Tonight: if you have been in bed awake more than about 20 minutes, get up - do something calm in dim light until drowsy, then try again. Long-term: the fix with the strongest evidence is not a pill, it is CBT-I (cognitive behavioral therapy for insomnia), which outperforms sleep medications in lasting results.
The evidence-backed basics, honestly ranked: 1) Consistent wake time every day including weekends - the anchor that fixes more sleep problems than any supplement. 2) CBT-I - a structured program (available online through programs like Sleepio, or via therapists) with the best long-term evidence in sleep medicine. 3) The stimulus-control rule: bed is for sleep only; awake past ~20 minutes, get up. 4) Cut caffeine after early afternoon and alcohol near bed - alcohol sedates but shreds the second half of the night. 5) Screens and bright light in the last hour genuinely delay melatonin. What about melatonin? Useful for shifting your clock (jet lag, delayed schedules) at low doses (0.5 to 3mg), mediocre for general insomnia. Sleeping pills: real but short-term tools with dependence and hangover trade-offs. When insomnia is a symptom: anxiety, depression, sleep apnea (snoring + gasping + daytime exhaustion), restless legs, and thyroid problems all hide behind 'can't sleep' - that is when a clinician earns the visit. Emergencies skip this list: chest pain, trouble breathing, stroke signs, severe bleeding, or thoughts of self-harm mean call 911, or 988 for a mental health crisis in the US.
What to do
Common questions
Does melatonin actually work?
For specific jobs, yes: shifting your body clock (jet lag, delayed sleep phase, adjusting to a new schedule) at low doses - 0.5 to 3mg is as effective as the 10mg tablets stores sell, with less next-day grogginess. For general 'I can't sleep' insomnia, the evidence is weak. Also know: melatonin is a supplement in the US, so actual content varies between brands - look for USP-verified on the label.
Why do doctors say CBT-I beats sleeping pills?
Because the trials say so. CBT-I - a 6-to-8-week structured program retraining your sleep habits and the anxiety loop around not sleeping - produces improvements that persist after treatment ends. Sleeping pills work while you take them and stop working when you quit, with dependence and next-day effects along the way. Guidelines from the American College of Physicians name CBT-I as the first-line treatment for chronic insomnia, before any medication.
Could my insomnia be sleep apnea?
If you snore, have been told you gasp or stop breathing at night, wake with headaches or a dry mouth, or feel exhausted despite 'enough' hours - yes, possibly, and no amount of sleep hygiene fixes it. Sleep apnea is common, underdiagnosed, and treatable; the diagnosis is a sleep study (many now done at home). This is one of the clearest 'see a clinician' cases in sleep.
When should I see a doctor about not sleeping?
When it has gone on most nights for a month or more despite the basics, when daytime function is suffering (nodding off driving is a red line), when you suspect anxiety or depression underneath it, when a partner reports snoring or breathing pauses, or when you have been relying on sleep medication - prescription or OTC - for weeks. Telehealth handles the evaluation well; home sleep tests ship to your door when apnea is the question. Emergencies skip this list: chest pain, trouble breathing, stroke signs, severe bleeding, or thoughts of self-harm mean call 911, or 988 for a mental health crisis in the US.