How to Sleep Better — What Actually Works

Most advice about sleeping better is sleep hygiene — dark room, no screens, regular bedtime. It is sensible, it is free, and on its own it does not treat insomnia.

That is not a criticism of the advice. It is that sleep hygiene is prevention, and once insomnia is established something different is needed.

The treatment that works

Cognitive behavioural therapy for insomnia — CBT-I — is first-line treatment in UK and international guidance. It outperforms sleeping tablets in the long term, and unlike medication its benefits persist after treatment stops.

It is available free on the NHS — through NHS Talking Therapies, which takes self-referrals without a GP appointment, and through NHS-approved digital programmes such as Sleepio and Sleepstation, available free in many areas.

Most people with long-term insomnia have never been offered it, and are given sleep hygiene leaflets or sleeping tablets instead. That is the gap this article exists to close.

Why it works when advice alone does not

CBT-I has two active components, and both are counterintuitive enough that they need proper instruction.

Sleep restriction

This sounds like the opposite of what you want, and it is the most effective part.

If you are in bed for nine hours but sleeping six, the bed has become a place where you lie awake. Sleep restriction temporarily limits time in bed to roughly the time you actually sleep, which builds sleep pressure and consolidates fragmented sleep. Time in bed is then extended gradually as efficiency improves.

It works, and the first week is genuinely hard — which is why doing it with proper guidance rather than from an article matters.

Stimulus control

The principle is that the bed should mean sleep, and nothing else.

• Go to bed only when sleepy — not merely tired
• If you are awake for what feels like more than 15 or 20 minutes, get up, go to another room, do something quiet in dim light, and return only when sleepy
• No lying in bed frustrated. That is the association being broken
• Bed is for sleep and sex only
• Get up at the same time every day, including weekends, whatever the night was like. This is the single most important anchor

Sleep hygiene — still worth doing

These support the above rather than replacing it:

• Caffeine cut-off by midday. Its half-life is five to six hours, so a 3pm coffee is still working at bedtime
• Alcohol is not a sleep aid. It shortens the time to fall asleep and then fragments the second half of the night badly
• Cool, dark, quiet room
• Morning daylight — which anchors the body clock more effectively than avoiding evening light does
• Regular exercise, though not in the two hours before bed for most people
• Do not clock-watch. Turn the clock away — checking the time converts wakefulness into anxiety about wakefulness

Why we do not prescribe sleeping tablets

Zopiclone, zolpidem and benzodiazepines work — for about two weeks.

After that, tolerance develops, dependence follows quickly, and stopping causes rebound insomnia that is worse than the original problem — which convinces people they cannot sleep without them. In older adults they also increase falls, fractures and daytime confusion.

We do not initiate them remotely under any circumstances, and any service that will is not acting in your interest.

Over-the-counter sleep aids — mostly sedating antihistamines — cause next-day grogginess, tolerance within days, and have anticholinergic effects that are best avoided in older adults.

The causes worth excluding

Insomnia is frequently a symptom rather than the diagnosis, and treating the sleep without the cause does not work:

• Sleep apnoea — substantially under-diagnosed, and particularly missed in women and in people who are not overweight. Waking unrefreshed despite adequate hours is the clue
• Restless legs — where the most useful test is ferritin, at a higher threshold than for ordinary anaemia
• Perimenopause — night sweats and sleep disruption are frequently the earliest symptoms, often before periods change
• Anxiety and depression — early morning waking is characteristic of depression
• Pain, an overactive thyroid, and medication — including some antidepressants, steroids and decongestants

What about melatonin?

Melatonin is prescription-only in the UK, and is licensed for short-term use in adults over 55 and for specific circumstances in children.

It is genuinely useful for jet lag and body-clock disorders — shift work, delayed sleep phase — where the problem is timing rather than sleep drive. For ordinary insomnia its effect is modest at best.

Melatonin bought online from overseas is unregulated, and analyses have repeatedly found actual content differing substantially from the label.

Where to start

1. Self-refer to NHS Talking Therapies, or look up whether Sleepio or Sleepstation is available free in your area. No GP appointment needed
2. Fix the caffeine cut-off and the fixed wake time — the two highest-yield free changes
3. Get assessed if you snore, wake unrefreshed, have restless legs, or suspect perimenopause. Those need treating rather than managing

Insomnia is genuinely treatable, and the treatment is not a tablet. If you have been offered nothing but sleep hygiene advice, there is considerably more available — and most of it is free.