It's 3 a.m. You've done the math on how many hours are left before the alarm, and now you're wide awake doing it again. The harder you try to fall back asleep, the more impossible it feels.
I hear some version of this story almost every week. And here's the part that surprises people: insomnia is one of the most treatable problems I see in my Los Angeles practice. It just rarely gets the patient, unhurried attention it needs. Most people have been told to "sleep better" without anyone asking why they can't.
So let's talk about what's actually going on, and what helps.
What counts as insomnia, really?
Insomnia is trouble falling asleep, staying asleep, or waking too early, often enough that it wears on your daytime self. A few rough nights after a stressful week aren't a disorder. That's just being human.
I start paying closer attention when the pattern lasts more than a few weeks, or when you're dragging through the day, irritable, foggy, or relying on caffeine to function. That's when I want to dig in. Short-term insomnia and the chronic kind are different animals, and they call for different plans.
Why can't I fall asleep even when I'm exhausted?
Usually because your body and brain are still running on alert, even though you feel tired. Sleep isn't a switch you flip. It's a wind-down your nervous system has to be allowed to do.
Here's what I look for when someone tells me they're exhausted but wired:
- Stress and worry that follow you into bed. Insomnia and anxiety feed each other, and untreated mood issues like depression very often show up first as broken sleep.
- Caffeine, alcohol, or late screens. Alcohol may help you nod off, then fragments the back half of your night.
- An irregular schedule. LA hours are real. Long commutes, shift work, and late dinners all push your internal clock around.
- Medical causes hiding underneath, like thyroid issues, reflux, pain, or sleep apnea.
That last point matters. Sometimes the fix isn't a sleep aid at all. It's treating the thing keeping you up.
How do I fix insomnia without medication first?
For most people, the strongest long-term tool is changing the habits and signals around sleep, not a pill. This is where a structured sleep hygiene protocol earns its keep.
A few principles I come back to with nearly every patient:
- Keep a steady wake-up time, even on weekends. Anchoring the morning fixes the night.
- If you're not asleep in about 20 minutes, get up. Do something dull and dim, then return when you're sleepy. Don't lie there negotiating with the ceiling.
- Reserve the bed for sleep, so your brain stops associating it with frustration.
- Get morning light and move your body during the day. Both help set your clock.
The most effective non-drug treatment we have is a specific, structured approach called CBT-I (cognitive behavioral therapy for insomnia). It retrains the patterns that keep the cycle going, and the results tend to last. I often refer patients to it directly, because it works better over time than most prescriptions.
When are sleep medications a good idea?
Sometimes they're exactly the right call, when used thoughtfully and for the right reasons. I don't think of medication as a failure. I think of it as one tool, best used with intention and a clear plan to step down.
What I won't do is hand over a long-term prescription and wave goodbye. When prescription sleep aid management makes sense, I want to know the why, the how long, and the exit plan. Some sleep medications carry real downsides with extended use, and certain options aren't right for older adults. That's a conversation, not a reflex.
This is one of the genuine advantages of how I practice. With a smaller patient panel, I have time to actually evaluate your sleep, look for the medical and emotional threads underneath, and adjust as we go, rather than rushing you out with a generic handout.
When should I see a doctor about my sleep?
Reach out if poor sleep has lasted more than a few weeks, is affecting your mood or focus, or comes with loud snoring, gasping, or jolting awake, any of which can point to sleep apnea worth ruling out. Sleep that doesn't bounce back on its own deserves a real look.
If you're tired of being tired and want someone to take your sleep seriously, I'd genuinely like to help. Reach out to the practice and let's figure out what's keeping you up, and how to get you resting again.