Why can't I sleep? The real reasons you're lying awake, and five things that help

adhd menopause metabolic health sleep Oct 02, 2026

If you're doing “all the right things” and still not sleeping, you're not doing it wrong. Here's what's actually getting in the way, five techniques that help, and some extra tips for ADHD and neurodivergent brains.

By Dr Lucy Burns and Dr Mary Barson, medical doctors and co-founders of Real Life Medicine. October 2026.

It's 3.07 am. You're awake. Again. Your brain has decided this is the perfect time to replay a conversation from 1994, remind you that you haven't booked the car in for a service, and wonder whether you turned the iron off. You don't own an iron.

If that sounds familiar, you've got company. Somewhere between a third and almost half of Australian adults say they aren't getting enough good-quality sleep. And here's the frustrating part: plenty of them already know the standard advice. No screens, no coffee after lunch, dark bedroom. They've tried it. They're still awake.

So this week's Friday 5 starts with a different question. Not “what are the rules?” but “why can't I sleep?” Because once you know what's actually getting in the way, it's much easier to pick the thing that will help.

The short answer: five techniques that help when the usual sleep advice hasn't been enough.

Anchor your wake-up time and get morning daylight
If you can't sleep, get up and retrain your brain to link bed with sleep
Park your worries before bed with a notebook or to-do list
Turn the temperature down, especially if hot flushes wake you
Stop chasing sleep and give your brain something gentle to focus on instead

Why sleep is worth fighting for

We've written about the benefits of sleep before, so here's the short version. Sleep isn't the absence of doing things. It's when your body does some of its most important work.

Your metabolism. In one study, a single night of four hours' sleep made healthy adults measurably more insulin resistant the next day. Another found that two nights of short sleep dropped leptin (the hormone that tells you you're full) by 18%, raised ghrelin (the hormone that tells you you're hungry) by 28%, and increased hunger by 24%. If you've ever noticed that the biscuit tin calls louder after a bad night, that's not a willpower problem. It's hormones.

Your brain. During deep sleep, the brain clears out waste products. In mice, the spaces between brain cells widen by around 60% during sleep, which lets that clean-up happen more efficiently. In people, a UK study that followed almost 8,000 adults for 25 years found that those who consistently slept six hours or less in their 50s, 60s and 70s had around a 30% higher risk of dementia. That's a link, not proof of cause and effect, but it's a strong one.

Your immune system. In a study where volunteers were deliberately given a cold virus (yes, really), people sleeping less than six hours a night were around four times more likely to catch the cold than people sleeping more than seven.

Your mood and your eating. Most of us know this one from experience. Everything feels harder when you're tired: patience, decisions, and saying no to the food that's been engineered to be impossible to say no to.

So why can't you sleep?

Poor sleep is rarely about one thing. Here are the most common culprits we see, and you might recognise more than one.

Your hormones have changed. Sleep problems are one of the most common symptoms around and after menopause, with research suggesting roughly 35% to 60% of postmenopausal women are affected. Hot flushes and night sweats wake you up, and falling oestrogen and progesterone affect sleep in their own right. For some women, the sleep disruption hangs around long after the flushes settle.

Your breathing has changed. Sleep apnoea, where your airway partly closes during sleep, becomes much more common in women after menopause, to the point where rates start to look similar to men's. It's also very underdiagnosed in women, partly because it doesn't always look like the classic loud snorer. Waking unrefreshed, morning headaches, waking to go to the toilet a lot, or being told you stop breathing are all worth mentioning to your GP.

Your mind won't switch off. Stress keeps your body in “alert” mode, with cortisol and adrenaline that are great for dealing with a crisis and terrible for drifting off. This is the “tired but wired” feeling, and it's a big driver of that 3 am wake-up where your brain is suddenly running a board meeting.

Bedtime is the only time that's yours. If you spend the day looking after everyone else, those late-night hours on the couch can feel like the only part of the day that belongs to you. So you stay up, even though you're exhausted. It even has a name: revenge bedtime procrastination. It's not a character flaw. It's a sign your days don't have enough room in them for you.

Your body clock is out of sync. Your internal clock is set mainly by light. Not much daylight in the morning, plus bright light and screens at night, tells your brain it's daytime when it isn't. Irregular sleep times, shift work and weekend sleep-ins make it worse. Our body clocks also tend to shift earlier as we get older, which is why some people find themselves awake at 4.30 am whether they like it or not.

Coffee and wine are doing more than you think. Caffeine hangs around in your system for hours. In one study, a big dose of caffeine (400 mg, about three or four cups of coffee) taken six hours before bed still cut total sleep by more than an hour. Alcohol helps you nod off, then disrupts the second half of the night, which is often when the 3 am wake-up kicks in. (We covered both of these in our evening habits blog, so we won't repeat ourselves here.)

Something else is waking you. A full bladder, reflux, pain, restless legs, a snoring partner, a dog who believes your pillow is theirs. Some medications affect sleep too. These are all worth looking at, because some of them are very treatable.

You're trying too hard. This is the sneaky one. When you've had a run of bad nights, bed can start to feel like a place of struggle. You lie there, willing yourself to sleep, checking the clock and calculating how many hours you'll get if you nod off right now. That effort creates exactly the alertness that keeps you awake. Your brain learns “bed = lying awake worrying”, and the cycle feeds itself.

When to see your GP

If poor sleep has been going on for more than three months, if you snore or someone's noticed you stop breathing, if you're falling asleep during the day when you don't mean to, or if you're feeling low or anxious most days. Persistent insomnia is a real, treatable health problem, not something you have to put up with.

Five techniques to help you get a better night's sleep

These aren't the usual “no screens in bed” tips (they still help, and they're in our evening habits blog). These are the techniques sleep specialists use when the basics haven't been enough.

1. Anchor your wake-up time

It sounds backwards, but the most powerful lever for better sleep is what time you get up, not what time you go to bed. Pick a wake-up time you can stick to seven days a week, give or take 30 minutes, and keep it even after a bad night.

Then get outside into daylight within the first hour or so. Morning light is the strongest signal your body clock gets. It tells your brain “the day has started”, which sets the timer for when you'll feel sleepy that night. A cuppa on the back step counts. Sunglasses off if you can.

The sleep-in after a rough night feels like kindness, but it pushes your body clock later and makes the next night harder. Think of your wake-up time as the anchor that holds everything else in place.

2. If you can't sleep, get up

If you've been lying awake for what feels like 20 minutes or so (no clock-watching, go with your gut), get up. Go to another room, keep the lights low, and do something calm and a bit boring: folding washing, a jigsaw, a familiar book. Go back to bed when you feel sleepy. Repeat as needed.

This is called stimulus control, and it's one part of cognitive behavioural therapy for insomnia (CBT-I). The idea is to retrain your brain to link bed with sleeping, not with lying awake worrying. It can feel worse for the first week or two before it feels better, so stick with it. An Australian-led review of CBT-I trials found that, on average, people fell asleep around 19 minutes faster and spent around 26 fewer minutes awake during the night. If insomnia has been going on for a while, ask your GP about CBT-I. There are good online CBT-I courses too.

3. Park your worries before bed

If your brain likes to do its admin at 3 am, give it an earlier appointment. Some time in the early evening, sit down for 10 to 15 minutes with a notebook. Write down what's on your mind and, for anything you can act on, the next small step. Then close the book. The worries haven't gone away, but they've been “filed”, so your brain has less reason to keep pulling them back up.

Even a to-do list helps. In one sleep lab study, people who spent five minutes writing a to-do list for the next few days before bed fell asleep around nine minutes faster than people who wrote about what they'd already done. The more specific the list, the faster they fell asleep.

Keep the notebook by the bed too. If something pops up in the night, jot it down. Your brain will happily let go of it once it knows it's been written somewhere.

4. Turn the temperature down

Your core body temperature naturally drops as you fall asleep, and a warm room or doona works against that. This matters even more if you're dealing with hot flushes or night sweats.

What this can look like:

A cooler bedroom, with a fan or the window open if it's safe and quiet
Layers on the bed instead of one heavy doona, so you can throw one off without waking fully
Breathable cotton or linen pyjamas and sheets
A glass of cold water by the bed
A warm (not hot) shower an hour or two before bed, which helps your body start cooling down afterwards

If hot flushes are waking you most nights, that's worth a conversation with your GP too. There are several treatment options, and it's not too late to ask.

5. Stop chasing sleep

Here's the paradox: the harder you try to sleep, the harder it gets. So stop trying. Turn the clock to face the wall so you can't do the 2 am maths. Swap “I have to get to sleep” for “I'm going to rest here and let my body do what it knows how to do”. Rest still has value, even when you're not asleep.

This is where relaxation techniques come in. Slow breathing, a body scan, a sleep meditation or a hypnosis recording gives your busy brain something gentle to hold onto, instead of the to-do list. The research on hypnosis for sleep is still small and mixed, but more than half the studies in a 2018 review found a benefit, and it's low risk and easy to try. Used the same way most nights, a recording can also become a cue that tells your brain it's time to let go.

The goal isn't to force sleep. It's to get out of its way.

Special tips for ADHD and neurodivergent brains

If you have ADHD, autism, or you're neurodivergent in another way, sleep can be harder, and it's not because you're doing it wrong. Sleep problems are very common in adults with ADHD. Research shows that many adults with ADHD who struggle to fall asleep have a body clock that runs later than other people's: their melatonin, the hormone that signals night-time, switches on later in the evening. Add in a brain that doesn't have an “off” switch, hyperfocus that can swallow three hours without you noticing, time blindness, and sensory sensitivities to noise, light, fabrics or temperature, and you can see why “go to bed at 10 pm” doesn't always cut it.

Many women are also being diagnosed with ADHD in midlife, often after years of being told they were disorganised or too much. And many find their symptoms feel harder to manage around menopause. Researchers are only starting to study this properly, but if it rings true for you, it's worth raising with your doctor.

Here's what can help.

Set an alarm for bedtime, not only for waking up. Time blindness means 10 pm can arrive without warning. An alarm an hour before bed, labelled “start winding down”, takes the remembering out of it. A second alarm at “lights out” helps too.

Make the wind-down interesting enough to stick with. A boring routine is a hard sell for a brain that craves stimulation. Pick something low-stakes but engaging: an audiobook or podcast you've heard before, a rewatched show (on a TV across the room, not a phone in your hand), colouring, a puzzle. Familiar is the key. You want it interesting enough to stop your mind wandering, but not so gripping you have to find out what happens next.

Do a sensory audit of your bedroom. Is it too bright, too noisy, too hot? Does the label in your pyjamas drive you mad? Earplugs, an eye mask, blackout curtains, white or brown noise and soft fabrics can all make a difference. Some people find a weighted blanket helps. In a Swedish trial of 120 people with insomnia alongside ADHD, depression, bipolar disorder or anxiety, people given a heavy chain-weighted blanket had much bigger improvements in insomnia over four weeks than people given a light one.

Use the brain dump, every night. Technique 3 matters even more for an ADHD brain. Ideas, worries and “oh, I must remember to” thoughts tend to arrive at bedtime. Get them out of your head and onto paper.

Lean hard on your wake-up time and morning light. If your body clock runs late, consistent mornings and early daylight are the most reliable ways to nudge it earlier. It takes a few weeks, so be patient.

Talk to your prescriber about medication timing. Stimulant medication can affect sleep, depending on the type, dose and when you take it. For some people, though, it actually makes settling easier. Don't change anything on your own. If sleep is a problem, raise it with your doctor so you can work it out together.

Our thoughts on melatonin. In Australia, prolonged-release melatonin is available from a pharmacist for people aged 55 and over, and on prescription for others. In a Dutch trial of adults with ADHD and a late body clock, low-dose melatonin moved their body clock earlier by around one and a half hours, and reduced ADHD symptoms a little. But, surprisingly, it didn't move their actual sleep times earlier. So it's not a magic answer, and the timing and dose matter. If you're curious, talk to your GP rather than buying it online.

And please, be kind to yourself here. Your brain works differently, and your sleep strategy is allowed to look different too.

The bottom line

If you're not sleeping, there's almost always a reason, and very often more than one. Working out yours is the first step. Then pick one technique from this list, give it two to three weeks, and see what changes. Small, steady shifts tend to work better than overhauling everything at once.

Sleep is one of the foundations we come back to again and again in My Metabolic Action Plan, alongside what you eat, how you move and how you manage stress. My MAP also includes our hypnosis recordings. You can use them any time of day, and they're most helpful when you listen most days, which makes the end of the day a natural fit as part of your wind-down. Strategies, Skills and Tools, built into real life, one step at a time.

Find out more about My Metabolic Action Plan

Frequently asked questions

Why do I keep waking up at 3 am?

Common reasons include stress hormones keeping your body on alert, alcohol wearing off in the second half of the night, hot flushes or night sweats, needing the toilet, and sleep apnoea. If it happens most nights for more than three months, it's worth talking to your GP.

Why is it harder to sleep after menopause?

Hot flushes and night sweats can wake you, and falling oestrogen and progesterone affect sleep directly. Sleep apnoea also becomes much more common in women after menopause, and it's often underdiagnosed.

What should I do if I can't fall asleep?

If you've been awake for around 20 minutes, get up, go to another room with low light and do something calm until you feel sleepy, then go back to bed. This is called stimulus control and is part of cognitive behavioural therapy for insomnia (CBT-I).

Why do people with ADHD struggle to sleep?

Many adults with ADHD have a body clock that runs later than other people's, so melatonin is released later in the evening. A busy mind, hyperfocus, time blindness and sensory sensitivities can make it harder too.

Does melatonin help with ADHD sleep problems?

In a trial of adults with ADHD and a late body clock, low-dose melatonin moved the body clock earlier but didn't move actual sleep times earlier. It isn't a simple answer, and timing and dose matter, so talk to your GP before trying it.

References

Adams RJ, Appleton SL, Taylor AW, et al. Sleep health of Australian adults in 2016: results of the 2016 Sleep Health Foundation national survey. Sleep Health. 2017;3(1):35-42. Read the study
Donga E, van Dijk M, van Dijk JG, et al. A single night of partial sleep deprivation induces insulin resistance in multiple metabolic pathways in healthy subjects. J Clin Endocrinol Metab. 2010;95(6):2963-2968. Read the study
Spiegel K, Tasali E, Penev P, Van Cauter E. Brief communication: sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite. Ann Intern Med. 2004;141(11):846-850. Read the study
Xie L, Kang H, Xu Q, et al. Sleep drives metabolite clearance from the adult brain. Science. 2013;342(6156):373-377. Read the study
Sabia S, Fayosse A, Dumurgier J, et al. Association of sleep duration in middle and old age with incidence of dementia. Nat Commun. 2021;12(1):2289. Read the study
Prather AA, Janicki-Deverts D, Hall MH, Cohen S. Behaviorally assessed sleep and susceptibility to the common cold. Sleep. 2015;38(9):1353-1359. Read the study
Baker FC, de Zambotti M, Colrain IM, Bei B. Sleep problems during the menopausal transition: prevalence, impact, and management challenges. Nat Sci Sleep. 2018;10:73-95. Read the study
Bixler EO, Vgontzas AN, Lin HM, et al. Prevalence of sleep-disordered breathing in women: effects of gender. Am J Respir Crit Care Med. 2001;163(3 Pt 1):608-613. Read the study
Drake C, Roehrs T, Shambroom J, Roth T. Caffeine effects on sleep taken 0, 3, or 6 hours before going to bed. J Clin Sleep Med. 2013;9(11):1195-1200. Read the study
Ebrahim IO, Shapiro CM, Williams AJ, Fenwick PB. Alcohol and sleep I: effects on normal sleep. Alcohol Clin Exp Res. 2013;37(4):539-549. Read the study
Trauer JM, Qian MY, Doyle JS, Rajaratnam SM, Cunnington D. Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Ann Intern Med. 2015;163(3):191-204. Read the study
Scullin MK, Krueger ML, Ballard HK, Pruett N, Bliwise DL. The effects of bedtime writing on difficulty falling asleep: a polysomnographic study comparing to-do lists and completed activity lists. J Exp Psychol Gen. 2018;147(1):139-146. Read the study
Chamine I, Atchley R, Oken BS. Hypnosis intervention effects on sleep outcomes: a systematic review. J Clin Sleep Med. 2018;14(2):271-283. Read the study
Van Veen MM, Kooij JJ, Boonstra AM, Gordijn MC, Van Someren EJ. Delayed circadian rhythm in adults with attention-deficit/hyperactivity disorder and chronic sleep-onset insomnia. Biol Psychiatry. 2010;67(11):1091-1096. Read the study
Ekholm B, Spulber S, Adler M. A randomized controlled study of weighted chain blankets for insomnia in psychiatric disorders. J Clin Sleep Med. 2020;16(9):1567-1577. Read the study
van Andel E, Bijlenga D, Vogel SWN, Beekman ATF, Kooij JJS. Attention-deficit/hyperactivity disorder and delayed sleep phase syndrome in adults: a randomized clinical trial on the effects of chronotherapy on sleep. J Biol Rhythms. 2022. Read the study

This content is for general information only and isn't medical advice. Please talk with your GP before making changes to your health care, including any medication.

Dr Mary Barson and Dr Lucy are the founders of Real Life Medicine. They help women who have been on every diet under the sun, optimise their health and achieve long-lasting weight loss without feeling miserable or deprived.

They do this with their 3-step framework that

Improves metabolism
Develops mindset skills
Provides tools to implement it easily into busy lives

With this comes increased energy, vitality and confidence.

You can avoid chronic disease and stop living life on the sidelines!

You can find out more about My Metabolic Action Plan here