From creators.yahoo.com
By Robin Raven
What chronic insomnia actually is, why it's linked to heart disease and dementia, and the treatment many patients never hear about
Are you sabotaging yourself? When you have insomnia, sometimes the harder you try to sleep, the more awake you feel. According to one leading sleep physician, that desperate effort to force sleep may be the very thing making your insomnia worse.
Dr. Ashkan Lee Naraghi, MD, FCCP, is a board-certified pulmonologist and sleep specialist who has spent years helping patients untangle the complicated, often misunderstood condition of chronic insomnia. In this in-depth conversation, he breaks down everything from the real definition of insomnia to the promising new treatments most patients never hear about. He also explains why the advice you've been following may be backfiring.
What insomnia actually is (and what it isn't)
Most people assume a few rough nights qualifies as insomnia. Dr. Naraghi draws a clear line. He says insomnia is defined as difficulty falling asleep, maintaining sleep, or waking up too early — despite having adequate opportunity to sleep — along with daytime consequences such as fatigue, poor concentration, mood changes, or impaired function. "Everybody experiences a few bad nights," he explains, "but to be diagnosed with chronic insomnia, symptoms are generally at least three nights per week for three months or longer."
That distinction matters, because chronic insomnia is a condition with measurable consequences for your body and brain.
The scary link between poor sleep, heart disease, and dementia
Research connecting chronic insomnia to cardiovascular disease and cognitive decline has been making headlines, and for good reason. Dr. Naraghi confirms there is "a clear association between chronic insomnia and cardiovascular disease and cognitive decline" — though he's careful to note this reflects association, not necessarily direct causation. Still, the risks are serious enough that he wants patients paying attention.
He outlines the warning signs that turn poor sleep into a medical urgency: chest pain, severe shortness of breath, confusion, suicidal thoughts, dangerous sleepiness while driving, or symptoms that suggest sleep apnoea — "such as choking, gasping, or witnessed pauses in breathing." On the question of dementia, he offers cautious reassurance: "Chronic insomnia has been linked with higher dementia or cognitive impairment risk, but this can be ameliorated with early diagnosis and treatment."
The habits that can make insomnia worse
Here's where many well-meaning people quietly sabotage themselves. Dr. Naraghi says the biggest mistake is self-medicating with sleep aids and alcohol. Also, the list of counterproductive behaviors goes further: taking caffeine late in the day, lying awake in bed for hours, sleeping in to compensate, "catch-up" napping, and watching the clock. "A lot of these behaviours," he explains, "program the brain to think the bed is a place of frustration."
That psychological imprint of the brain learning to associate the bedroom with anxiety rather than rest is at the heart of why chronic insomnia becomes so self-perpetuating.
“Trying harder to sleep usually makes insomnia worse. Sleep has to be allowed, not forced." The real goal of insomnia management, he says, is "to rebuild confidence in sleep and stop the vicious cycle of fear, frustration, and compensating behaviours."
What melatonin actually does (and doesn't do)
Melatonin has become a cultural reflex for anyone with sleep trouble, but Dr. Naraghi wants to set the record straight. "Melatonin is not a sleeping pill per se but a circadian rhythm signal," he notes. "It's basically a hormone that your body naturally produces to help control your sleep-wake cycle." It has legitimate uses such as jet lag, delayed sleep phase, and shift-related timing problems. However, "results are not consistent with chronic insomnia."
He also flags risks most people overlook: next-day grogginess, vivid dreams, drug interactions, inconsistent supplement dosing, and "false reassurance that a deeper sleep problem is being treated." And on the instinct to take more when the standard dose isn't working? "Higher doses are generally not more effective than lower doses," he cautions.
The gold-standard insomnia treatment most people have never tried
If you've never heard of CBT-I, you're in good company, and that's a problem. Cognitive behavioural therapy for insomnia is, according to Dr. Naraghi, a helpful treatment for many people with chronic insomnia. "It is a structured program that retrains the sleep system," he shares. The program typically includes sleep restriction, stimulus control, work around sleep anxiety, relaxation techniques, and targeted sleep scheduling.
Why is it better than medication? Because "it treats the underlying learned insomnia pattern and has durable benefits." So why aren't more people using it? "The problem is access: there are not enough trained CBT-I clinicians, and many patients are offered medications first." The good news, he adds, is that "there are newer virtual programs that are very promising."
Why standard sleep advice doesn't work for everyone
Sleep hygiene tips like consistent bedtimes, dark rooms, and no screens get repeated so often they've almost become background noise. Dr. Naraghi insists they’re not a catch-all solution, and certain groups need a fundamentally different approach. Menopause, pregnancy, having a newborn, shift work, anxiety, depression, chronic pain, and sleep apnoea all "warrant a different approach," he states.
The specifics matter enormously. "A shift worker may need circadian scheduling and light management, whereas someone going through menopause may need treatment of hot flashes or hormonal contributors." One-size-fits-all advice, he suggests, can do more harm than good when the underlying cause is being ignored.
When it's time to stop self-treating and see a specialist
Dr. Naraghi is specific about the red flags that mean it's time to seek professional help. Insomnia lasting more than a few weeks, affecting daytime functioning, or requiring regular medication or alcohol is a clear signal. So is insomnia occurring alongside snoring, gasping, restless legs, abnormal behaviours during sleep, depression, anxiety, or excessive daytime sleepiness. If poor sleep is affecting your driving, work, relationships, or existing medical conditions, he's unequivocal: get help.
What the future of insomnia treatment looks like
For patients who feel like they've tried everything, Dr. Naraghi offers genuine optimism. He thinks the future is moving toward more personalized care: better access to virtual cognitive behavioural therapy programs and behavioural sleep medicine. Also there should be better access to newer medications — specifically "dual orexin receptor antagonists, which target wakefulness rather than simply sedating the brain." He's measured but hopeful: "These are not magic fixes, but they give us more nuanced tools for patients who have not responded to older approaches."
The science of sleep is evolving, the tools are improving, and the conversation is finally catching up to the complexity of the problem. If you've been suffering in silence, Dr. Naraghi's message is clear: help exists, it works, and you don't have to white-knuckle your way through another sleepless night alone.
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