When Sleep Stops Working

By Dr Afraz Adam

Sleep is one of those things we rarely appreciate until it stops working.

Every week I meet people who tell me they have tried everything. Magnesium. Melatonin. Herbal teas. Meditation apps. White noise. Expensive mattresses. Sleeping tablets.

Yet they still wake feeling exhausted.

What I’ve learnt over the years is that poor sleep is rarely the real problem. More often, it’s the body’s way of telling us that something else deserves our attention.

Sleep isn’t simply about being tired

One of the biggest misconceptions I hear is this:

“I’m exhausted, so why can’t I sleep?”

It seems logical that the more tired you are, the easier sleep should come.

Unfortunately, biology doesn’t always work that way.

Sleep isn’t something that happens because your body runs out of energy. It’s an active process that relies on your brain, hormones, nervous system and internal body clock all working together.

You can be physically exhausted yet remain biologically alert.

It’s one of the reasons new parents, shift workers and busy professionals often struggle to fall asleep despite feeling completely drained.

Your brain doesn’t have an off switch

For many people, bedtime is the first quiet moment they’ve had all day.

The emails have stopped.

The children are asleep.

The television is off.

Suddenly, the brain finally has room to think.

Patients often tell me they replay conversations, solve tomorrow’s problems or remember everything they forgot to do that day.

It isn’t because they’re poor sleepers.

It’s because their nervous system hasn’t had a chance to slow down.

Our brains were never designed to move from full speed to complete rest in a matter of minutes.

Sometimes poor sleep is trying to tell us something

While stress is a common cause of poor sleep, it certainly isn’t the only one.

Over the years I’ve diagnosed patients whose sleep problems were actually being driven by:

• Obstructive sleep apnoea

• Restless legs syndrome

• Hormonal changes, including menopause and low testosterone

• Thyroid disorders

• Iron deficiency

• Chronic pain

• Anxiety and depression

• Alcohol and caffeine

• Certain prescription medications

This is why I encourage patients not to simply accept poor sleep as a normal part of ageing.

If you’ve been struggling for months—or years—it’s worth asking whether there’s an underlying reason.

The answer isn’t always another sleeping tablet

Sleeping medications absolutely have a place in medicine. Used appropriately, they can be incredibly helpful.

The challenge is that they don’t always answer the most important question.

Why has sleep become difficult in the first place?

If we don’t understand what’s driving the problem, we’re often treating the symptom rather than the cause.

In medicine, that’s rarely the best long-term strategy.

The small habits that quietly make a difference

People often expect me to recommend complicated sleep routines.

The reality is much simpler.

Some of the biggest improvements come from consistently doing the basics well.

• Getting outside within an hour of waking.

• Keeping a regular wake-up time—even after a poor night’s sleep.

• Reducing caffeine later in the day.

• Limiting alcohol close to bedtime.

• Creating a cool, dark bedroom.

• Putting your phone away long enough for your brain to realise the day is over.

None of these changes are revolutionary.

But together they help restore something many of us have lost—our natural sleep rhythm.

We underestimate how important sleep really is

When people think about sleep, they usually think about feeling tired.

But sleep affects almost every system in the body.

Poor sleep can influence mood, concentration, memory, blood pressure, metabolism, weight, immune function and hormone regulation.

It can make us less patient with our families, less productive at work and less motivated to exercise.

It also becomes a vicious cycle.

The worse we sleep, the harder it becomes to make the healthy choices that would help us sleep better.

My perspective

One of the things I enjoy most about medicine is that symptoms are rarely random.

They are clues.

Sleep is no different.

When sleep stops working, I don’t immediately think about prescribing a sleeping tablet.

I start wondering what the body is trying to tell us.

Sometimes it’s stress.

Sometimes it’s hormones.

Sometimes it’s sleep apnoea, nutrition, medications or an underlying medical condition that has quietly developed over time.

And occasionally, it’s a combination of several small things that have gradually pushed the body out of balance.

The goal shouldn’t simply be to get more hours of sleep.

The goal should be understanding why sleep changed in the first place.

Because once you identify the reason, improving sleep often becomes far more achievable than people ever imagined.