Two things worth knowing before you ask for a sleeping tablet. First, the recommended first-line treatment for chronic insomnia is not medication — it is a structured programme called CBT-I, which outperforms pills over the long run and has none of the dependence. Second, if you snore heavily and wake unrefreshed however long you sleep, the problem may not be insomnia at all but sleep apnoea, which is a cardiovascular risk factor and is very treatable.
Both need a conversation rather than a prescription, and both are worth having.
Which problem do you have?
| Insomnia | Sleep apnoea | |
|---|---|---|
| The complaint | Cannot fall asleep, or wake and cannot get back | Sleeps plenty, wakes exhausted |
| Nights | Lying awake, clock-watching, frustrated | Loud snoring, gasping, witnessed pauses in breathing |
| Mornings | Tired, but sleep felt short | Headache, dry mouth, feels unrested |
| Days | Tired and wired, anxious about sleep | Genuinely sleepy — nodding off reading or driving |
| Partner says | “You were awake half the night” | “You stop breathing, then gasp” |
You can have both. And the second column is the one people ignore for years.
Sleep apnoea: get tested if this is you
Signs worth acting on: loud habitual snoring, witnessed pauses in breathing, gasping or choking awakenings, waking with a headache or dry mouth, daytime sleepiness that makes driving or reading hard, night-time urination, and morning irritability.
Higher risk with: excess weight, a larger neck circumference, being male, being over 50, nasal obstruction, a family history, alcohol in the evening, and menopause (which is why it is under-diagnosed in women — the textbook picture is a middle-aged man, and that costs women years).
Why it matters beyond tiredness. Untreated sleep apnoea is associated with high blood pressure, atrial fibrillation, heart failure, stroke, type 2 diabetes, and a substantially raised risk of motor-vehicle crashes. It is also one of the commonest reasons blood pressure stays high despite medication. Treating it is not a comfort measure.
Testing is easier than people expect. Many people can now be diagnosed with a home sleep test — a small device worn for a night or two in your own bed — rather than a night in a laboratory. Treatment is usually CPAP, which has improved enormously (quieter machines, far better masks); alternatives include an oral appliance made by a dentist, positional therapy, weight management, and in some cases surgery. If you tried CPAP years ago and gave up, it is genuinely worth revisiting.
Insomnia: the treatment is not a pill
CBT-I — cognitive behavioural therapy for insomnia — is the recommended first-line treatment, endorsed over medication by major clinical guidelines. It works at least as well as sleeping tablets in the short term and considerably better after treatment ends, because it changes the mechanism rather than sedating you through it. It is available through therapists and through well-validated apps and online programmes.
Its core moves are counterintuitive, which is why it works where advice has failed:
Get up if you cannot sleep. After about 20 minutes awake, leave the bed and do something quiet and dull in low light until sleepy. Lying awake trains your brain to associate bed with frustration.
Keep one fixed wake time, seven days a week, regardless of how badly you slept. This is the single most powerful lever, and the hardest.
Do not chase lost sleep with lie-ins or long naps — it fragments the following night.
Stop trying. Effort is the enemy of sleep. Paradoxically, giving up on making it happen tonight helps.
Bed is for sleep and sex only. No working, no scrolling, no television.
On sleeping tablets: they have a place, mainly short-term and situational. But tolerance, dependence, rebound insomnia on stopping, and — importantly for older adults — a raised risk of falls and confusion make them a poor long-term answer. If you have been on one for months or years, that is worth reviewing with us rather than continuing by default, and stopping should be tapered rather than abrupt.
Things that are not “just stress”
Restless legs syndrome — an urge to move the legs, worse in the evening, relieved by movement. Often linked to low iron, which is a blood test away.
Thyroid disease — an overactive thyroid causes insomnia, an underactive one causes daytime exhaustion. See thyroid symptoms and testing.
Depression and anxiety — early-morning waking is classically associated with depression, and treating the mood disorder often fixes the sleep. See mental health.
Medications — some antidepressants, steroids, beta blockers, decongestants, and stimulants. Worth a review.
Menopause — night sweats and hormonal change genuinely disrupt sleep, and it is treatable. See women’s health 45 to 75.
Chronic pain, reflux, prostate symptoms, heart failure — all wake people repeatedly, and all have treatments.
Alcohol. It gets people to sleep and then wrecks the second half of the night. A nightcap is a false friend.
The Arizona angle
Summer nights are the problem. When overnight lows stay in the 80s and 90s, sleep quality drops measurably — the body needs a core temperature fall to initiate sleep. Keep the bedroom genuinely cool, use the air conditioning overnight rather than economising, and consider a cool shower before bed. A hot bedroom in July is a real cause of a real problem.
Our light is intense, which cuts both ways: bright morning light is one of the best things for a disrupted body clock, and late-afternoon sun exposure can push your clock later. Get outside early, and use blackout curtains.
Snowbird arrivals cross time zones and change routine simultaneously — allow a couple of weeks and hold the fixed wake time.
Where to go
Book our Medical Clinic to sort this out properly: a sleep history, blood work for thyroid and iron, a medication review, screening for apnoea and depression, a home sleep test where indicated, and a referral to CBT-I. Call (602) 671-7981.
Bring a two-week sleep diary — bedtime, wake time, estimated hours, caffeine and alcohol, how you felt. It is the most useful thing you can hand us, and patterns show up on paper that are invisible in memory.
Come to our Emergency Room — open 24 hours — if you wake gasping and struggling to breathe, have chest pain at night, or fall asleep at the wheel. Falling asleep driving is an emergency, not an embarrassment: (602) 671-7990.
Sources
- American Academy of Sleep Medicine — Insomnia treatment guidelines
- American College of Physicians — Management of chronic insomnia in adults
- NHLBI — Sleep apnea
- CDC — Sleep and chronic disease