The first-line treatment for chronic insomnia in clinical guidelines isn't a drug — it's CBT-I (cognitive behavioral therapy for insomnia), and it beats sleeping pills over the long run. Its core moves are counterintuitive. Stimulus control: only use the bed for sleep, and if you're awake more than ~20 minutes, get up — this stops your brain from learning that bed means lying awake frustrated. Sleep restriction: temporarily limit time in bed to build sleep pressure and consolidate fragmented sleep, then expand. Consistent wake time, even after a bad night, anchors the circadian clock.
The baseline habits matter too: morning daylight exposure to set the clock, no caffeine within about 8–10 hours of bed (its half-life is ~5 hours, so an afternoon coffee is still working at midnight), a cool dark room, and alcohol avoided — it knocks you out but suppresses REM and fragments the second half of the night, which is why you wake unrefreshed after drinking.
In 2016 the American College of Physicians reviewed the evidence and issued a guideline that surprised many practitioners: cognitive behavioral therapy for insomnia should be the initial treatment for chronic insomnia in all adults, with medication considered only as a secondary option after CBT-I, and only after a discussion of risks. The reasoning was in the data. Meta-analyses comparing CBT-I to sleeping pills consistently found that drugs work slightly faster in the first few weeks, but CBT-I matches them by around six weeks and then keeps working after treatment ends — while medication's benefits stop when the pills stop, and carry dependence, tolerance, and fall risk in older adults. The behavioral protocol fixes the mechanism; the pill suppresses the symptom.