Can’t Sleep? Start Here.
When poor sleep becomes a pattern—not just a problem—and how to reset it.
What Kept Me Up for a Decade
At one point in my career, I was responsible for over 3,600 patients.
Around that time, I developed a pattern I could not shake: I would wake up in the middle of the night, mind running, and stay awake for hours. The pattern continued for more than a decade, long after my workload improved. The issue was no longer external. My brain had learned a habit, and the habit had outlived its cause.
I refused sleep medications. So I had to find another way.
This post is about what eventually worked—and what I now recommend to patients who tell me the same thing I used to tell myself: I just don’t sleep well anymore.
The Foundation: Sleep Hygiene
Before any supplement, device, or protocol, the basics need to be in place. None of this is surprising. Most people have never fully implemented all of them at once.
A completely dark room—pitch black, no light at all
A cool sleep environment, whether through room temperature, a cold cloth on the forehead before bed, or a cooling mattress topper like Flux Sleep or BedJet
Consistent sleep and wake times, including weekends
No screens, news, politics, or arguments in the 30 minutes before bed
Support tools—meditation, breathwork, a sound machine—if your brain needs help downshifting
Magnesium glycinate, which I find more reliable than melatonin for most adults
The Breakthrough: Pattern Interruption
Once the foundation is solid, the next question is what your brain is actually doing when you get into bed.
This is the piece I had to figure out for myself.
This is not about thinking positive thoughts. It is about giving the brain a different track to run on.
The brain that has learned to wake up at 3 a.m. and engage will keep doing that until it learns to do something else. Forcing positivity does not work—especially if life is genuinely hard right now. Most people lying awake are not thinking dark thoughts. They are simply replaying the day, or rehearsing tomorrow, on a loop the brain has practiced thousands of times.
So the goal becomes simple: redirect. For 5 to 10 minutes after lights out, I started running a deliberate sequence:
A simple acknowledgment of the day: I did what I could today
A short mental list of some of the things I’m grateful for in my life
Visualizing sleep itself—deep, uneventful, uninterrupted
Letting tomorrow land somewhere neutral to slightly positive
Some nights this is easy. Some nights it is not. If you are under significant stress, it may not feel accessible at all, and that is real. But over weeks, the default shifts. Instead of automatically waking up and engaging, my brain started doing something different.
That change—from rumination to interruption—was the first thing in years that actually moved the needle. I went from sleeping through the night maybe a few times a year to sleeping through the night twelve nights in a row.
If That Is Not Enough
If you have the foundation in place, you have given pattern interruption a fair trial of several weeks, and sleep is still broken—it is time to look deeper.
Targeted Supplements
Some patients respond to herbal blends like Somnapure, or to formulations from Integrative Therapeutics, like Prosom. Response varies. They are worth a structured trial; they are not worth taking forever if nothing changes.
CBT-i (Cognitive Behavioral Therapy for Insomnia)
The most evidence-backed non-pharmaceutical approach for chronic insomnia. The most important principle: do not stay in bed awake for more than about 15 minutes. The brain forms associations quickly, and the bed should mean sleep, not anxious wakefulness. There are good free CBT-i resources on YouTube.
Track and Experiment
Devices like Apple Watch, Oura or Whoop can help you run small experiments. Establish a baseline—total sleep, deep sleep, efficiency, sleep score—then test one variable at a time, like magnesium, other supplements, or different routines, and see what actually makes a difference. Without a baseline, you are just guessing.
Consider Blood Sugar
A small but real subset of people wake between 2 and 3 a.m. due to nocturnal dips in blood sugar. Continuous glucose monitors from Abbott’s Lingo, Dexcom Stelo, or Levels can reveal this in a few days. Adjusting meal timing or composition often resolves it.
Don’t Overlook Hormones
For women in perimenopause and after, low progesterone is a frequent and frequently missed driver of poor sleep. For men, low testosterone can do the same. Both are worth raising with your primary care provider or gynecologist—and both are subjects I will return to in future posts.
Why Sleep Matters More Than People Realize
Poor sleep doesn’t just cause fatigue. It impairs memory, focus, mood, and productivity—which increases stress… and worsens sleep. It’s a closed loop, and most people have been inside it long enough that they have stopped noticing how much of their lives it shapes.
When patients come in worried about cognitive decline, the first thing I look at—after ruling out sleep apnea (which I wrote about in a separate sleep apnea post)—is the quality and quantity of their sleep. Then we get to work on improving it. Get sleep right, and a surprising number of other problems start to resolve on their own.
What the World’s Best Sleeper Will Tell You
Bryan Johnson is a controversial figure in the longevity world. He spends roughly $2 million per year on his own health, works with a team of more than 30 experts, and tracks nearly every measurable metric produced by the human body. When asked what matters most for long-term health, his answer was not diet. It was not exercise. It was sleep.
He tracks sleep latency, total sleep time, sleep efficiency, and time in deep, light, and REM sleep, all of which roll into a nightly score from 0 to 100. He has reportedly held a perfect score for eight months straight.
Extreme? Absolutely. Useful? Also yes. The man with every resource in the world has decided that getting sleep right is the highest-leverage thing he does. The rest of us, working with considerably less infrastructure, would do well to take the same answer seriously.
You can find him online at bryanjohnson.com, and it’s worth watching one of his most important YouTube videos: How I FIXED my Terrible Sleep - 10 Habits.
Sleep is one of the foundational pillars of good health that I write about in my forthcoming book—when it’s off, everything else tends to follow.
If this post resonated, the comments are open. Share what has worked for you, what has not, and what you are still trying to solve. The more honest the conversation, the more useful this becomes for everyone reading.
This content is for educational purposes only and is not a substitute for personalized medical advice. Always consult a qualified healthcare professional for decisions about your care.
Andrew Lenhardt, MD, is a board-certified physician focused on root-cause medicine. He blends conventional and holistic care and writes on chronic illness, prevention, and wellness in his Substack, Middle Ground Medicine.
What about mouth taping? That works to relax my jaw and forehead. Also a spoon of almond butter seems to stabilize my blood sugar before sleep so that my liver doesn't wake me up cranky - in the middle of the night.
Before I read Mary's comment I was going to ask what to do if we think our blood sugar drops at the 2-3pm time? i will try a spoon of almond butter. If there is other advice I would like to know. I appreciate the first half of this article a lot .....having the right attitude feels like the most important part of the journey for me. I had to skip the part about why sleep is so important as i know that and it just adds to my anxiety if i am not sleeping well. Accepting when you are not falling back to sleep or asleep to begin with is one of the most potent sources of sleep for me - taking the pressure off!