The nighttime trick a doctor uses to fall asleep fast (it’s not melatonin)
Dmitrii Shirnin/Unsplash
Lifestyle factors and daily habits leave the nervous system revved up with nowhere to go. "The good part," Agarwal said, "is those are a lot more easily corrected."
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Throughout my 20s and early 30s, I was on the mom sleep schedule. My kids were good sleepers, but as a mom you only ever sleep as deeply as your lightest sleeper. You’re on call for 3 a.m. puke sessions (why is it always the middle of the night?), startled awake by sleepwalkers looking for a bathroom and peeing in a hamper (true story), or attempting to will yourself to pass out the second they do so you don’t miss the prime hours. Mom sleep isn’t generally deep sleep.
And now that I’m in my mid-40s with older kids who can easily sleep past noon, perimenopause asks my body to lie awake and solve all the world’s problems from the hours of 2 to 4 a.m. So when Dr. Shilpi Agarwal, a board-certified family medicine physician at Georgetown and on-air medical contributor for Fox 5 D.C., pitched me on the idea that most of us don’t actually have a sleep problem, I was listening. Skeptically, from a place of deep exhaustion, but listening.
“It isn’t a sleep disorder,” she told me. “It’s probably your nervous system needing help and a boost regulating, and then you’ll get to sleep easier.”
Wait, so what’s the difference?
A true sleep disorder is physiologic. Think sleep apnea or narcolepsy, the stuff that shows up in a sleep study and usually requires a device or real medical intervention. What most of us are dealing with is different. Lifestyle factors and daily habits leave the nervous system revved up with nowhere to go. “The good part,” Agarwal said, “is those are a lot more easily corrected.”
She sees this constantly in moms, and she gets it, because she’s raising three boys herself. “We’re always just on,” she said. It could be a regular Wednesday, nothing unusual about Thursday, and you still can’t shut down.
Why trying harder makes it so much worse
If you’ve ever watched the clock tick from 2 a.m. to 4 a.m. while aggressively attempting to relax (hello, it’s me), Agarwal can explain why that never works. “Your body views that perceived lack of sleep as a threat,” she said. And threats don’t make us drowsy. They make us alert. “Physiologically, your body is shooting out more hormones to help you be more focused. And you can’t get to deep sleep anymore because you’re so worried.”
Her first fix costs nothing and takes two words. So what. “It’s not a catastrophe if you don’t fall asleep right away. We put so much pressure on ourselves to fall asleep right then and there. Just say it’s okay, I’ll get to sleep when I get to sleep.” Basically, stop treating your own wakefulness like an emergency, because your body will believe you.
The two techniques she actually uses
When the pressure release isn’t enough, Agarwal has two go-to moves. She prescribes them to patients and uses them in her own bed.
The first is box breathing. Picture a box, breathe in along one side, hold across the top, breathe out down the other side, hold along the bottom. She does 10 to 12 rounds. “You really have to focus on your breath, which is hard. But that’s the point.”
The second one is my favorite, and I’ve already started using it. Recap your day in detail, backwards. Start where you are (“I just got out of the shower, I did my skincare routine”) and work in reverse. What did you pack in the kids’ lunches? “It’s a low-stress way to recap something your brain already knows,” she said. “It’s almost boring, but you have to focus on it. Most people fall asleep before they get to breakfast.” The magic is that these events already happened. Unlike tomorrow’s to-do list, there’s no room for spiraling. All you have to do is remember.
I’ve been teaching my kids a version of this for years without knowing it had legs, clinically speaking. When they’d ask what to think about at bedtime, I’d say think about your day. Turns out mom instinct and family medicine occasionally arrive at the same place.
Her one supplement endorsement
Agarwal isn’t big on the sleep-supplement aisle, but she’ll make an exception for magnesium glycinate. “I really think magnesium glycinate is wonderful. Everyone should be taking it,” she said. “It truly relaxes your muscles.” A lot of us are a little low in magnesium to begin with, and the mineral helps our cells function at a basic level, which creates a sense of calm in the body. Her one caution is not to overdo it, since too much can bring on some unwelcome GI side effects.
The best sleep tip has nothing to do with nighttime
Ask Agarwal for the highest-impact, lowest-effort sleep habit and she won’t mention your bedroom at all. It’s morning sunlight. Bright light in your eyes early in the day sets your circadian rhythm so melatonin releases at the right time that night. Skip it, and “your body doesn’t secrete melatonin until much later in the day.” Which is how you end up wide awake at midnight, again.
As a Vermonter who spends roughly half the year in what I’d describe as ambient dusk, I pressed her on this one. Good news for my fellow light-deprived northerners. You don’t need a sunrise hike. Coffee by an open window counts. A light box is “better than nothing. Better than waking up, showering, and going straight to your desk.”
Realistic rules for phones, decisions and winding down
I appreciated that Agarwal didn’t pretend she charges her phone in another wing of the house. “Doctors are bad patients,” she admitted. Instead of banishing devices, she suggests what people will actually do. Flip the phone face-down, set a nightly get-off-your-phone alarm, gray out your apps after a certain hour. For kids, though, she holds the line with the AAP. No devices in the bedroom, period, including the tablets and watches charging overnight.
She’s also firm on one rule that has nothing to do with screens. No big decisions after midnight. (Perimenopause, take note.) “The night should be preserved for recovery, restoration, and optimistic thinking for the next day,” she said. Big decisions require exactly the analytical brain pathways you’re trying to power down, and they keep you ruminating. Table it for morning, when “your thinking will be clearer and the day’s worries are gone.”
Her daytime prescription is refreshingly doable. Exercise, finished well before bedtime. No late caffeine. A protein-heavy rather than carb-heavy dinner, so your blood sugar doesn’t spike and crash right before bed. And the rule I’m adopting immediately, which is that if you want to be asleep by 10, be in bed by 9. Read a real book, journal, breathe. “Non-digital things.”
My nervous system and I will report back.
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