Finding Rest Again: Natural and Medical Approaches to Better Sleep

By Christine Sagan, MSN, APRN, FNP-BC

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Sleep difficulties are one of the most common concerns patients bring to the clinic. Trouble falling asleep, waking during the night, or feeling unrefreshed in the morning can affect mood, energy, metabolism, and overall health. The good news? Both science and integrative medicine offer effective ways to restore balance.

The Gold Standard: CBT-I

According to a 2024 invited review in The New England Journal of Medicine, cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for persistent insomnia. It’s strongly recommended by leading medical groups, including the American College of Physicians and the American Academy of Sleep Medicine.

CBT-I goes beyond “sleep hygiene” by combining:

• Behavioral strategies (such as sleep restriction and stimulus control)

• Cognitive tools to address unhelpful beliefs about sleep

• Relaxation training

• Education on healthy sleep practices

  
  

Studies show CBT-I produces lasting improvements in falling asleep, staying asleep, and daytime functioning—without the side effects of medications.

When Medications Are Considered

If CBT-I is unavailable, insufficient, or declined, guidelines recommend short-term use of FDA-approved sleep medications, such as:

• Dual orexin receptor antagonists (suvorexant, daridorexant, lemborexant)

• Benzodiazepine receptor agonists (zolpidem, zaleplon, eszopiclone)

• Low-dose doxepin or ramelteon

  
  

These can be effective but are best used at the lowest effective dose, for the shortest possible time, due to risks of dependence and side effects. Over-the-counter agents (antihistamines, melatonin for most adults) show limited benefit in clinical trials.

Alcohol and Sleep: A Hidden Disruptor

Alcohol is one of the most common—but overlooked—sleep disruptors. While it may make you feel drowsy at first, alcohol fragments sleep, reduces deep and REM stages, and leads to more nighttime awakenings. After age 40, the body’s ability to metabolize alcohol declines, so its disruptive effects on sleep and recovery become more pronounced. Regular evening drinking can worsen fatigue, impair memory, and increase risks for weight gain and metabolic imbalance.

Natural and Integrative Supports

While CBT-I remains the foundation, many patients benefit from complementary approaches that calm the nervous system, regulate circadian rhythm, and lower nighttime stress hormones:

• Cortisol Manager (adaptogenic blends) – may help reduce evening “tired but wired” feelings.

• Passionflower – shown in small studies to support relaxation and sleep depth.

• L-Theanine – an amino acid found in green tea that promotes calm focus and can reduce nighttime restlessness.

• Soothing teas – chamomile, lemon balm, or lavender tea can be gentle aids in winding down.

• Hormone therapy – in select patients, imbalances in estrogen, progesterone, or testosterone may disrupt sleep; evaluation with a provider can clarify if support is needed.

• Acupuncture – long used in traditional medicine, acupuncture helps regulate the nervous system, reduce stress hormones, and improve vagal tone, often leading to better sleep quality.

• Yoga Nidra – a guided meditation practice that induces deep relaxation and lowers stress.

• Circadian rhythm balance – keep a consistent sleep/wake schedule, expose yourself to natural morning light, and dim lights/screens in the evening.

• Light therapy – especially helpful in northern winters, bright light boxes or red/infrared light devices can reset biological rhythms and support energy.

• Huberman’s practical tips – neuroscientist Dr. Andrew Huberman emphasizes: morning sunlight within 30–60 minutes of waking, avoiding caffeine after 2pm, cooling the room for sleep, and using breathwork to calm the body at night.

  
  

Tracking and Optimizing Your Sleep

Wearable monitoring devices (such as Oura, Whoop, or Apple Watch) can provide valuable insights into your deep sleep and REM cycles. A healthy goal is roughly 1.5 hours of deep sleep (for physical repair and hormone balance) and 1.5 hours of REM sleep (for memory consolidation, mood, and emotional processing). Tracking patterns can help identify how lifestyle choices—like late meals, alcohol, or screen time—affect recovery.

Why Sleep Matters for Your Health

Sleep is not just “rest”—it’s an active process where your brain and body repair, reset, and integrate. During deep and REM sleep, your brain lays down memory, regulates mood, balances hormones, and supports metabolism. Chronically disrupted sleep is linked to weight gain, insulin resistance, depression, and even accelerated aging.

Putting It All Together

For most people, the best path forward starts with non-drug strategies like CBT-I, circadian alignment, and relaxation practices, while layering in targeted natural supports when appropriate. Medications may help in short bursts but should not be the long-term solution.

If sleep struggles are ongoing, it’s important to work with a provider who can:

• Rule out underlying medical or hormonal issues

• Guide safe supplement use

• Offer or refer for CBT-I

• Provide acupuncture or other integrative therapies

• Discuss short-term pharmacologic options if needed

  
  

If sleep difficulties are affecting your health or quality of life, you don’t have to struggle alone. Schedule a visit with our team to explore safe, effective, and individualized options—from evidence-based to natural integrative supports—so you can wake rested and ready for your day.