helps you sleep better and feel more rested through behavior changes. The advice given here aims to be straight forward, practical, and actionable. This is not a substitute for medical advice, but rather information that can be accessed by a wider audience at a reduced cost.
The article may be read in order or you may skip around. It is recommended, but not essential, that you read Determining a Sleep Schedule, Daytime Behavior Influences Sleep, and Winding Down for Bed first. If you already practice good sleep hygiene, but simply can't turn your mind off, read the How to Fall Asleep and Psychological Causes sections. If you have a specific question, it may be in the FAQ.
Important: Don't expect immediate results, but instead gradual improvement. Insomnia is often the result of ineffective behavior learned over a long time, and it will likely take a while to internalize new behaviors that promote better sleep. There will be setbacks, but keep applying the strategies within this guide and you will sleep better for the rest of your life.
Insomnia is a generalized term for unsatisfactory sleep - usually a combination of time to fall asleep, ability to stay asleep, and early awakenings. The cause of insomnia may be physiological or psychological, or a combination of both. Insomnia correlates with fatigue, reduced mental health, occupational and driving hazards, reduced quality of life, and a myriad of other symptoms. Insomnia is very treatable, often without any drug therapy. The safest and most effective treatment for insomnia is behavior changes. Internalizing and using the strategies outlined in this guide will make a dramatic difference in your sleep quality.
There is a distinction between “sleepy” and “tired.” Sleepy is your body releasing the chemicals which promote sleep and tired is feeling fatigued or foggy. They can be independent of each other and, with insomniacs, often are.
When you are sleepy, that’s controlled by your circadian rhythm. This is why you might have a horrible night sleeping, but if you try to sleep mid morning the next day, you simply can’t get to sleep no matter how exhausted you are. Then your normal bed time gets closer and you’re able to. Another example is after sleeping too many hours, you feel tired (a "sleep hangover").
This distinction might seem trivial, but it is helpful in learning to recognize when your body actually needs sleep, versus when your mind is tired - which may prompt you to check for a coexisting condition (physiological disorder diagnosed by a sleep medicine doctor, or a psychological disorder diagnosed by a mental health professional.).
The first step to getting good rest is to determine a sleep schedule and stick to it. While it may be difficult depending on your lifestyle, the more consistent your schedule is, the better. There is a physiological reason for this. The more consistent you are about your bed-time and wake-time, the more concentrated your bodies ‘sleepy time’ chemicals are and the easier it will be to fall and stay asleep. This is, quite literally, an act of programming your body.
It varies. Most people need between 6 and 9 hours of sleep - varying by age and individual. There are outliers, but that is acceptable for the vast majority. If you sleep outside that range, you may want to see a doctor about it. Younger people generally sleep longer. So, you may have needed 8 1/2 hours in your teens, but only need 7 1/2 in adulthood. The main takeaway is that the "get eight hours of sleep" is a generalization, and might not be true for you. If you feel consistently rested with only five hours, for example, that doesn't mean you are suffering from insomnia - you may simply not require much sleep.
Most people have a general idea of how much sleep they need. This is the hours that you repeat the most. If you don’t know, then pick 8 hours and try it for a week. Adjust as needed.
If you struggle to fall asleep, still get up at your predetermined wake-time, stay up for the entire day and don’t go to sleep until your regular bed-time. You may be very tired doing this, but keep repeating. After a few days your body will adjust and fill that block of time. Don’t nap during the day.
For example, Pepe decides to go to bed at 11pm and wakes up at 6am. The first night, he turns off the light at 11pm, but doesn’t fall asleep until 2am. He still gets up at 6am. He’s tired that day, but makes it until 11pm the next night. He then sleeps from 11pm to 6am, even though he could sleep longer due to the deprivation of the previous night. The following night, he repeats and sleeps soundly.
In order to track your progress and find any patterns, keep a log of your sleep. Mark what time you turned off the light, what time you think you went to bed (you won't know exactly, and that is okay), any wake-ups during the night that you remember, and what time you woke up. It is best not to keep a clock by your bed (so you don't watch the minutes tick) and so a lot of this will be relative - just do your best. You might also mark significant factors that might contribute to sleep, such and what time you ate, any medications or alcohol taken, and for sure any naps (even if accidental). These are especially helpful while programming your sleep, but you may return back to them at any time to find patterns.
Here is a good PDF sleep diary, just keep it by your bed and follow the instructions: Download & Print [Archive]
Here are some example logs to give you an idea of how it will work
Figure 1. Example of Sleep Diary To keep on the same schedule, it's important to not oversleep the next night.
Figure 2. Example of Sleep Diary Sleep diary where wakeup and bed times were consistent, despite having a few bad nights sleeping.
Everyone has bad nights. Even with perfect sleep hygiene, it's completely normal to have some nights where you just don't sleep right. If you have a bad night, don't get frustrated, just accept it and check out the "How to Get Through the Day After a Bad Night" section for some tips.
A common mistake insomniacs make is not realizing that good sleep is a product of 24 hours of sleep-promoting activity. The things you do during the daytime, influence your sleep as much as the things you do in the evening.
Get out and move a bit. Pick an exercise that works for you, even if you start with just walking. Exercise is shown to grow new brain cells, it’s considered an ‘active rest.’ When bed time comes, make sure your body is as tired as your mind.
It helps your body clock. Get some light. If you work in an office try and be by a window. There is also some evidence that exposure to nature lowers stress, another cause of restless nights.
Make sure you are getting a balanced diet and not eating lots of junk food. Avoid having your largest meal in the evening, which may cause indigestion for some and weight gain in others. Maintaining a healthy body weight is important to keep your breathing and airways clear.
I'll list some general recommendations, but the more I have researched what activities seem to promote sleep, the wider the variance I find from the standard recommendations your everyday sleep hygiene article has. For example, many sleep hygiene articles say to avoid all backlit displays. Yet, a lot of people swear they need TV before bed or to read on their mobile device/reader. Most also say not to read in bed, but instead to do so in a chair - but many people swear reading in bed helps them sleep. The takeaway is that these recommendations are things to try for a few weeks, but if you were better off watching TV in bed after trying without, then go back to that.
Do a relaxing activity like reading or watching light TV. Avoid video games and browsing 4chan. Some people find a warm bath and/or meditation helps them calm their mind. Avoid the telephone, messaging, and work related activities. Choose activities that don't make you think of tomorrows activities or life troubles - instead pick something that lets you escape and not think too much.
This trains your body to associate your bed with sleep and only sleep. It's generally a bad idea to study or do paperwork on your bed, because then your mind will associate bed with work - which doesn't make it want to prepare itself for sleep.
It’s not only the actual display, but also the brain activity as a result of those displays. Turn off video games, email and messaging services. Light falloff is an inverse square, so laptops and mobile phones are worse than TVs (since you sit closer). Turning down the backlight on displays can also help if you must use them.
If you must use a computer at night, computer displays are set to daylight balanced color temperature - or a very white light. After dark, this can strain the eyes, and some people find it easier to run software which adjusts the display color to match indoor lighting at night. F.Lux is a very popular solution for this in the IT fields.
Light and noise can interfere with sleep. If it is not possible to control the environment, some people find sleeping with ear plugs or white noise is helpful. For light, eye shades can be worn. Lower the room temperature until comfortable, generally cooler is better (within reason).
Sleep and noise don't go well together. Between loud music, barking dogs, traffic, tree branches hitting a window, and general urbanization - it's louder than ever. There are three ways to combat sound for better sleep: mask the sounds, absorb them, or isolate from them. Usually some combination is best, I'll discuss all three.
Not all noise is bad for sleep. Constant, non-distracting, noise blocks external, bothersome, noise and can even be soothing. Getting a room to be acoustically well suited for sleep is about balancing ambient sound that is good, and troublesome sound from outside the room.
Generally, constant noise doesn't bother us; Droning air conditioners, fans or humidifiers are just fine, or even pleasant. The sounds that are bothersome are ones that oscillate between soft and loud, such as speech, music, honking horns, or dogs barking.
Masking sound using constant noise (such as white or brown noise) works well for traffic and general far-away sounds that are just above the ambient sound level. This is generally done through playing white noise or using a fan.
My personal white noise machine is an old smart phone connected to a speaker, then I use a white noise application or mp3 recordings of white noise. On the road, I'll bring this extra device along and simply use its internal speaker. In a pinch, hotel rooms often have clock radios that you can tune to a frequency that isn't used giving you nice constant white noise.
Absorption and isolation from exterior sounds is more difficult, but when successful are hugely rewarding. Check that your doors and windows are sealed properly, as often ambient sound enters through them. A simple trip to the hardware store to get door sealing tape can make a huge difference. Actually sound proofing a room is a very big, and expensive, task - because it requires literally building a room within a room to fully isolate. If this is of interest, consider contacting a recording studio or home theater contractor, as they will be most familiar with these projects.
Ear plugs are an option as well. Some swear by them, others can't get comfortable. If you want to try them, be sure to give it a few nights to get used to them and initially they can be bothersome. Earplugs lower the overall magnitude of ALL sound - the sound in the room that masks external sounds in addition to disturbing sounds. This leaves the amplitude (difference between quiet and the disturbing sound) roughly the same, even though the overall volume is lower. Ideally, to mask the sounds best, we want the room ambient sounds (which are acceptable) to stay the same, and only the irritating sounds from outside to lower. For this reason, try white noise and isolation as a first line defense. Remember, not all noise is bad. The constant, non-bothersome, noise the masks external noise and blocks transient sound is good.
Searching around for my own struggles, it was amazing to me how little advice there was on actually falling asleep. There were all kinds of tips around sleep hygiene, but, few on how to actually get to sleep.
When going to bed you may have intrusive thoughts and your mind may be having lots of worry. To fall asleep, the trick is to concentrate on something in the present to essentially block the brains ability to roam into the past or future.
Here is how: first say 100 in your mind, and breathe deep, on the exhale, relax your shoulders and count 99. Count down from 99, with each step being a comfortable breath in and out, with a muscle being relaxed. So for 98, maybe it is your right shoulder, for 97, the back of your neck. If your mind wonders, gently bring it back, and do not beat yourself up, just continue the count. This flooding if the mind will act as a sort of "DDoS attack" on your thoughts, preventing them from entering your mind and becoming distracting or anxiety provoking.
“concentrate on something in the present to essentially block the brains ability to roam” Be aware and involved in one thing in the present moment
Room should be cooler, get under your blanket for warmth. Find a mattress that you find comfortable, the ‘technology’ doesn’t matter since it’s all just a different way to distribute body weight.
Air flows easier in these positions, making for potentially better sleep - especially if you have a sleep disorder (like sleep apnea). Keep your neck at a natural level, don’t create a wedge with your pillows (it obstructs airflow and can hurt your neck). You can use a giant pillow to keep from rolling on your back.
Instead of watching the clock or laying there frustrated, get out of bed and read. When you feel sleepy again, go back to bed and try again. The key is to not train your mind to ‘stare at the clock’ which may cause anxiety that is counter productive to sleeping.
Long term sleeping pill use gives only the illusion of ‘more’ sleep. Sleeping pills suppress slow wave and REM sleep, hurting your sleep quality. Tolerance is inevitable, causing inter-dose withdrawals that may get mistaken for requiring a stronger dose rather than removing it. Many doctors fail to recognize this, so be aware of the possibility yourself.
Avoid stimulants such as caffeine, nicotine, modafinil, amphetamines, or cocaine. ADD/ADHD medications helpful effects wear off before the androgenic properties stop, so if you must take stimulants, try for earlier in the morning.
If you are having trouble falling asleep, stimulants are the first thing to try cutting. Even strong stimulants have a rather quick withdrawal compared to depressants. It might take a few months for your body to readjust. Any time stopping a medication do so slowly and log your progress.
Just because it’s ‘natural’ and over the counter doesn’t mean it’s not a drug. If you take melatonin (hormone), for example, your body will down regulate it’s natural melatonin making the effects short term and leave potential for rebound insomnia and dependence.
Insomnia is a symptom of many psychological disorders, from generalized anxiety to depression. Anxiety and depression are often said to be two sides of the same coin, and anxiety (excessive worry) tends to be the leading component. Anxiety comes, in part, because of an overactive amygdala - the primitive part of the brain that controls the fight and flight response.
Psychological research on treatments for anxiety and depression is notoriously poor and oversold. Just by nature of what is being researched, the result is non-double blind, poor sample sizes, self reporting, ad hoc, and poor controls. That said, most therapists have adopted a behaviorist strategy, and many incorporate “mindfulness meditation” - which is essentially buddhist meditation but without a spiritual component. Meditation has been correlated in some studies to reduce activity in and even shrink the right side of the amygdala 8 weeks of 22 minutes a day.
Be careful if you end up at a psychiatrists office. Personally, I wouldn’t take any medications unless psychotic. You become dependent on any drug and your body adapts to the chemical changes which can have unpredictable consequences. It is likely better to just bear your anxiety and raise your pain tolerance through acceptance (research ‘radical acceptance’ ) rather than being drug therapy that is still largely guess work. Drugs can’t fix everything, they can mask symptoms, interfere with sleep architecture, and there is usually a personal cost to that.
If after completing all the steps of this guide, and you are still not sleeping, it is time to see a sleep medicine doctor to investigate if you have a sleep disorder such as sleep apnea, circadian rhythm disorders, restless legs syndrome, and periodic limb movements.
It is beyond the scope of this article to cover physiological sleep disorders. Diagnosing requires visiting a professional. Examples of when you might visit a sleep doctor are if you have trouble breathing while sleeping, are requiring more and more sleep, wake up with choking sensations, or a physical sensation is keeping you awake.
If the doctor recommends you get a sleep study, ask for an in-hospital study rather than at-home. The in-hospital studies collect better data and are less prone to error. Insurance companies prefer at-home studies because they are cheaper.
You've had a bad night, and now have to deal with the day. There are a few things you can do to make your day more pleasant, and also to keep your sleep schedule from getting affected.
First, don't nap. It might be hard, but try to stay up all day and don't go to sleep until your usual time. This will keep your bad night from causing any disturbance in your sleep wake cycles. To stay up, try getting some exercise (not too late in the day) and take an extra shower when you feel a lull. The worst part of the day will likely be around 1PM/13:00 when your circadian rhythm has a natural dip, so know that after that period you'll feel less sleepy until day.
When you are short on sleep, you're more likely to get stressed and irritated, so avoid sensitive discussion if possible. Save important talks and decisions for when you are more rested, whenever possible. When we are tired, the part of the brain that handles reasoning can be compromised and you're more likely to act using the primitive brain (amygdala).
When the night comes, go to bed at your usual time, and set your alarm for the usual time (+20 minutes or so if you absolutely must). Oversleeping can cause your sleep schedule to get mis-aligned. The key is to not let one bad night screw up multiple nights in the future - which is how so many of us fall into insomnia periods.
This FAQ is based off of common questions I came about in researching for my own questions. Therefore, it is currently weighted toward specific needs - in the future I'll add more based on contributions.
Nightmares tend to coincide with life stressors, and may come in waves over time. If you have a recurring nightmare, look into Dream Rewriting and Dream Rehearsal Scripting which is commonly used by psychologists to change the narrative of a dream. If you have nightmares where you wake up gasping for air, consider visiting a sleep medicine doctor to investigate the possibility of sleep apnea. Commonly, there just isn't much you can do about nightmares other than realize that they are harmless.
You do dream, you just don't remember them. It can be perfectly normal and dreaming seems to come in stages throughout life. You may also be taking medications that interfere with the dream stages of sleep.
See Sleep Schedule: How Much Sleep Do I Need?.