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Why sleep and mood are so tangled — and the approach that doctors recommend first for insomnia.

Poor sleep and poor mood feed each other. Worry keeps you awake; a bad night makes the next day harder and the next worry louder. Insomnia — trouble falling or staying asleep at least three nights a week for three months or more — is common, especially with depression, anxiety, pain, and in later life.

The first-line treatment recommended by the American College of Physicians is not a pill. It is cognitive behavioral therapy for insomnia (CBT-I), a short, structured program that retrains the body's sleep system.

What it can feel like

  • Taking more than 30 minutes to fall asleep
  • Waking in the night and struggling to get back to sleep
  • Waking too early
  • Feeling unrefreshed in the morning
  • Daytime tiredness, low mood or poor concentration
  • Worrying about sleep itself
Loud snoring, gasping, or stopping breathing during sleep can be signs of sleep apnea — a medical condition worth checking with a doctor.

What helps — and how sure we are

CBT for insomnia (CBT-I)

Strong evidence · first-line treatment

Includes a steady wake time, getting out of bed when you can't sleep, only using the bed for sleep, and working with anxious thoughts about sleep. Available through therapists, programs, and apps.

A steady wake-up time

Moderate evidence · part of CBT-I

Getting up at the same time every day — even after a bad night — is one of the strongest levers in CBT-I.

Qigong and Baduanjin

Promising · older adults

Meta-analyses in older adults show improved sleep quality with regular practice.

Try Baduanjin →

Relaxation before bed

Promising

Body scans and muscle relaxation can ease the transition to sleep.

Try a body scan →

Sleep hygiene on its own

Limited research

Tips like cutting caffeine and dimming screens are sensible, but alone they rarely fix real insomnia. They work best as part of CBT-I.

Something small for today

  • If you've been awake for about 20 minutes, get up and do something quiet in dim light until sleepy.
  • No clock-watching — turn the clock away.
  • Try the body scan in bed.
  • Write tomorrow's worries on paper before bed.
  • Get up at your usual time tomorrow, no matter how you slept.
Start a bedtime body scan

When to get help

Talk to your doctor if poor sleep lasts more than a few weeks, you snore loudly or stop breathing at night, or you're relying on sleep aids. Many over-the-counter “PM” sleep aids contain antihistamines that can cause confusion and falls in older adults.

If you're thinking about suicide or feel you might hurt yourself, call or text 988 now, or call 911 if you're in immediate danger.

Sources

Reviewed September 2026. Education only — not a substitute for professional care.

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