Sleep is so fundamental to our well-being. It’s almost frustrating how elusive it can be for so many people. Patients often come to me with stories of trying every solution under the sun—literally.

“I’ve tried everything,” one patient recently told me, “Ayurvedic herbs, homeopathy, yoga, exercise routines, melatonin… and sure, they worked… at first. But after a while, it just stopped helping.”

That moment of frustration is something I hear quite often. You’re dedicated to improving your sleep, doing all the right things, but then it’s like your body builds up some kind of resistance, and you’re back to square one—sleep-deprived and exhausted.

Why Does This Happen?

Our bodies are adaptable. That’s generally a good thing, but it can also make it harder to find long-term solutions for sleep. You see, the brain craves balance. If you’re introducing something external—whether it’s herbal remedies, exercises, or even melatonin supplements—your body may initially respond positively. But over time, it adjusts. The brain starts to expect the external aid and compensates, which can result in the diminishing effects of these methods.

In the case of melatonin, for example, it’s a hormone that your brain naturally produces. When you introduce it from an outside source, like a supplement, your body may reduce its own production over time. This could be why melatonin seems less effective the longer you take it.

Where Does That Leave You?

It’s frustrating, right? You’re doing everything in your power, and yet the insomnia sneaks back in. But here’s the thing—while these methods may stop working as effectively, they are still part of a larger puzzle. I often tell my patients that we need to look at the bigger picture.

Think of sleep as a multi-layered process. It’s not just about what you do before bed or the supplements you take; it’s about the entire ecosystem of your day-to-day life—your stress levels, your routines, your emotional state, and even the beliefs you hold about sleep itself.

Understanding the Sleep Cycle: A Journey Through the Night

Sleep isn’t just one long, continuous state. It’s made up of several cycles, each lasting around 90 minutes. During these cycles, we pass through different stages of sleep. Let me break them down for you:

1. Stage 1: NREM (Non-Rapid Eye Movement) Sleep – Light Sleep
   • This is the “drifting off” stage. It’s that space where you’re not fully awake, but you’re not deeply asleep either. Your muscles start to relax, your heart rate slows, and your breathing becomes more regular.
   • Think of it as the transition phase. If you’re a light sleeper, you might wake up easily during this stage.
2. Stage 2: NREM Sleep – Deeper Sleep
   • In this stage, your body goes into energy-saving mode. Your brain waves slow down, and your core body temperature drops. Your heart rate and breathing continue to slow.
   • This stage makes up about half of your total sleep and prepares your body for the deeper stages.
3. Stage 3: NREM Sleep – Deep Sleep (Slow-Wave Sleep)
   • Here’s where the magic happens. Deep sleep is essential for physical recovery, muscle repair, and immune system strengthening. Your brain produces slow delta waves, and it’s tough to wake up from this stage.
   • This is when your body heals itself. If you miss out on this stage, you’ll likely feel physically tired and worn out, even if you’ve slept for a long time.
4. Stage 4: REM (Rapid Eye Movement) Sleep
   • REM sleep is where most dreaming occurs. Your brain becomes highly active, almost mimicking the same activity level as when you’re awake. However, your body becomes temporarily paralyzed (except for your eyes and respiratory muscles), which prevents you from acting out your dreams.
   • REM is essential for mental and emotional processing. If you’ve ever woken up from a vivid dream, you were likely in REM sleep.

The Role of Hormones in Sleep

Your body’s ability to fall asleep and stay asleep isn’t just a matter of willpower; it’s orchestrated by a symphony of hormones. Let’s take a look at some of the key players:

1. Melatonin: The Sleep Hormone
   • Produced in the pineal gland (a tiny pea-shaped gland in your brain), melatonin is crucial in regulating your sleep-wake cycle (circadian rhythm). Its production increases as the evening progresses, making you feel sleepy. When morning comes, melatonin levels drop, signaling your body to wake up.
   • Light, especially blue light from screens, can suppress melatonin production, making it harder to fall asleep at night.
2. Cortisol: The Stress Hormone
   • While cortisol is often associated with stress, it also plays a role in your sleep cycle. Cortisol levels are highest in the early morning, helping you wake up and feel alert. However, if your cortisol levels are elevated at night due to stress or anxiety, it can interfere with melatonin production and disrupt your sleep.
   • Chronic stress can throw off this balance, keeping you in a state of alertness when you’re supposed to be winding down.
3. Adenosine: The Fatigue Signal
   • Throughout the day, adenosine builds up in your brain, promoting sleep by inhibiting arousal systems. The more adenosine accumulates, the sleepier you feel. Caffeine blocks the effects of adenosine, which is why that afternoon cup of coffee can make it harder to fall asleep later.
4. GABA (Gamma-Aminobutyric Acid): The Calming Neurotransmitter
   • GABA is like your brain’s natural tranquilizer. It inhibits neural activity, helping your body and mind to relax. If your GABA levels are low, you might experience heightened anxiety and difficulty winding down at night.
5. Orexin (Hypocretin): The Wakefulness Hormone
   • Orexin regulates wakefulness and appetite. When it’s too active, it can lead to insomnia. Certain sleep disorders like narcolepsy are linked to a deficiency in orexin.
6. Serotonin: The Mood Stabilizer
   • Serotonin plays a dual role. It helps regulate mood during the day and is also a precursor to melatonin. Low serotonin levels, often seen in depression and anxiety disorders, can disrupt your sleep-wake cycle.

What Disrupts Sleep?

With all of these hormones at play, it’s easy to see how sleep can be disrupted by various factors. Let’s take a closer look at some of the common causes of sleep disturbances:

1. Stress and Anxiety
   • When you’re stressed, your body produces more cortisol and adrenaline, both of which keep you alert and awake. You may also have racing thoughts that make it difficult to relax and transition into sleep.
   • Stress-induced insomnia is a vicious cycle. The more you stress about not sleeping, the harder it becomes to actually fall asleep.
2. Lifestyle Choices
   • Late-night eating, too much caffeine, irregular sleep schedules, and lack of physical activity can all throw off your sleep cycle.
   • Alcohol is often misunderstood. While it may initially make you feel sleepy, it actually disrupts the deeper stages of sleep, leaving you feeling groggy and unrefreshed.
3. Blue Light Exposure
   • Our modern lifestyle is filled with screens—phones, laptops, TVs. The blue light emitted from these devices suppresses melatonin production, making it harder to fall asleep. This is why “screen-free” time before bed is often recommended.
4. Hormonal Changes
   • Hormonal fluctuations—whether due to menstruation, pregnancy, or menopause—can significantly affect sleep patterns. For example, a drop in estrogen during menopause is linked to night sweats and insomnia.
5. Sleep Disorders
   • Conditions like sleep apnea, restless legs syndrome, or periodic limb movement disorder can directly interrupt the normal sleep cycle, preventing deep, restorative sleep.
6. Environmental Factors
   • Noise, light, temperature, and even the comfort of your mattress or pillow can play a role in sleep disruption. Your body prefers cooler temperatures for sleep, and anything that takes you out of that comfort zone can cause issues.

What Can We Do?

Understanding the complex interplay of hormones and external factors that influence sleep is the first step. The next step is to take practical actions:

1. Create a Sleep-Conducive Environment: Aim for a cool, quiet, and dark room. Invest in a comfortable mattress and pillows. Consider blackout curtains if light pollution is an issue.
2. Mind Your Light Exposure: Get plenty of natural light during the day to help regulate your circadian rhythm, and minimize blue light exposure in the evening by using screen filters or switching to “night mode” on devices.
3. Manage Stress: Incorporate relaxation techniques like deep breathing, meditation, or journaling into your bedtime routine. Mindfulness-based practices can be powerful tools to quiet the mind.
4. Exercise Wisely: Regular exercise can promote better sleep, but try to avoid vigorous activity close to bedtime as it can increase adrenaline and make it harder to fall asleep.
5. Seek Professional Help: If sleep problems persist despite your best efforts, don’t hesitate to consult with a healthcare provider. Sometimes, underlying medical conditions or mental health issues are at play, and addressing them is key to improving sleep.

In Summary

Sleep isn’t just about lying down and closing your eyes. It’s a complex process governed by various stages and hormones, all working together to ensure your body and mind can recharge. But when even one part of that system is disrupted, the whole process can go awry.

If you’ve tried different methods for better sleep—whether it’s herbal remedies, yoga, or melatonin—and they’ve stopped working, you’re not alone. It’s important to understand that sleep isn’t a one-size-fits-all solution. Our bodies are constantly changing, and our approach to sleep needs to be just as dynamic.

Remember, improving sleep is a journey. It’s okay to seek help, and sometimes small adjustments to your routine, lifestyle, and mindset can make a world of difference.

Disclaimer: This blog is for educational purposes only and is not intended as medical advice. Always consult a healthcare provider for advice tailored to your individual circumstances, especially if you’re dealing with persistent sleep problems or related health issues.

Dr. Rameez Shaikh, MD Psychiatrist at Mind & Mood Clinic