You can spend eight hours in bed and wake up exhausted. You can be tired all day, then suddenly available for every thought you have ever had the moment your head hits the pillow. You can fall asleep beautifully and be awake again at 3 a.m., doing math about how much sleep is still possible.
And someone, somewhere, will suggest a bedtime routine.
In my practice, sleep was where every care plan started. Meals, movement, mood, hormones, and blood sugar all got easier when a woman was sleeping and harder when she wasn’t, and no supplement made up the difference. So I wrote the sleep piece I wish I’d been able to hand women in the exam room. It’s long on purpose, it’s built to be skipped around in, and it’s meant to be sent to someone.
The short version:
A night is four to six cycles of light, deep, and dreaming sleep. “Light” sleep counts, and cutting the morning short takes away a REM-rich part of the night.
Two things decide when you sleep: a pressure that builds while you’re awake, and a clock set by light. Caffeine hides the first. A bright evening confuses the second.
Getting by on less is not needing less. In the lab, performance kept falling while people stopped noticing.
Your night changes with your cycle, pregnancy, a new baby, the menopause transition, and age. The useful question is what changed for you.
A bad night sorts into three questions: enough chance to sleep? unable to sleep despite the chance? something interrupting? You can answer yes to more than one.
Coffee, wine, gummies, melatonin, the herbal shelf, and screens each do something specific, and most of it isn’t what the label implies.
Chronic insomnia has a first-line treatment with a name, CBT-I, and you can start it from your phone. Snoring, breathing pauses, or waking unrefreshed with headaches need an evaluation, not a checklist.
This weekend: the clocks go back on Sunday, November 1. If you’re already short on sleep, the American Academy of Sleep Medicine’s advice is the simplest thing in the whole article: don’t shift anything, and take the hour as sleep. Section 10 has the rest, including what to do in March when the harder change comes.
If a woman came to mind while you were reading, send it with that same intention.
Has anyone ever actually taught you about sleep?
Never. This is the first time.
A little, from a parent or in school.
A clinician brought it up once.
I figured it out the hard way, on my own.
Congratulations, we’re healthing.
Lindsay Savage, PA-C