Chronic insomnia means trouble falling asleep, staying asleep, or waking too early at least three nights a week for three months or more, with daytime effects. It's one of the most common problems I see, and often it travels with anxiety or depression.
CBT-I comes first
Cognitive behavioral therapy for insomnia (CBT-I) is recommended as the first-line treatment for chronic insomnia by major medical organizations. It usually takes 4 to 8 sessions, and its benefits tend to last longer than medication's. Core pieces include:
- Stimulus control: bed is for sleep and sex only. If you're awake more than about 20 minutes, get up and do something calm until sleepy.
- Sleep restriction: temporarily limiting time in bed to match actual sleep, which builds sleep drive. It's done with guidance.
- A fixed wake time, every day, including weekends.
- Working with racing thoughts instead of fighting them.
There are also good digital CBT-I programs if in-person therapy is hard to access.
Where medication fits
Medication can help, especially short-term or alongside CBT-I. Options differ in how they work, how long they last, and their risks. Some are approved specifically for sleep; others are used off-label at low doses. The right choice depends on whether you can't fall asleep or can't stay asleep, your other conditions, and your other medications. Over-the-counter antihistamine sleep aids often cause next-day grogginess and aren't a good long-term answer, especially for older adults.
Things to rule out
- Sleep apnea, especially with snoring, gasping, or daytime sleepiness
- Restless legs
- Depression, anxiety, or bipolar disorder
- Caffeine, alcohol, and medications that disrupt sleep
Small changes that help
- Morning daylight within an hour of waking
- No caffeine after noon
- Screens down an hour before bed
- A cool, dark bedroom
This article is general information, not medical advice for your situation. If you're in crisis, call or text 988, or call 911.