Almost everyone sleeps badly sometimes, and most of the advice available for it is aimed at the wrong problem. This section separates three things that get run together: ordinary bad nights, insomnia as a condition, and sleeping badly because something else is going on.
Sleep hygiene is sensible, and it is not a treatment
A dark, cool room, a regular hour, no screens late, no caffeine after the afternoon — all reasonable, all worth doing, and none of it effective against established insomnia on its own. That is not an opinion; it is the consistent finding, and sleep hygiene is the weakest component of the treatment that works.
What does work is cognitive behavioural therapy for insomnia, and its active ingredients are counter-intuitive enough that nobody arrives at them by common sense. The central one involves spending less time in bed rather than more.
Spending longer in bed is the commonest response to sleeping badly, and one of the few that reliably makes it worse.
Eight hours is a figure, not a rule
Adults need somewhere in a range, it differs between people and shifts across a lifetime, and no single number applies to everybody. The figure does real harm when it becomes a target, because lying awake calculating the shortfall is itself one of the things that keeps people awake.
Sometimes the sleep is the symptom
A person can do everything right and still sleep badly, because the problem is not the sleeping. Obstructive sleep apnoea, restless legs, chronic pain, depression and anxiety, the perimenopause, alcohol, prescribed medicines and shift work all produce poor sleep, and in each case treating the sleep without finding the cause is why some people get nowhere for years.
One of them deserves naming at the top. Untreated sleep apnoea carries consequences beyond tiredness — for cardiovascular health, and for anyone who drives, where there are legal obligations as well as practical ones. It is common, it is substantially underdiagnosed, and it is very treatable once identified.
On sleeping tablets
They work, in the short term, and the short term is the whole of it: the standard courses are measured in days rather than weeks, because tolerance and dependence follow quickly. They are not a failure of character to need and they are not a solution to keep returning to. Newer medicines exist with different limits, and the honest framing is that medication buys time while something more durable is put in place.
What is sold, and what is licensed
Melatonin is the clearest example of why a section like this is needed. It is widely described as a supplement to pick up in a health food shop, which is how it works in North America. In the UK it is a prescription-only medicine, licensed for a specific group and a limited period. That kind of difference is the sort of thing an article written for one country quietly gets wrong for readers in another.
The articles below set out what each of these conditions actually is, what the treatment involves, and — where the honest answer is that something does not work — that it does not.