Plans for Your Body · Hormones, sleep & ageing
The sleep plan
Stop trying to sleep. Fix what keeps you awake.
The goal: Most bad sleep is a trained habit, a clock out of time, or a breathing problem. Fix the first two with the core of CBT-I, the first-line treatment in AASM and ACP guidelines: a fixed wake time, bed only for sleep, morning light, caffeine cut by noon, no alcohol. Screen for sleep apnea. If it won’t budge in 6–8 weeks, see a doctor.
The usual advice is a list of “sleep hygiene” tips: dark room, no screens, warm milk. The sleep guidelines say that list, on its own, doesn’t treat insomnia. What does is retraining the two systems that run sleep, the pressure to sleep and the body clock, and ruling out the breathing problem that hides in millions of bedrooms. This plan does all three.
- MeasureTwo-week sleep diary · STOP-Bang apnea screen · caffeine, alcohol and medication audit
- RetrainFixed wake time · bed only for sleep · time in bed matched to sleep · morning light
- EscalateCBT-I with a trained clinician · sleep study if apnea is likely · your doctor
Most people chase sleep. This removes what’s in its way.
Not medical advice
Discuss everything here with a medical doctor before acting on it — supplements included. Your doctor has your bloodwork and history. We have neither.
02 Why it matters
Short sleep is a metabolic problem, not a mood.
The default
Lie in bed longer, nap, add a nightcap, then a pill. Each one makes tonight a bit easier and next month a bit worse. Meanwhile the snoring nobody investigated keeps dropping your oxygen all night.
The cost
The AASM and Sleep Research Society link regularly sleeping under 7 hours with weight gain, diabetes, high blood pressure, heart disease, depression and earlier death. In a classic Lancet study, six nights of 4 hours left healthy young men handling glucose like much older men.
Sleep is the input every other plan on this site depends on.
03 How it works
Two systems decide when you sleep. One habit can override both.
Sleep comes when two things line up: enough pressure built up from being awake, and a body clock that says it’s night. Insomnia usually means one is weak, the other is mistimed, or your brain has learned to treat the bed as a place to lie awake and worry. Matthew Walker’s research on what sleep does, and Charles Morin’s and Daniel Buysse’s on how to fix it, come back to the same point: protect the systems and, for most people, sleep follows.
- Sleep pressure
- Adenosine builds the longer you’re awake. Naps, lie-ins and long hours in bed bleed it off, so you go to bed less sleepy than you should be.
- Body clock
- Set mainly by light. Bright light in the morning pulls it earlier; bright light late at night pushes it later. An irregular wake time leaves it permanently jet-lagged.
- Learned arousal
- Spend enough nights awake in bed and the bed itself becomes a cue to be alert. That’s why some people fall asleep on the couch and wake up the moment they get into bed.
- Caffeine
- Blocks adenosine and lasts for hours. In one trial, caffeine taken 6 hours before bed still cut measured sleep by more than an hour, and people didn’t notice.
- Alcohol
- A sedative, not sleep. It knocks you out faster, then fragments the second half of the night and suppresses REM sleep. That’s your 3 am wake-up.
- Sleep apnea
- The airway collapses during sleep, oxygen drops, and the brain wakes you briefly, dozens or hundreds of times a night, without you remembering. Loud snoring, gasping and daytime sleepiness are the clues. Untreated, it raises blood pressure and wrecks sleep quality.
- Deep sleep and the brain
- Deep, slow-wave sleep is when the brain seems to do its overnight housekeeping. In mice, the fluid that washes waste such as amyloid out of the brain flows much faster during sleep than waking. Neurophysiologist Louisa Nicola, who works on brain health and cognitive performance, makes this a core reason to protect a regular schedule: deep sleep comes mostly early in the night, and an erratic bedtime or late alcohol cuts into it. The human evidence is still early; the case for steady, sufficient sleep doesn’t rest on it.
- Insulin and appetite
- Short sleep worsens insulin sensitivity and pushes appetite up the next day. Bad sleep and metabolic disease feed each other.
04 The steps
Measure. Retrain for 6–8 weeks. Escalate if it won’t move.
Measure · Weeks 0–2
Find out what kind of bad sleep you have.
- Sleep diarytwo weeks, every morning
Write down when you went to bed, roughly when you fell asleep, how long you were awake in the night, when you woke and when you got up. Use your estimate, not a tracker. You need it to set your sleep window.
- Sleep efficiencyfrom the diary
Time asleep divided by time in bed. Under about 85% means you spend too long in bed awake, which is the habit this plan retrains.
- STOP-Bangeight yes/no questions
Snoring, Tiredness, Observed pauses, blood Pressure, BMI over 35, Age over 50, Neck over 40 cm, male Gender. Three or more yeses means talk to your doctor about a sleep study before you start sleep restriction.
- Audit the inputscaffeine, alcohol, medication
When you have your last coffee, tea, cola or energy drink; how much you drink and when; and which medications you take. Some medications disturb sleep. Ask your doctor or pharmacist; don’t stop anything yourself.
Retrain · Weeks 2–8
The core of CBT-I, done yourself.
These are the behavioural parts of cognitive behavioural therapy for insomnia (CBT-I), the treatment both the AASM and the American College of Physicians put first. It doesn’t need to be long: in Daniel Buysse’s trial in older adults, four short sessions with a nurse, two of them by phone, left about two-thirds improved, against a quarter of those given only printed advice. Expect sleep to feel worse for the first week or two before it gets better.
- Fixed wake timesame time, 7 days a week
The anchor for everything else. Pick a time you can keep every day, weekends included, and get up then however you slept.
- Sleep windowtime in bed = time asleep
From your diary, take your average time asleep (never less than 5½ hours) and only allow that much time in bed, counting back from your wake time. When your efficiency is above about 85% for a week, add 15 minutes. If it’s under 80%, take 15 away.
- Bed is for sleepand sex, nothing else
No phone, TV, work or worrying in bed. Go to bed only when sleepy, not just tired. If you’re awake and frustrated for what feels like 20 minutes, get up, do something dull in dim light, and come back when sleepy.
- Morning lightoutdoors, within an hour of waking
Ten to thirty minutes outside, even on a cloudy Canadian winter day, is far brighter than indoor lighting. It sets your clock and makes evening sleepiness arrive on time.
- Wind downthe last hour
Dim the lights, keep the room cool and dark, put the phone in another room. Write tomorrow’s worries on paper so they aren’t rehearsed at 2 am.
- Caffeinenone after noon
If you go to bed at 10 or 11 pm, a noon cut-off gives you a margin over the 6 hours the trial showed still costs sleep. Slow metabolisers may need earlier.
- Alcoholnone while fixing the numbers
It goes straight to the liver, raises triglycerides and adds to liver fat. Less is better; none is best while you’re fixing the numbers. For sleep, it’s the second half of the night it ruins. If you won’t stop, stop within 3–4 hours of bed.
- No napswhile retraining
A nap spends the sleep pressure you’re building for the night. Once sleep is fixed, a short early-afternoon nap is fine if it doesn’t cost you the night.
Not alone if…
Don’t do sleep restriction without a clinician if you have bipolar disorder, a seizure disorder, untreated sleep apnea, are pregnant, or drive or operate machinery for a living. Short-term sleepiness is part of the process, so don’t drive drowsy.
Daytime inputs · ongoing
What you do awake decides how you sleep.
- Trainingstrength 2–3×/week, cardio 150+ min/week
Lift, and walk briskly or cycle most days. Muscle is where most of a meal’s glucose ends up, so more muscle means more room for it. Cardio makes that muscle more sensitive to insulin. Regular exercise improves sleep quality. Finish hard sessions a few hours before bed if they wind you up.
- Daylight and movementoutdoors, during the day
The more light and activity in your day, the sharper the contrast with night. Desk-bound, indoor days produce flat, shallow nights.
- Dinner2–3 hours before bed
A big meal late, especially a heavy or sugary one, can mean reflux and restless sleep. Eat your last meal earlier.
- Eating windowdaily, e.g. noon to 8 pm
Eat inside a fixed window and not outside it. Fewer insulin spikes per day, fewer chances to overeat. A window that closes 2–3 hours before bed does double duty.
Supplements · optional · discuss with your doctor first
One, for the clock, not insomnia.
- Melatonin0.5–3 mg, at bedtime
In pooled trials people fell asleep about 7 minutes faster and slept about 8 minutes longer: modest. It works better for jet lag, taken at bedtime in the new time zone for a few nights. It can leave you groggy the next morning. Not for pregnancy or breastfeeding; ask first if you take a blood thinner or have epilepsy. Modest: about 7 minutes faster to sleep. Most useful for jet lag and a body clock that runs late, not as a sleeping pill.
Find it on Amazon: Melatonin
Escalate · If no better by week 8
When to hand it over.
- CBT-I with a clinicianor a structured digital program
If doing it alone hasn’t worked, the full therapy with a trained psychologist or physician adds the cognitive part and adjusts the window with you. Ask your doctor for a referral. Charles Morin’s group at Université Laval has spent decades on self-help and digital versions; structured programs exist where therapists are scarce.
- Sleep studyif apnea is likely
Loud snoring, witnessed pauses, gasping, high blood pressure or a STOP-Bang of 3+: ask your doctor about a home sleep apnea test or an overnight sleep study. Apnea is very treatable once it’s found.
- Sleeping pillsyour doctor’s call
Guidelines put CBT-I first and medication as a shared decision for when it isn’t enough. Ask your doctor about the options and the trade-offs; don’t change any existing prescription without them.
- If the numbers won’t moveyour doctor
Take the before-and-after numbers to your doctor. Whether you need medication is their call. Needing it isn’t failure. Also see your doctor for restless legs, acting out dreams, or sleepiness that makes you nod off while driving.
05 The rules
Short list. No exceptions.
Choose
- The same wake time every day, weekends included
- Light outdoors within an hour of waking
- Bed only when sleepy; out of bed when you can’t sleep
- A cool, dark, quiet bedroom, and the phone elsewhere
Avoid
- Caffeine after noon
- Alcohol in the evening
- Lie-ins and naps while you retrain
- Checking the clock at night
Non-negotiables
- Screen for sleep apnea before you restrict your sleep.
- Don’t drive or operate machinery when sleepy.
- Don’t stop or change prescribed medication without your doctor.
- Give it 6–8 weeks. Week 1 feels worse; that’s expected.
06 Checkpoints
What to track, and what good looks like.
Use your diary, not a wearable, as the main record. Daniel Buysse argues good sleep is more than hours: how satisfied you are, how alert you feel by day, when you sleep, how efficiently, and how long. The metrics below cover all five. These are common clinical reference points.
| What | Target | How and when |
|---|---|---|
| Total sleep | 7–9 hours for adults 18–64; 7–8 hours over 65 | Diary average over a week. Canada’s 24-Hour Movement Guidelines; the AASM says 7 or more. |
| Sleep efficiency | >85% | Time asleep ÷ time in bed × 100. Your signal to widen or narrow the window. |
| Time to fall asleep | <30 minutes | Diary estimate. Under 5 minutes every night can mean you’re sleep-deprived. |
| Awake in the night | <30 minutes total | Diary estimate. |
| Wake time | Same time ±30 min, 7 days a week | Diary. The one number you control completely. |
| STOP-Bang | 0–2 low risk · 3–4 intermediate · 5–8 high | Once at the start. 3+ is a conversation with your doctor. |
| Daytime | Alert without caffeine by mid-morning | A rough self-check. Persistent sleepiness despite enough time in bed points to a sleep disorder. |
Consumer sleep trackers are decent at total sleep and poor at sleep stages. Use them for trends, if at all, and stop if the score starts keeping you awake.
07 Where experts disagree
Where the sleep experts don’t agree.
Nobody serious argues that chronic short sleep is harmless, or that apnea should go unchecked. The arguments are about how much you need, and how hard to push.
Do you really need eight hours?
More is protective: Walker
Adults need 7–9 hours. Routinely sleeping under 7 raises the risk of metabolic disease, heart disease, poor mental health and accidents, and most people underestimate their debt.
Don’t panic about it: Kripke
In over a million adults, the lowest mortality was around 7 hours; people reporting 8 or more did worse, not better. If you average 6½–7 hours, you can be reassured.
Our read Aim for 7–9 hours in bed, accept that 7 asleep is fine for many people, and judge by how you function. Long sleep paired with fatigue is a reason to see a doctor, not to sleep more.
Is “sleep hygiene” enough?
Common practice
A sheet of tips (dark room, no screens, no caffeine) is quick, cheap and harmless, so it’s what most people are given.
AASM guideline: Edinger et al.
As a stand-alone treatment for chronic insomnia, sleep hygiene doesn’t work well enough to recommend. Stimulus control, sleep restriction and full CBT-I do.
Our read Keep the tips; they help. But the active ingredients are the fixed wake time, the sleep window and getting out of bed when you can’t sleep.
Pills or CBT-I?
Guidelines: ACP, AASM; trials: Morin
CBT-I first for every adult with chronic insomnia. It works as well as medication in the short term, lasts longer after it stops, and has fewer harms. In Morin’s trial, people who added a sleeping pill for the first six weeks and then carried on with CBT-I alone did better at six months than those who stayed on the pill.
Practical objection
Pills work tonight; CBT-I takes weeks, feels worse first, and trained therapists are scarce, so many doctors and patients default to medication.
Our read Start CBT-I now; digital programs close much of the access gap. If you and your doctor decide on medication, Morin’s results suggest it works best as a short bridge alongside CBT-I, not a replacement for it.
Do sleep trackers help?
Track it to fix it
Data makes sleep visible: you see the cost of the late coffee or the second drink, and that motivates change.
Orthosomnia: Baron et al.
Some patients become so fixated on their tracker scores that the anxiety worsens their sleep, and they trust the device over clinical testing.
Our read If a tracker helps you keep the wake time, fine. If you check it before you ask yourself how you feel, put it in a drawer.
Melatonin?
AASM pharmacologic guideline: Sateia et al.
For chronic insomnia, the benefit in trials was small and the evidence weak; the guideline suggests clinicians not use it for falling or staying asleep.
Circadian specialists
It’s a timing signal, not a sedative. Used correctly, it can help shift the clock for jet lag or a body clock that runs very late.
Our read Not an insomnia treatment. If your problem is a clock that runs hours late, discuss timed use with your doctor first.
08 Limits
What this plan can’t fix.
Sleep disorders
Sleep apnea, restless legs, narcolepsy and REM behaviour disorder need diagnosis and medical treatment. Better habits help around the edges; they don’t open a collapsing airway.
What’s keeping you up
Depression, anxiety, chronic pain, menopause, a newborn or night shifts all wreck sleep. CBT-I still helps with most, but the cause needs its own treatment, often with your doctor.
Medications
Some prescriptions disturb sleep, and some sleep aids leave you groggy or dependent. Changes are your doctor’s call, not this page’s.
The plan retrains the habit and the clock. It doesn’t treat a disorder.
09 Resources
Worth your time.
Why We Sleep
The case for sleep as the foundation of health. Some of its numbers have been challenged; the core argument stands.
The Neuro Experience
A neurophysiologist on sleep, exercise and brain health, with researchers as guests.
Efficacy of brief behavioral treatment for chronic insomnia in older adults
Proof that the behavioural core of CBT-I works in four short sessions, delivered by a nurse. The steps in this plan, tested.
Sleep health: can we define it? Does it matter?
Why sleep should be judged on satisfaction, alertness, timing, efficiency and duration, not hours alone.
Behavioral and psychological treatments for chronic insomnia disorder in adults
What actually works for insomnia, graded: CBT-I, stimulus control and sleep restriction at the top.
Canadian 24-Hour Movement Guidelines for Adults
Canada’s official advice on sleep, activity and sitting, in one page.
10 Questions
Questions, answered plainly.
What is the fastest way to fix insomnia?
Fix your wake time, limit your time in bed to roughly the time you actually sleep, and get out of bed when you can’t sleep. Many people see improvement within 2–4 weeks, though not everyone; it often feels worse in the first week.
Is CBT-I better than sleeping pills?
Guidelines put CBT-I first. It works about as well as medication in the short term and its effects last after treatment ends. In Charles Morin’s trial, about two-thirds of people who finished on CBT-I alone were in remission at six months, against about four in ten who stayed on the pill. Whether to add medication is a decision to make with your doctor.
How late can I have coffee?
In a controlled trial, a strong dose 6 hours before bed still cut sleep by over an hour. A noon cut-off is a safe default if you go to bed at 10 or 11 pm.
Does alcohol help you sleep?
It helps you fall asleep, then fragments the second half of the night and suppresses REM sleep. Net effect: worse sleep.
How do I know if I have sleep apnea?
Loud snoring, someone seeing you stop breathing, gasping awake, morning headaches and daytime sleepiness are the classic signs. A STOP-Bang score of 3 or more is a reason to ask your doctor about a sleep study.
Should I take melatonin?
The AASM suggests against it for chronic insomnia. It’s a body-clock signal, not a sleeping pill. Discuss it with your doctor first, particularly if you’re pregnant or on other medication.
Why do I wake at 3 am?
Common culprits: evening alcohol, too long in bed, an early-running body clock, stress, reflux and sleep apnea. The diary usually shows which.
11 Sources
Where this comes from.
Experts drawn on
- Matthew Walker, PhD — Professor of neuroscience and psychology, UC Berkeley. Author of Why We Sleep.
- Louisa Nicola — Neurophysiologist; founder of Neuro Athletics. Works on brain health and cognitive performance; host of The Neuro Experience podcast.
- Charles Morin, PhD — Professor of psychology, Université Laval; Canada Research Chair in Behavioural Sleep Medicine. Led landmark trials of CBT-I against and alongside medication.
- Daniel Buysse, MD — Professor of psychiatry, University of Pittsburgh. Developed brief behavioural treatment for insomnia and the sleep health framework.
- Jack Edinger, PhD — Clinical psychologist. Lead author of the 2021 AASM guideline on behavioural treatments for insomnia.
- Frances Chung, MD — Anesthesiologist, University of Toronto. Developed the STOP-Bang screening questionnaire.
- Daniel Kripke, MD — Psychiatrist and sleep researcher, UC San Diego. Studied sleep duration and mortality.
Sources
- Behavioral and psychological treatments for chronic insomnia disorder in adults: an AASM clinical practice guideline. Journal of Clinical Sleep Medicine, 2021.
- Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 2016.
- Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. JAMA, 2009.
- Efficacy of brief behavioral treatment for chronic insomnia in older adults. Archives of Internal Medicine, 2011.
- Sleep health: can we define it? Does it matter?. Sleep, 2014.
- Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults. Journal of Clinical Sleep Medicine (AASM), 2017.
- Meta-analysis: melatonin for the treatment of primary sleep disorders. PLoS One, 2013.
- Melatonin for the prevention and treatment of jet lag. Cochrane Database of Systematic Reviews, 2002.
- Recommended amount of sleep for a healthy adult: a joint consensus statement of the AASM and Sleep Research Society. Journal of Clinical Sleep Medicine, 2015.
- Canadian 24-Hour Movement Guidelines for Adults aged 18–64 and 65+. Canadian Society for Exercise Physiology, 2020.
- Caffeine effects on sleep taken 0, 3, or 6 hours before going to bed. Journal of Clinical Sleep Medicine, 2013.
- Alcohol and sleep I: effects on normal sleep. Alcoholism: Clinical and Experimental Research, 2013.
- Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea. American Academy of Sleep Medicine, 2017.
- STOP-Bang questionnaire. American Thoracic Society.
- Impact of sleep debt on metabolic and endocrine function. The Lancet, 1999.
- Sleep drives metabolite clearance from the adult brain. Science, 2013.
- Mortality associated with sleep duration and insomnia. Archives of General Psychiatry, 2002.
- Orthosomnia: are some patients taking the quantified self too far?. Journal of Clinical Sleep Medicine, 2017.
Not medical advice
Discuss everything here with a medical doctor before acting on it — supplements included. Your doctor has your bloodwork and history. We have neither.