Following every sleep tip and still can’t sleep: why, and what to do

Nine at night, and the phone is already charging out in the living room. The only coffee of the day was at ten in the morning. Before bed there is a glass of warm milk, the curtains are drawn tight, and the air conditioner is set just right. And yet eleven o’clock comes, then midnight, and you are still lying there, eyes closed but mind wide awake. On the nights you do drift off, you jolt awake close to three in the morning, glance at the clock and do the math: four more hours until you have to get up for work. That calculation makes your heart beat faster, and this time you lie awake until morning.

Many people who come to us for insomnia have read up on sleep tips and follow almost all of them. Those tips are sound and worth keeping. But for insomnia that has lasted for months, they are often not enough, because the nervous system stays on alert even while the body lies still in bed.

Why you still can’t sleep after following every tip

Chronic insomnia affects about 10% of adults. Current models describe a long-lasting state of heightened activation (hyperarousal) in people with insomnia, affecting thoughts, emotions and the body’s physiology alike (Riemann and colleagues, 2012). The mind keeps going over today and worrying about tomorrow, while the heart beats fast and the muscles refuse to relax.

Palagini’s group (2023) classifies insomnia disorder as a stress-related disorder. In people with insomnia, the regulation of stress and emotions is disrupted and the switch between wakefulness and sleep is less stable, so they wake easily. How stress travels through the body is covered in our article Normal test results but still tired, in pain and sleepless: how stress affects you.

Also according to Riemann, people with insomnia perceive their sleep as much worse than the changes measured by instruments, even though the daytime tiredness is real. Some people do sleep but spend the whole night dreaming about unhappy things from the past, and still wake up tired. The worries they take to bed shape what they dream about.

How insomnia starts and why it lasts

The three-factor model, known as the 3P model, explains why insomnia stays for so long (Palagini and colleagues, 2015). Predisposing factors are already there beforehand. A precipitating factor is an event, such as a job change or a family member falling ill. Perpetuating factors keep the insomnia going after the event has passed, and they are also the part you can do something about.

The harder you try to sleep, the more awake you are

Our grandparents had a saying: “If you can eat and sleep, you live like an immortal; if you can’t eat or sleep, you spend more money and worry more.” After a few weeks of lying awake, people start worrying from the afternoon: will I sleep tonight, will I be alert at tomorrow’s meeting? Once in bed, they glance at the clock every little while. Each look sends the nervous system another alarm signal, and sleep becomes even harder to reach. Try turning the clock to face the wall, and stop counting the hours until you have to get up.

Scrolling in bed and catching up on sleep

After lying awake for a long time, many people pick up their phone to ease the restlessness. When the bed becomes a place for reading the news, watching shows and answering work messages, the brain gradually links the bed with being awake. Catching up on sleep works the same way. Lingering in bed in the morning, a long nap at noon, going to bed early just to be safe, sleeping until noon on weekends: in the end you feel less sleepy the next night, and your sleep schedule gradually drifts.

Types of insomnia and how traditional medicine tells them apart

Some people lie awake for an hour before falling asleep. Others wake many times, or wake at four in the morning and cannot get back to sleep. Still others sleep enough hours but wake up feeling as if they had not slept, after a night full of dreams.

Traditional medicine calls insomnia “loss of sleep” (失眠, shī mián) and divides it into several patterns to guide treatment. Three common patterns:

• Heart–Spleen deficiency (心脾虚 / 心脾虛, xīn pí xū), often seen in people who worry a lot or overwork their minds: light, broken sleep, waking easily, frequent dreams, palpitations, forgetfulness, poor appetite and fatigue;
• Liver fire (肝火, gān huǒ), often seen after resentment and frustration that have been bottled up: trouble falling asleep, irritability, headaches, a bitter taste in the mouth and red eyes;
• Heart and Kidney failing to communicate (心肾不交 / 心腎不交, xīn shèn bù jiāo), when the yin of the Kidney is not enough to hold down the Heart fire (心火, xīn huǒ) flaring upward: inner restlessness, little sleep, many dreams, ringing in the ears, aching lower back and knees, hot palms and soles, and sometimes night sweats.

Sleep habits worth keeping

Cognitive behavioral therapy for insomnia (CBT-I) is recommended as the first-line treatment for chronic insomnia. Pooling 20 studies with 1,162 people, CBT-I shortened the time it takes to fall asleep by about 19 minutes and reduced time awake in the middle of the night by about 26 minutes; the benefit held up over time, and no harmful effects were reported (Trauer and colleagues, 2015).

Three CBT-I-based steps you can start at home:

• Use the bed only for sleep; don’t bring your phone or work into bed;
• If you lie awake for a long time and start to feel restless, get out of bed, sit somewhere else under soft light and do something calm, and go back to bed only when you feel sleepy again;
• Get up at a fixed time every morning, including weekends and after a bad night.

Sleep restriction (limiting time in bed), however, needs guidance and monitoring from a trained professional; don’t cut your sleep hours on your own at home.

During the day, get morning sunlight and move regularly; yoga and tai chi have evidence in people with insomnia (Bu and colleagues, 2026), as long as you avoid hard exercise close to bedtime. Keep coffee and strong tea for the morning. Have dinner not too late and not too heavy, and cut back on alcohol, because it makes sleep in the second half of the night fitful and snoring worse. If you often get up at night to urinate, drink less close to bedtime. Turn off screens early, keep the room dark and quiet, and take a warm shower or soak your feet to help your body wind down.

An insomnia case at our clinic

A young woman came to us with insomnia that had lasted several months. She slept only about two hours a night. She was often stressed, and when she did sleep, she dreamed about unhappy events from her past. In the morning her head felt heavy, as if covered by a layer of fog. She felt sleepy all day, but when she lay down she still could not sleep, and her work suffered.

After the examination, the doctor treated her with acupuncture. The main treatment principle was to drain fire, secure the Kidney and nourish yin, that is, to bring down the fire flaring upward and to protect and nourish the yin of the Kidney. After two acupuncture sessions, her condition was more stable. Not long after, the foggy feeling in her head and the daytime tiredness were gone; she felt at ease and her mood was brighter. When the clinic checked in with her a week later, she was still doing well and did not need any further medicine.

This is a single case with no comparison group, and responses vary from person to person; others may need more sessions or the addition of an herbal decoction.

Insomnia consultations at Tam Duc Clinic

For your first visit, allow about 30–45 minutes. The doctor asks when you go to bed, when you fall asleep, how many times you wake up, when you get up, about coffee and alcohol, and about what is weighing on you, only if you are willing to share. A sleep diary kept for one or two weeks makes this part clearer.

Besides a standard clinical examination, the doctor looks at your tongue, takes your pulse, and asks about feeling hot or cold, sweating and appetite, following the four examinations, to place your insomnia in one of the three patterns above. The psychological side is assessed further with Applied Kinesiology (AK) muscle testing, which targets stress in the frontal lobe, the limbic system and the cingulate gyrus; muscle testing also helps check ions, and magnesium is often checked in people who have trouble sleeping. To see how muscle testing works, read Why the doctor tests your muscles, even when your arm is strong; magnesium is covered in Normal blood magnesium but still muscle twitches, cramps and poor sleep: why?.

If another condition is suspected of contributing to your insomnia, such as thyroid disease or anemia, the doctor will suggest tests before treatment.

Treatment options

Pooling 13 randomized trials in 911 adults with insomnia, Liu and colleagues (2020) found that acupuncture improved sleep quality and insomnia severity more clearly than sham acupuncture, so the effect is not just a placebo. In a small subgroup of people with severe depression (2 trials), no difference has been seen yet. The doctor performs the acupuncture personally, choosing points according to the type of insomnia identified at the examination, sometimes together with moxibustion (warming points with burning mugwort).

Herbal decoctions are prescribed according to the pattern, with herbs changed at each follow-up visit; the clinic can cook the decoction for you if it is not convenient to do so at home. If you are taking sleeping pills or blood thinners, tell us before an herbal decoction is prescribed, because some herbs change how these medicines work (Ulbricht and colleagues, 2008).

When to see a doctor soon

See a doctor soon, rather than relying on sleep tips alone, if:

• Your bed partner notices that you snore loudly and sometimes stop breathing and then gasp for air, as this may be sleep apnea;
• You are so sleepy during the day that you nod off in meetings, and especially while driving;
• Your insomnia comes with low mood that has lasted for weeks and a loss of interest in everything; in that case you need an assessment by a psychiatrist;
• You ever have thoughts of harming yourself: tell a family member who is nearby right away and see a psychiatrist the same day, or call 115 (the emergency number in Vietnam) if it feels urgent.

Frequently asked questions

Should I buy sleeping pills on my own?

No. Sleeping pills need to be prescribed by a doctor, for a clearly defined period; taking them on your own for a long time can easily lead to dependence and to drowsiness that carries over into the next day. If a doctor has already prescribed sleeping pills, keep taking them as directed and bring them to your visit.

How long until I can sleep again?

It depends on how long you have had insomnia, which factors are keeping it going, and whether you have other health conditions. The doctor reassesses using your sleep diary and does not promise a timeline in advance.

Worth keeping

• Get up at the same time every morning, weekends included;
• Keep the bed for sleep only, with your phone out of reach;
• If you lie awake for a long time, get out of bed and come back only when you feel sleepy;
• Get morning sunlight and move every day; yoga or tai chi both work;
• Keep a sleep diary for two weeks before your first visit.

If you have kept these habits for a few weeks and are still awake many nights, bring your sleep diary and a list of the medicines and supplements you take to a consultation with Dr. Dinh Ngoc Duc (MD, MSc in Traditional Medicine).

References

1. Trauer JM, Qian MY, Doyle JS, Rajaratnam SM, Cunnington D (2015). Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Ann Intern Med 163(3):191-204. https://doi.org/10.7326/M14-2841;
2. Palagini L, Geoffroy PA, Riemann D et al. (2023). Current models of insomnia disorder: a theoretical review on the potential role of the orexinergic pathway with implications for insomnia treatment. J Sleep Res 32(4):e13825. https://doi.org/10.1111/jsr.13825;
3. Riemann D, Spiegelhalder K, Nissen C et al. (2012). REM sleep instability – a new pathway for insomnia? Pharmacopsychiatry 45(5):167-76. https://doi.org/10.1055/s-0031-1299721;
4. Palagini L, Drake CL, Gehrman P, Meerlo P, Riemann D (2015). Early-life origin of adult insomnia: does prenatal-early-life stress play a role? Sleep Med 16(4):446-56. https://doi.org/10.1016/j.sleep.2014.10.013;
5. Liu C, Xi H, Wu W et al. (2020). Placebo effect of acupuncture on insomnia: a systematic review and meta-analysis. Ann Palliat Med 9(1):19-29. https://doi.org/10.21037/apm.2019.11.15;
6. Bu ZJ, Liu FS et al. (2026). Effects of various exercise interventions in insomnia patients: a systematic review and network meta-analysis. BMJ Evid Based Med. https://doi.org/10.1136/bmjebm-2024-113512;
7. Ulbricht C et al. (2008). Clinical evidence of herb-drug interactions: a systematic review by the Natural Standard Research Collaboration. Curr Drug Metab 9(10):1063-120. https://doi.org/10.2174/138920008786927785.