Our pursuit of a good night’s sleep is more than an activity, it’s an industry. According to the Sleep Foundation, an estimated 50 to 70 million people have ongoing sleep disorders, including insomnia, sleep apnea and narcolepsy. As a result, poor sleep isn’t just a medical problem, it’s become a multibillion-dollar market for drug companies in the form of prescription and over-the-counter sleep aids, not to mention a wildly lucrative category of consumer products promising to help us achieve better rest. There’s no question that a lot of us are tired. What are the best, researched-backed solutions? We spoke with two Florida-based sleep experts to better understand where our sleep issues originate, how they affect our quality of life and learn about recommended long-term ways of treating them.
Let’s start with the basics. How much sleep does the average person need? “The bottom line is whatever it takes for you to feel well the next day, which varies individually,” says Dr. Samuel Gurevich, a board-certified sleep physician and pulmonary critical care doctor at Cleveland Clinic Weston Hospital.
“Eight hours is an average and a suggestion, but there are seven-hour people who feel good and nine-hour people who need a little longer to feel their best.”
If you can get by on less than seven hours, great. Just don’t push it. “If that’s all your body is asking for, consider yourself lucky, but if you’re forcing it — like setting an alarm hours before your body is naturally ready — there are well-established health consequences,” Gurevich explains.
Lots of us are getting less sleep than we need, but not by choice. Whether it’s trouble falling asleep or going back to sleep after waking up in the middle of the night, what qualifies as insomnia varies from person to person. “The American Academy of Sleep Medicine leaves it open,” Gurevich notes. “It’s subjective to patient’s daytime consequences like sleepiness, concentration issues, potency issues, short-term memory problems, impaired performance and attention to tasks. So it’s two things: a short sleep time that’s forced and consequences during the day.”
The overwhelmingly top cause: stress.
From global concerns to personal fears, our worries tend to ramp up and ruminate when the lights go out. “Elevated anxiety is incredibly common, racing thoughts or the inability to shut off your mind,” says Dr. Abhay Sharma, Sleep Surgeon Medical Director (ENT) at Tampa General Hospital and assistant professor and director of the Division of Interventional Sleep Surgery at the USF Health Morsani College of Medicine.
At night, technology isn’t really our friend, either. “People watching television before bed has long been an issue, but in the last couple of decades, smartphones have become a very common factor. Searching the internet or scrolling through news or social media over-stimulates the brain and emits excessive light exposure. That’s something I see very frequently,” says Sharma.
Best practices before sleeping, also known as sleep hygiene, says Sharma, include shutting down at least 30 minutes before bed.
“Ideally, people should stop an hour before bedtime. No TV, no social media, no cell phone, nothing. If they can’t do it, at least 30 minutes is important.”
A dark room is equally crucial. “Our entire circadian rhythm, our internal clock, is based on light. Light plays an incredible role in our ability to stay awake, so you should attempt to make the room as dark as possible at a generally cooler temperature. People are comfortable at different temperatures, but generally, you should be cooler at night than you are during the day because it promotes better sleep.”
Be as consistent as possible. “Keeping the same bedtimes and the same wake times, whether it’s the weekend or the weekday, can make a big difference in being able to fall asleep and stay asleep. Whether you’ve gotten enough sleep or not, it’s important to wake up at the same time every day.”
If you wake in the middle of the night and can’t fall back asleep, get out of bed. “For people with chronic problems, they start associating their beds with poor sleep, so you have to disassociate that. The bed is for sleeping, so if you’re not sleeping, you shouldn’t be in bed. It helps bring good association back to sleeping. So get up and do something mundane, like read a book or listen to soft audio. Putting on the TV or looking at your phone is counterproductive because no matter what you’re looking at, that light is going to cause your sleep to suffer more.”
Popping a pill sounds so much easier, doesn’t it? A 2023 study from the Centers for Disease Control and Prevention (CDC) cited by The Washington Post reported that 18% of U.S. adults take some form of sleep medication. However, Gurevich and Sharma warn against them for long-term use. “For the vast majority, you will develop a tolerance, you may develop dependence and you will also likely develop side effects,” Gurevich explains. “We use medications very selectively in scenarios that are going to be temporary, like if someone is going through a specific, stressful situation or traveling across multiple time zones.”
Over-the-counter sleep aids, notes Gurevich, are essentially allergy medications with different marketing. “Ninety percent of them are antihistamines, like Benadryl. So, your Tylenol PM, your NyQuil and so forth, it’s really just an antihistamine. They tend to wear off very slowly, leaving you with a hangover effect. You can build up a tolerance to them as well, leaving you needing more and more of the medication to get the same effect.”
In America, the prescription and over-the-counter sleep aid industry is $65 billion and growing, according to Forbes.
In addition, what Forbes describes as the global sleep aid economy — a massive range of consumer products marketed around better sleeping — tops off at roughly $432 billion a year. That includes mattresses, nasal sprays, apps, mouth tape, over-the-counter devices, CBD and much more. In our quest for undisturbed sleep, we’re spending serious money. “It’s a big business and it’s not really regulated,” says Sharma. “Those kinds of things are fine to try. If you find something that works for you, awesome. The problem is there’s no guarantee they will and, in fact, most of the time they don’t. There’s a lot of deceptive advertising.”
If you’re someone struggling with prolonged chronic insomnia, a better investment might be Cognitive Behavioral Therapy (CBT) with a psychologist or other mental health professional who provides CBT.
“Very often, what you’re dealing with is a side effect of another potentially serious condition like general anxiety disorder and major depression. So when you treat the underlying mental health disorder, the insomnia improves,” says Gurevich. CBT is designed to uncover the root of the mental health issue and equip you with psychological tools to reorient your mind and encourage your body to relax. “Cognitive Behavioral Therapy for insomnia is one of the best treatments. It works better than medication,” says Sharma.
There’s no one-size-fits-all diagnosis or treatment for sleep issues. If you’re having significant trouble sleeping, don’t underestimate the effects this can have on your overall ability to function.
The National Safety Council (NSC) reports over 300,000 car crashes occur every year as a result of drowsy driving. “If there’s a problem that’s continuing for two or three months and it hasn’t gotten better — whether it’s poor sleep at night or sleepiness during the day — it’s important to tell your primary care provider who can refer you to a sleep specialist,” concludes Sharma. “What’s great about the expanding world of sleep and sleeping problems is that people are talking about it more. Ask for help if you need it.”