Living With Chronic Insomnia

Medically Reviewed by Jennifer Robinson, MD on September 19, 2023
5 min read

If you have chronic (long-term) insomnia, you’ve had trouble getting to sleep or staying asleep at least 3 nights a week for more than 3 months. And these sleep troubles limit how well you function the next day. You are past the point of trying different sleep habits and need serious help getting your sleep back on track. You also need to know how to cope and live your life in the meantime.

Treatment with a professional can help get you back to sleep. Lifestyle changes can boost the effects of your treatment as you go through it.

If you’ve been spending those sleepless nights scouring the internet for advice, you’ve probably come across the term “sleep hygiene.” These practices help make sure that your daily routine isn’t getting in the way of your sleep. You will need to come back to these healthy habits later, after your sleep is back on track. But when you’ve had insomnia this long, experts agree that good sleep hygiene alone isn’t going to do much for you.

Sleeping pills aren’t the answer either. Doctors prescribe these for a short bout of insomnia to help you get back on schedule. You can take them for only a few days to a few weeks. They are not the first treatment choice for a problem that you’ve been having for several months.

The first treatment choice for chronic insomnia is CBT-I, which stands for cognitive behavioral therapy for insomnia. “Talk therapy” may not sound like your kind of thing. But before you write it off, consider this: Up to 75% of people with chronic insomnia who go through CBT-I improve their sleep. Not only do they get back into a normal sleep pattern, but they also get 30% more of the deepest, most restful type of sleep (slow-wave sleep) than they did before. Six months after completing CBT-I, most people are still sleeping well.

This treatment helps you undo negative thoughts, attitudes, or misguided beliefs that may keep you awake. For example, the idea that you can make yourself go to sleep may be keeping you up: You try to go to bed at the same time every night only to lie awake for several hours. This then convinces you that you physically cannot sleep, which leads to anxiety, which makes it harder to sleep. CBT-I can help undo that cycle of negative thinking.

The program helps you do away with any habits that keep you from good sleep. It also provides you with multiple practices to start working toward better sleep until eventually, you sleep the way you should again.

People tend to see improvement in about 6-8 sessions. And they then have the tools to continue improving on their own.

When you start CBT-I, your sleep may get worse before it gets better. That happens partly because your therapist might recommend during the first week that you keep yourself up very late at night. But while you wait to see improvements in your sleep, you can take other steps on your own to set yourself up for success.

Quite a few things you can do (or not do) every day can make a big impact on your ability to sleep (and sleep well) every night.

Get regular exercise. When you don’t get enough sleep, it’s hard to get exercise the next day. But regular exercise can help you fall asleep faster, cut down on the amount of time you lie in bed awake, help you feel more alert during the day, and sometimes reduce the need for sleep meds. It could help you begin to break the cycle of sleeplessness you’re in. Though you may not feel like it, try to get a brisk walk in every day. You can try scheduling it at a time of day when you’re usually more alert, but don’t exercise too close to bedtime -- it could ramp you up before sleep.

Try yoga, meditation, or tai chi. Limited research suggests that these Eastern practices may help improve sleep. In an analysis of multiple studies, 4 to 24 weeks of these “mind-body therapies” led to less severe insomnia and better sleep quality. Explore them and see if one of them suits you.

Get some sun every morning. Try to time that brisk walk in the mornings after the sun is up. Or eat breakfast by a sunny window. Exposure to natural sunlight in the morning can help you get sleepy earlier, fall asleep faster, and sleep better.

Eat a healthy diet. The foods that you already know to be healthy can help you get to sleep sooner, stay asleep, and sleep better. Get a variety of fruits and vegetables, lean protein, and complex carbs (think brown rice rather than white). Avoid excess salt, sugar, and junk food. If you want a specific diet to follow, both the Mediterranean diet and the DASH diet have proven positive effects on sleep.

Try supplements. Research shows that melatonin and valerian could help improve sleep in certain cases. Melatonin could help get your body’s natural sleep-wake cycle (called “circadian rhythms”) back to normal if that’s the root of your problem. Valerian may help you fall asleep faster if getting to sleep, rather than staying asleep, is the main hurdle for you. Talk to your doctor about dosages and what’s safe to take with any of your other medications.

Avoid smoking and drinking. Like caffeine, nicotine is a stimulant. Research shows that smokers may take longer to fall asleep and have more interrupted sleep than nonsmokers. As for alcohol, a drink can make you drowsy, but it doesn’t lead to restful sleep. Though you might fall asleep fast with a drink in your system, you may not achieve the deep sleep that helps you feel well-rested the next day. When you don’t sleep deeply, you’re more likely to wake multiple times in the night.

Use caffeine wisely. Try not to use coffee or other sources of caffeine to power through your day. The later in the day you drink a cup of joe, the more likely you are to still feel its effects at bedtime. Make sure you cut off caffeine at least 6 hours before your ideal bedtime, and even earlier if you can.

Write off your worries. If a constant slew of worries keeps you awake at night, studies show that writing them down at least 2 hours before bedtime can help you offload your thoughts and get some sleep. Constructive worry worksheets available online for free can guide you through this anxiety-reducing exercise.