Top 10 insomnia fixes

Moderate evidenceLight therapy helps insomnia in pooled studies, but effects are small to medium and may be inflated by publication bias [22].

What it is: Getting bright light, ideally daylight, soon after your fixed wake time to anchor your body clock.

The evidence: A 2016 meta-analysis of 53 studies with 1,154 participants found bright light therapy improved sleep problems in general and insomnia specifically, with larger effects at higher light intensity, though most effects were small to medium and there were signs of publication bias [22]. Natural daylight shifts the body clock earlier, which helps if your clock runs late [23].

Limited evidenceOne small lab trial in healthy young adults [24].

What it is: Writing down tomorrow's tasks and worries so your brain does not have to hold them in bed.

The evidence: In a lab trial, 57 healthy adults aged 18 to 30 spent 5 minutes before bed writing either a to-do list for the coming days or a list of tasks they had already done. The to-do list group fell asleep significantly faster, and the more specific their list, the faster they fell asleep [24]. Many people with insomnia say their bedtime thoughts are about planning and problem-solving [25].

Limited evidenceOne small trial supports engaging imagery; counting sheep and cognitive shuffling themselves have not been tested in trials we could find [26].

What it is: Giving your mind something calm but engaging to do so it cannot return to worries. Imagery means walking through a detailed, pleasant scene. Cognitive shuffling means picturing a random string of unrelated objects (bread, bicycle, bee...). Counting sheep is the old, dull version.

The evidence: In a 2002 experiment, 41 people with insomnia were given instructions for one night: distract yourself with a detailed, interesting mental image, distract yourself any way you like, or no instructions. The imagery group fell asleep faster and had fewer and less distressing unwanted thoughts than the no-instruction group. The researchers think imagery works because it fills enough mental space to keep worries out [26]. A 2020 review found that different thought-control strategies before sleep can help, do nothing, or backfire, depending on the method [25]. We found no trial of counting sheep or of cognitive shuffling itself; both are cousins of imagery distraction, and counting sheep is probably too boring to hold attention.

Limited evidenceSmall studies only, and no trial of 4-7-8 breathing for sleep that we could find [27, 28].

What it is: Breathing slowly, with a longer breath out than in, to calm the body's stress response. 4-7-8 means breathe in for 4 counts, hold for 7, breathe out for 8. Cyclic sighing is a double inhale through the nose, then a long, slow exhale through the mouth.

The evidence: In a small study of 14 people with insomnia and 14 good sleepers, slow paced breathing for 20 minutes before bed helped the people with insomnia fall asleep faster, wake less and sleep more efficiently, measured in a sleep lab; there was no randomized comparison group [27]. In a 1-month randomized trial, 5 minutes a day of cyclic sighing improved mood and lowered breathing rate more than the same time spent in mindfulness meditation, but the trial did not measure sleep [28]. We found no published trial testing 4-7-8 breathing for sleep.

Limited evidenceA small lab trial and a large survey point the same way, but neither proves screens cause insomnia [29, 30].

What it is: Ending scrolling, streaming and gaming before bed, and keeping the phone out of reach.

The evidence: In a small lab trial, reading on a light-emitting e-reader before bed instead of a printed book suppressed evening melatonin by 55%, pushed the body clock 1.5 hours later and added nearly 10 minutes to the time taken to fall asleep [29]. In a survey of 45,202 Norwegian students, each extra hour of screen use after going to bed was linked to 59% higher odds of insomnia symptoms and 24 minutes less sleep, whatever the screen was used for; a survey like this cannot show which came first [30].

Limited evidenceObservational studies only, but the changes are cheap and safe [31, 32, 33].

What it is: Setting up the room so temperature, light and noise do not wake you.

The evidence: In older adults tracked at home, sleep was most efficient at bedroom temperatures of 20 to 25 °C (68 to 77 °F), and efficiency dropped 5 to 10% as the room warmed from 25 to 30 °C [31]. In 857 older adults in Japan, those with the brightest bedrooms at night had 61% higher odds of insomnia than those with the darkest [32]. In a field study of 105 people, every 10 decibels more outdoor noise in the first hour after bedtime added about 5.6 minutes to the time taken to fall asleep [33].

Limited evidenceOne randomized trial, in people with psychiatric conditions [34].

What it is: A heavy blanket, filled with chains or beads, that presses gently on the body.

The evidence: In a 2020 trial, 120 adults with insomnia alongside depression, bipolar disorder, generalized anxiety or ADHD slept under either a weighted chain blanket or a light one for 4 weeks. Insomnia severity improved much more with the weighted blanket (a large effect), along with daytime fatigue, depression and anxiety, and the benefit held over a year of continued use [34]. It has not been tested this way in people with insomnia alone.

Limited evidenceFine as background habits, but guidelines advise against relying on sleep hygiene alone to treat insomnia [3, 35].

What it is: The familiar list of good sleep habits: regular hours, no late caffeine, a comfortable bedroom and so on.

The evidence: In a 2018 review of 15 studies, sleep hygiene education produced small to medium improvements, but was clearly less effective than CBT-I, and only self-reported measures improved [35]. The American Academy of Sleep Medicine suggests clinicians not use sleep hygiene as a single treatment for chronic insomnia [3]. In the HABIT trial, the booklet-only group did clearly worse than the group that also did sleep restriction [4].

Limited evidenceSmall average effect on insomnia; the sleep medicine guideline suggests not using it for chronic insomnia [36, 37].

What it is: A hormone your brain releases in the evening, sold as a supplement in many countries.

The evidence: A meta-analysis of 19 placebo-controlled trials with 1,683 people found melatonin helped people fall asleep 7 minutes faster and sleep 8 minutes longer [36]. The American Academy of Sleep Medicine suggests clinicians not use melatonin to treat chronic insomnia in adults (a weak recommendation) [37]. It has better support for jet lag [38].

Limited evidenceFew, small and often low-quality trials; the sleep medicine guideline suggests not using valerian [39, 40, 37].

What it is: Over-the-counter supplements marketed for sleep.

The evidence: Magnesium: in 3 small trials with 151 older adults, people fell asleep about 17 minutes faster than with placebo, but all trials were at moderate to high risk of bias [39]. Valerian: 16 trials with 1,093 people suggested it might improve sleep quality, but most had serious design problems and there was evidence of publication bias [40], and the American Academy of Sleep Medicine suggests not using it for chronic insomnia [37]. Ashwagandha: 5 trials with 400 people showed a small to moderate benefit, with limited safety data [41].

Moderate evidenceSome work in trials, but guidelines put them after CBT-I, short term, and as a decision made with a doctor [2, 37].

What it is: Prescription sleep medicines, plus over-the-counter sedating antihistamines.

The evidence: The American College of Physicians recommends CBT-I first, and only then a shared decision with a clinician about short-term medicine if CBT-I has not worked (a weak recommendation, low-quality evidence) [2]. The American Academy of Sleep Medicine gives weak recommendations for several prescription drugs, and suggests not using the over-the-counter antihistamine diphenhydramine, trazodone, melatonin, tryptophan or valerian for chronic insomnia [37]. In observational studies, people taking sleeping pills and anti-anxiety drugs had 43% higher mortality than non-users, though these studies cannot separate the drugs from the health of the people taking them [42].

No direct evidenceWe found no study testing it for sleep.

What it is: A viral tip: with eyes closed or open, move your eyes slowly from side to side for a minute or so to wind down.

The evidence: We searched PubMed and found no trial of side-to-side eye movements as a way to fall asleep. If it helps you, the likeliest reason is the same one behind imagery distraction: a simple, absorbing task that leaves less room for worries [26]. That is a guess, not a finding.

No direct evidenceWe found no study testing the pose alone for sleep.

What it is: A restorative yoga pose: lying on your back with your legs resting straight up against a wall, often for 5 to 10 minutes before bed.

The evidence: We found no trial of legs up the wall on its own for sleep. It appears in some gentle yoga routines, and gentle yoga as a whole has trial support for sleep quality (remedy 7) [14]. Any benefit on its own is unknown.