I am a board-certified clinical sleep psychologist with expertise in sleep, here to answer all your questions about insomnia. AMA!

What can I do when my mind is jumping between thoughts at night? How do you get it to settle down?

Also why is it mid day I feel exhausted but at night I feel energized?

It’s not unusual for a person's mind to race at night, occasionally. A few strategies that might help to prevent this from interrupting your sleep are:

1. Go to bed when you feel sleepy
2. Do a calming activity for the last 30 minutes or so before getting in to bed
3. Practice a mindfulness exercise that you can use if this continues to be a problem.

Feeling exhausted during the day, but “revved up” at night can be caused by several factors.

First, you might be trying to go to bed and getting up earlier than your natural tendency. Sleeping “out of sync” with your internal clock can cause this to occur. Second, some people with chronic insomnia get more anxious as bedtime approaches. If you struggle with sleep for more than 3 months, this can represent a clinical condition called “chronic insomnia disorder”. That may require help from a sleep specialist.

Chronic insomnia disorder is:

Trouble falling or staying asleep that is severe enough to impact how you feel or function during the day. If this occurs more than 3 times per week for longer than 3 months, you should reach out to a sleep specialist for help. You may have chronic insomnia disorder.

What are some good tips to increase the amount of deep sleep I’m getting each night?

In general, getting more deep sleep is achieved by getting good sleep overall. Making sure to eliminate things in the environment that disrupt your sleep is critical. Some noises, for example, might not fully wake you from sleep, but may keep you in lighter stages of sleep. There also is evidence that exercise increases deep sleep -- but it’s important not to exercise too close to bedtime. That can be counter-productive.

What are some good tips to increase the amount of deep sleep I’m getting each night?

Love this question!

In general, getting more deep sleep is achieved by getting good sleep overall. Making sure to eliminate things in the environment that disrupt your sleep is critical. Some noises, for example, might not fully wake you from sleep, but may keep you in lighter stages of sleep. There also is evidence that exercise increases deep sleep -- but it’s important not to exercise too close to bedtime. That can be counter-productive.

Hi Jennifer, do you know what's the best way to combat sleep procrastination? I often find myself reluctant to sleep in lieu of activities I find either productive or fun which leads me to sleep extreme hours.

It's been a growing habit of mine for several years that i'm finding it exceedingly hard to break.

It’s true that there is more than 24 hours of fun to be had in a given day! Unfortunately, sacrificing our sleep is not a healthy strategy, and in fact, we might enjoy things less the next day if we are tired. One strategy is to use a “bedtime alarm”. Set a time to wind down at the end of the day, and start preparing for a restful night of sleep. This doesn’t have to be very early -- maybe 20-30 minutes before your planned bedtime. Also, make sure to reward yourself for taking care of your sleep. There is probably some little treat you’ve been waiting for. Perhaps that could be a reward for sticking to your bedtime for 2 weeks?

Hi! Thank you so much for doing this AMA.

I’ve been struggling with chronic insomnia for years now, which is probably caused by my depression and anxiety disorders.

I have tried for so long to fix this, by going to therapy for my anxiety, cutting out caffeine and naps, and following all other recommended sleep hygiene habits. I’ve tried multiple medications, and so far the only combination that works is trazodone+hydroxyzine+magnesium+melatonin. I know that this is not a long term solution and I don’t want to have to take so many medications, but I don’t know what else to do. When I go on SSRIs to try and fix the root of the problem, my insomnia gets even worse from the side effects.

Additionally, I am an extremely light sleeper. I will wake up from footsteps outside, whispers, a door closing, etc. I can wake up 10+ times during the night because of this. I have to wear earplugs every night, to the point where my ear canal got inflamed and damaged from using them too much. A white noise machine helps a little bit for background noise, but it’s not enough on its own.

I’m sorry for the extremely long post but this is a culmination of years of frustration. Do you have any feedback? It would be greatly appreciated.

Your story is not unusual. I understand how hard it can be to struggle with insomnia for a long time. My patients often suffer for a decade or more before they seek treatment. You are correct that medications are not the best long-term solution. The good news is that cognitive-behavioral therapy for insomnia is a good alternative. While most people try a lot of different strategies, during CBT-I, you and your provider can come up with a comprehensive plan that accounts for your individual characteristics. For example, being a light sleeper might mean that your sleep environment is very important (while someone who sleeps deeply might not need to worry much about that). One of the most challenging things about insomnia is that the only way to get to sleep is to stop trying to get to sleep. CBT-I can help. You can find a specialist by reaching out to a local sleep center, or by finding a Behavioral Sleep Medicine Provider at https://www.behavioralsleep.org/index.php/society-of-behavioral-sleep-medicine-providers/member-providers

Hello! I sleep better during the day than I do at night. Even if I practice good sleep hygiene, I tend to slowly move away from it and sleep later and later into the day. Is it true that some people are just night people? If so would it be healthier for me too build my life around my body’s preferred sleep schedule?

Some people have an internal circadian rhythm that is "out of sync" with typical sleep routines. There are, in fact two solutions to this type of problem. First, you can arrange your activities to accommodate your schedule. Some people are, in fact "night people" and feel well if they are able to do this. Unfortunately, most activities (and jobs) happen during daytime hours, and as a result, many people choose to shift the timing of their sleep. This can be done with carefully timed exposure to bright light, sometimes in combination with other strategies. The best thing to do is consult with a board certified sleep medicine specialist who can guide to to the best treatment plan.

Hi Jennifer,

Great time to be posting the AMA. Can you please provide some proof it's you and not someone pretending to be you? A post to twitter or a selfie with a sign would do the job.

Here is a link to my bio: https://aasm.org/aasm-spokesperson-jennifer-martin-phd/

Please advise how to add my selfie. It is not giving me an option to add an image. Thanks!

Continually wake up between 3-4am, how does one stay asleep without awakening? Any suggestions? Usually stop eating by 7pm...

Waking up during the night is normal; however, you should be able to fall asleep again fairly quickly. If you are having hard time falling back asleep, there are a few habits that can help

1. Don’t check the clock. Once you know it’s 3:18 am, your mind starts going. That makes it harder to fall asleep. You might ask yourself, “Is this the same time I woke up last night?” “Why does this ALWAYS happen?” Those thoughts are not helpful in terms of falling back asleep. Get the clocks/phone etc. away from the bed
2. Make sure you aren’t spending too long in bed. It might just be that getting up a bit earlier will help this go away over time.

What are the best things to take and do that are non habit forming to help with insomnia?

The best way to get a good night’s sleep is to have a regular routine and healthy sleep habits. In general, sleep works best if you:

1. Go to bed and get up at about the same time each day
2. Spend the right amount of time in bed to get the sleep your body needs - but not more than that.
3. Avoid caffeine, alcohol and interacting with technology close to bedtime.

If you think your sleep problem is more than these simple strategies will address, reach out to a sleep specialist for help. In general, medications and supplements are not recommended as a first-line treatment for insomnia - that means it’s best to try non-medication approaches first such as cognitive-behavioral therapy for insomnia (CBT-I).

I often have trouble staying asleep at night and feel exhausted during the day more than half of the week. Do I have insomnia, or is this just poor sleep?

It’s not uncommon to have difficulty sleeping once in a while -- especially right now during the COVID-19 pandemic. If you consistently have trouble staying asleep at night, it could be chronic insomnia if it occurs at least three times per week and lasts for at least three months.

Fixed proof image.

Thank you!!

Is sex just before sleep a bad idea? (I'm Male, 26 if that helps)

Truthfully, it depends. Some people find sex relaxing and can fall asleep easily afterward. Some people find it activating and therefore sleep after sex is difficult.

I once had a neurologist tell me the average amount of sleep an adult needs is about 7:30/night, based on studies. Is there any truth to this, or if not, is it something else?

That is correct. Adults typically need between 7-8 hours of sleep each night to feel rested. This is based on a number of large studies from countries around the world.

There are loads of audio aids available on Youtube to help with falling asleep - guided meditation, serotonin release music. What are your opinions on the effectiveness of them?

The key to falling asleep is feeling relaxed at a time of day that you brain is ready for sleep. For some people, an audio recording is helpful, but for some people it feels like work. If there is something that interests you, try it for a week and see how you like it. There is no “perfect answer” here. It’s a very personal solution.

How can I figure out how many hours I need to sleep and if there's a deficiency?

The AASM recommends that adults get 7 or more hours of sleep per night. Children, teens and adults can use the this bedtime calculator to identify their appropriate bedtime based on when they need to get up in the morning.

Are you aware of any studies concerning medical / recreational marijuana's impact on sleep patterns?

There isn’t a lot of research on marijuana as a sleep aid, in particular, we have very little information about it’s safety. There also is some research showing that, over the long term, marijuana use can make sleep worse. This study shows that a history of cannabis use was associated with an increased likelihood of reporting difficulty falling asleep, struggling to maintain sleep, experiencing non-restorative sleep, and feeling daytime sleepiness. https://aasm.org/marijuana-use-is-associated-with-impaired-sleep-quality/

What is your opinion of an at home sleep study vs the traditional ones through a local sleep doctor or clinic? I’m thinking I have sleep apnea and from I’m seen there’s not much difference between the two, but that is the non professional internet talking.

Which type of test you need is best determined by a Board Certified Sleep Medicine Physician. They are the real “experts” in deciding which test you might need. You can find one near you by searching the You can find an accredited sleep center near you at http://sleepeducation.org/find-a-facility.

What are these ‘sleep paralysis demons’ I hear so much about?

Sleep paralysis is a phenomenon that occurs (for some people) when waking up from REM sleep. During REM sleep, the muscles of the body become “paralyzed”, and at times, this paralysis doesn’t end at the exact moment the brain wakes up. That is the cause of sleep paralysis. It can be a symptom of a sleep disorder called narcolepsy, but it can occur in people without this condition as well.

What are your thoughts on meditation? I feel like sometimes it's treated like pseudoscience, but perhaps it's not entirely nonsense?

Meditation is helpful for people with insomnia, especially if you learn meditation strategies you can use at bedtime or at night. There are several studies showing that yoga and tai chi are also beneficial for people with insomnia. These natural remedies are supported by good science.

What are the different stages of sleep and how can I get more deep sleep?

Sleep has been traditionally divided into two distinct phases: Non-rapid eye movement (NREM) and rapid eye movement (REM). Both are what they sound like: your eyes remain still during NREM and move rapidly during REM. We shift through NREM and REM sleep stages throughout the night, in a cycle of about 90 minutes. A single cycle usually progresses sequentially through each stage of sleep: wake, light sleep, deep sleep, REM, and repeat.

I have a sleeping probleme since my father passed away 5 years ago, i only sleep after midnight even if I'm tired and i focus on sleeping i can't do it, this probleme makes my life hardest when i have to get up early to attend my classes. surprisingly I have better sleep when i sleep less than 4 hours.

Oftentimes poor sleep is part of our response to grief, stress or an acute period of anxiety. We refer to those as “precipitating events.” For some people, sleep simply gets better over time, but for others, sleep problems persist long after the period of acute grief or stress has passed. Once chronic insomnia develops, the initial trigger is often long in the past, and new factors come in to play. This might include worrying about not sleeping well, having an unusual or irregular sleep schedule, or using too much caffeine or alcohol. We refer to those as “perpetuating factors”. Since these factors become habits, it sometimes takes a structured and systematic approach to develop new and healthy habits.

Is there any connection between insomnia and menstrual cycles? A few days before my cycle starts, I usually have a hard time sleeping. It's especially strange since I'm also diagnosed with Narcolepsy and normally have very few issues with sleeping- it's being awake that is difficult!

First, insomnia is more common among women compared to men. Some women experience more severe symptoms based on their menstrual cycle phase. Insomnia is also common in people with narcolepsy, so it’s especially important to have a regular routine for sleep and for taking medications used in the treatment of narcolepsy.

How long should I try to fall asleep for before which I give up and take like a 15 minute break?

The strategy you are describing is a good one. If sleep is not coming, it IS best to give up and get out of bed. There isn’t a specific magical number of minutes. Once sleep is running away from you, get up for a while. Similarly, 15 minutes out of bed is not always necessary. You should go back to bed when you feel sleepy again, and see what happens.

My sleep cycle is all out of whack. I work remotely so my hours are very flexible, but within the last few months I have only been able to get to sleep very late, between 4 and 5 AM, and then sleep until noon or later which is the "start" of my day. I really want to go back to normal and get to sleep at a normal time, but no matter what I do I simply cannot fall asleep before 4. What can I do to change my sleep schedule back to normal?

Try to get back on track by having a fixed wake up time in the morning, and getting some bright light early in the day (like going out for a walk). It might take several weeks for your sleep schedule to adjust, so be patient. Some people who find it hard to fall asleep and get up at “standard” times suffer from circadian rhythm sleep/wake disorders. People with these conditions often feel like they are living in the wrong time zone. Some people are able to get themselves back on track, but others need more comprehensive treatment, and should find an accredited sleep center where they can get specialty care.

What’s the best way to break out of a bad sleep cycle that’s maintainable?

Try to get back on track by having a fixed wake up time in the morning, and getting some bright light early in the day (like going out for a walk). It might take several weeks for your sleep schedule to adjust, so be patient. Some people who find it hard to fall asleep and get up at “standard” times suffer from circadian rhythm sleep/wake disorders. People with these conditions often feel like they are living in the wrong time zone. Some people are able to get themselves back on track, but others need more comprehensive treatment, and should find an accredited sleep center where they can get specialty care.

Any correlation between natural lucid dreamers and insomnia?

Not that I know of. I haven't seen any research on that topic. Interesting question, though.

Two (kind of three) questions:

Is it okay to use a medication in conjunction with CBT-I? For example, a low dose of Xanax to get used to a schedule.

Have you ever come across sporadic fatal insomnia in your career and what do you wish chronic insomniacs knew about it before freaking out and jumping to the conclusion that they have it?

If you already already taking medications, you can still benefit from CBT-I; however, studies that try to combine CBT-I with medications show some surprising results. Adding a medication to CBT-I actually REDUCES the long-term benefits. The best thing to do is to try CBT-I first, and add medications, after a conversation with your doctor about the risks and benefits, only if a good “dose” of CBT-I hasn’t worked.

I think your second question refers to fatal familial insomnia, which is a rare prion disease. It is not the same as chronic insomnia disorder.

What is your approach to UARS? What do you think need to be done to decrease the rate of false negatives in sleep studies that test for OSA since the RERAs typical of r/UARS are more often than not overlooked?

The primary symptoms include chronic insomnia, anxiety, fatigue or sleepiness, unrefreshing sleep, and difficulty concentrating

All sleep-related breathing disorders can co-occur with insomnia. For people who have more than 1 sleep disorder, working with a sleep specialist is essential. As a psychologist, I refer people with sleep-related breathing problems to a board certified sleep medicine specialist to discuss diagnosis and treatment options.

Are there any sleep aids you would recommend to block out noise and light when trying to fall asleep?

In general, medications are not the best choice as sleep aids; however, noise and light can make it harder to fall asleep (and stay asleep). Any "white noise" can help block out noises you can't avoid, and consider black-out shades or an eye mask if light is a problem. I don't have a particular favorite. In my experience, everyone is a little different in terms of what they prefer.

How can I get into a routine of sleeping at regular hours. I frequently fall asleep in the early morning hours (1-3am). Even when I "fix" my sleep schedule back to 9-10pm, it somehow ends up gettting back into the early morning hours. How can I prevent this back and forth and stay with a regular sleep clock

Some people who find it hard to fall asleep and get up at “standard” times suffer from circadian rhythm sleep/wake disorders. People with these conditions often feel like they are living in the wrong time zone. Some people are able to get themselves on track by having a fixed wake up time in the morning, and getting some bright light early in the day (like going out for a walk). Other people need more comprehensive treatment, and should find an accredited sleep center where they can get specialty care.

Thanks for all the great questions! I will try to answer more in the coming days. Good night.