I tried everything to treat my chronic insomnia – then a sleep lab revealed two simple changes that cured me for life
I wasn’t always a poor sleeper. When I was a teenager, I could sleep anytime, anywhere. I once slept in a photo booth (I had missed the last train home). Another time I slept in a phone booth.
But by the time I entered my 40s, I had begun to show classic signs of insomnia.
I had difficulty going to sleep and kept waking up at 3am with thoughts rushing through my head.
I would lie there for what felt like hours, and going to bed, which was once a real pleasure, was something I began to approach with a sense of unease. Would this be a good night or a bad night? Would I get up feeling shattered or would this be one of those rare nights when I would sleep through until morning?
As part of my quest to learn more about sleep in general, and my own sleep in particular, I agreed to take part in a clinical trial run by experts from Flinders University Sleep Institute in Adelaide, Australia.
What made this trial so unusual, and from my perspective so compelling, is that it combined a personalized approach with cutting-edge sleep monitoring technology.
Despite my initial fears it was one of the best things I have ever done, both personally and professionally.
Like the 29 other participants in the trial, I started off by having a medical examination, to exclude any health problems.
Do you struggle to get to sleep at night? Or wake up early and are then unable to get back to sleep?
Dr Mosley had difficulty going to sleep and kept waking up at 3am with thoughts rushing through his head
I was then given some kit to take home, including a couple of different sleep trackers and something called a Withings Sleep Analyzer mat, which you can buy online and contains, among other things, a microphone.
The idea is you slip it under your mattress, and it detects the breathing sounds and movements that you make while you are sleeping. You sync it to a smartphone and the next morning it will tell you how well you slept, whether you snored, and whether you might have sleep apnea.
With our consent, data from all these devices were sent to the Flinders team. We were also all given a sleep diary to fill in, as that is a key part of the program.
More surprisingly, I was given an electronic pill to swallow, linked by Bluetooth to a recording device.
As psychologist Professor Leon Lack explained, the pill is a very accurate way of measuring core body temperature, the temperature of your internal organs. The reason this matters is because your core body temperature is, like so many other processes in our bodies, driven by our internal, circadian clock and is linked to sleep.
Core body temperature changes across the course of a day, but should be at its lowest around 4am, which helps us stay asleep for the second half of the night.
The Flinders team wanted to see if any of us had circadian clocks that were out of sync, either running faster or slower than you might expect, which can lead to sleep disruption and symptoms of insomnia.
This used to be measured using a rectal thermometer, which had to be kept in place, so I was grateful that I was only required to swallow a pill.
Dr Mosley had electrodes attached to his head and body, along with other devices to monitor him while he slept
Dr Mosley with his wife Clare – he said his insomnia gradually developed in his 30s and 40s
After a few days getting acclimatized to all this kit, I went into the Nick Antic Flinders Sleep Laboratory for an overnight assessment. This involved having electrodes attached to my head and body, along with other devices to monitor me while I slept.
So, after all that monitoring, what did they find?
To be honest, it was a bit of a shock.
They told me that I had quite severe insomnia, which I knew.
They also said that I had a body clock that runs faster than expected. So, while most people’s core body temperature (which is linked to the body clock) is at its lowest around 4am, then starts to rise, the temperature-measuring pills I’d been swallowing showed mine was at its lowest around 1am.
That could explain why I get so sleepy early in the evening and why I often wake up, feeling surprisingly alert, around 3.30am.
In fact, Professor Lack said he thought my fast-running body clock could be what had triggered my insomnia in the first place.
My fellow volunteer Priyanka had the opposite problem. Her core body temperature dipped to its lowest point at around 6am, which explained why she found it so hard to go to sleep at a ‘normal’ time, and would lie awake for hours, before eventually falling asleep early in the morning.
He was prescribed exposure to bright light, delivered by something called Re-Timer Light Therapy Glasses (but which can also work with a light box)
Another trial participant couldn’t get to sleep at a ‘normal’ time and ended up tossing and turning for hours
Then, around 6am, she’d be woken by the alarm, leaving her feeling extremely sleep deprived, and on edge.
To treat our circadian problems, we were both prescribed exposure to bright light, delivered by something called Re-Timer Light Therapy Glasses, developed by Professor Lack.
Priyanka was told to wear hers first thing in the morning, to try to bring her body clock earlier, while I was asked to wear mine in the evening, to push my body clock back.
She was also encouraged to go out for early morning walks, while I was told to get more light in the evenings.
And it worked. Within a few weeks, the tests on my core temperature showed my body clock had shifted two hours later, while Priyanka, the extreme owl, found that exposure to early morning light had the opposite effect, making it easier for her to fall asleep at night.
She later told me: ‘It’s been life changing… I am able to wake up without feeling like I’m fighting my body, and I’m ready to start off my day in a very, very positive mindset.
Now that my circadian rhythm is reset, I try to take our dog for a 30-minute walk before breakfast.
Part of the reason is to get the exercise, but mainly it is to expose myself to lots of early-morning light.
Dr Mosley with his father, who died aged 74 of heart failure: ‘It’s obvious to me now that… he must have had sleep apnea, which contributed to his early death’
‘During the long, dark winter, or if you really struggle with getting up in the morning, you might want to invest in a light box,’ Dr Mosley said
The amount of light you experience in your house, or in the car on the way to work, is only a fraction of what you get when you are outdoors, even when it is overcast and gloomy.
The point of going out into the early-morning light is that it will reset your internal clock, and let your body know that the day has begun.
During the long, dark winter, or if you really struggle with getting up in the morning, you might want to invest in a light box.
A good one produces 10,000 lux (a measure of light intensity), which is similar to the levels you get outdoors on a bright spring morning. Light levels in your house or at the office are more likely to be a miserable 25 to 50 lux.
A light box is also a good way to help turn an owl into a lark because it can help reset your internal clock.
But a warning: when you use your light box depends on what your sleep problem is.
If you are a super-lark, waking up much earlier than you want (something that is common as people get older, and which was my problem) and you are struggling to stay awake at night, then you should not use a light box in the morning.
In fact, you might want to shun the early-morning light as much as possible. Instead, you should aim to get a good blast of light in the late afternoon, thereby delaying the release of melatonin.
Some of us in the trial were also prescribed Sleep Restriction Therapy (SRT), also known as Bedtime Restriction Therapy, to treat our underlying insomnia.
It might appear paradoxical to ask people who are suffering from insomnia to spend less time trying to sleep, but studies have shown that bedtime restriction can be highly effective and long lasting.
For me this meant going to bed at 11pm and getting up each morning at 5am.
It was quite brutal to start with, but in combination with getting more evening light, I was soon sleeping better than I had for a long time.
And once my sleep started to improve, which it did fairly fast, I was allowed a bit more time in bed each night, which was wonderful.
By the end of the eight-week study I was declared insomnia free.
Getting a proper diagnosis, and treatments that really worked, was a massive relief, but also bittersweet.
My dad died at the age of 74 of heart failure and it’s obvious to me now that, as well as type 2 diabetes, he must have had sleep apnea, which contributed to his early death.
And that makes me sad because if he had been diagnosed he could have been treated and he might still be with us.
Dr Michael Mosley died tragically aged 67 in June 2024, after getting lost during a mountain walk in Greece. His 2020 bestseller, Fast Asleep, was republished last month as 4 Weeks to Better Sleep: Improve Brain Function, Lose Weight, Boost Your Mood, Reduce Stress, and Become a Better Sleeper, updated with the latest sleep science and the revolutionary experiments that cured his own insomnia.
