Cognitive and behavioral therapy for insomnia (CBT-I) is the best treatment for chronic insomnia disorder, full stop. @andyberkowskimd of ReLACS Health explains what CBT-I is and why it is so effective for those with difficulty falling asleep or staying asleep, which has been affecting them for weeks, months, or even years.

CBT-I involves sessions of sleep therapy, generally 4-6 sessions every 1-2 weeks in which the clinician addresses changes in behaviors around sleep and adjustments of the ways in which one thinks about sleep (cognitive treatment). Supplements, medications, procedures, etc. do not work in the long run for those with chronic insomnia. Sleep is so natural that it has been engrained into our evolution down to the tiniest organisms and there are two main physical components: the homeostatic sleep drive and the circadian rhythm.

The homeostatic sleep drive, or that fuel to sleep, must be sufficient to sleep through the night. This video explains it more detail:
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The circadian rhythm, known as the biological clock, has to be set consistently as well, with appropriate timing of sleep and wake times that are optimized to normal body patters. This video explains the circadian rhythm and the importance of waking up at the same time every day:
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These two physical factors can get screwed up in insomnia and must be addressed behaviorally to improve sleep. They are so powerful that medications cannot compensate for the effect of these two components.

Even if the physical processes of sleep are well-aligned and optimized, the psychophysiological aspect of sleep can still impede good sleep. This comes from human evolution in that we evolved the ability to keep ourselves awake if physically able to sleep, but not the ability to put ourselves to sleep with out mind if the physical components do not allow. We evolved to stay awake to hunt or forage for food or fend off that attacking lion. Those who kept sleeping are...well...lost to evolution.

In modern industrial times, stressors or overactivity of mind are the main drivers of psychophysiological impact interfering with physical sleep. These can be personal stress, family issues, health concerns, work demands, and even the focus or worry about sleep itself. To sleep from a psychophysical standpoint, the mind has to be deactivated. You can keep yourself awake all night counting sheep too hard! CBT-I addresses the quieting of the mind in great detail with multiple techniques and changes to thought processes.

For example, this video addresses the CBT-I component of "constructive worry" and how to keep from worrying when one should be sleeping with a calm mind:
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There is no medication, supplement, or procedure for that matter that can induce sleep. Most work to cause drowsiness, which may quiet or relax the mind enough for the physical components to initiate. Unfortunately, if the physical components are not improved or the mind remains overactive, these more powerful factors overcome the relatively impotent effects of drugs and supplements and the insomnia will return within days or weeks. By addressing the fundamentals of mind and body through CBT-I, this can provide a long-term improvement to sleep, allowing the innate ability to return unimpeded.

To read in more depth about general tips to improve sleep quality, read this blog:
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Unfortunately, in the insurance-based medical system in the U.S., most sleep physicians do not actually do this first-line treatment for insomnia themselves despite being specialists in sleep. Insurance does not reimburse enough for most sleep clinics to justify the physicians' time, when they could be seeing more patients and running more lucrative sleep studies. However, there are many psychologists, therapist, and even social workers that do an excellent job of CBT-I, but there is still a significant lack of availability in both the US and worldwide. Apps that do CBT-I through modules with or without a clinician providing guidance on the other end have been shown to be effective as well and can be considered.

In the direct specialty care system at ReLACS Health, @andyberkowskimd is one of rare sleep physicians that does CBT-I himself, accessible to those who live in MI, OH, or FL. Go to [ Ссылка ] for more information. All others seeking treatment for chronic insomnia should avoid those hypnotics or sedatives and still seek CBT-I. Here are two databases in which you may find a specialist in your area:
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