Sleep · Guide

Insomnia: what actually helps

If you struggle to fall or stay asleep most nights, the best-proven fix isn't a pill or a supplement. It's a short course of therapy that retrains your sleep, and it now comes as an app.

What insomnia is

Insomnia means trouble falling asleep, staying asleep, or waking too early, despite having the chance to sleep, and feeling the effects during the day. When it happens at least three nights a week for three months or more, doctors call it chronic insomnia.

Short spells of poor sleep are normal after stress or change. Chronic insomnia is different: the original trigger has often passed, but the sleeplessness has taken on a life of its own.

What keeps it going

Time awake in bed. Lying in bed for hours trying to sleep teaches your brain that bed is a place for being awake.
Irregular hours. Sleeping in, napping, or going to bed early to catch up weakens your body's drive to sleep at night.
Worry about sleep. Anxiety about not sleeping keeps your mind alert at exactly the wrong time, which creates a cycle.

Options compared

We grade each option on the same evidence scale as everything else on the site.

A
Digital CBT-I programs
Large benefit, moderate certainty
Across dozens of trials, app and online programs cut insomnia severity more than control groups, and the benefits lasted. Programs with a therapist or coach worked best.
–
CBT-I with a therapist
Recommended first treatment; not yet graded by us
Guidelines recommend CBT-I as the first treatment for chronic insomnia. In-person therapy did somewhat better than apps in head-to-head comparisons.
C
Melatonin
Small to moderate benefit, low certainty
About 7 to 10 minutes faster to fall asleep on average, depending on the analysis. Useful for jet lag and late body clocks, not for ordinary insomnia.
C
Magnesium
Moderate benefit, low certainty
Three small trials in older adults found about 17 minutes faster sleep onset, but the trials were weak. May help people who are low in magnesium.
–
Prescription sleep medicines
Outside our scope
These are a medical decision. Talk to your doctor about benefits and risks.

How to get CBT-I

Ask your doctor about prescription CBT-I apps such as SleepioRx or Somryst, both FDA-cleared.
Check your employer or health insurer: many offer Sleepio or similar programs as a free benefit.
Look for a therapist trained in CBT-I (behavioral sleep medicine) if you'd like in-person support.
See a clinician first if you snore loudly or gasp in your sleep, have bipolar disorder or seizures, or drive or operate machinery for work. Parts of CBT-I can make you sleepier at first.

Things you can start tonight