You Can't Force Sleep

One of Dr. Nishi Bhopal's patients wanted a shopping answer to his sleep problem. "Just tell me what mattress to get," he said. If he could throw $5,000 at the problem, what should he buy?

Dr. Nishi asked him to take a step back. He was working late and sleeping too little. The mattress was not the problem. Sleep had never made his priority list.

That story opened my conversation with Dr. Nishi, a Bay Area psychiatrist and sleep medicine doctor. We talked about questions our patients bring us all the time: Why am I tired when my tracker says I slept well? Is waking at 3 a.m. abnormal? Do I really need eight hours?

Her answer was reassuring: your body already knows how to sleep. The harder part is getting out of its way.

A Bad Night Becomes a Bigger Problem When You Start Fighting It

One rough night is not insomnia. Neither is a stressful week when sleep comes and goes.

Dr. Nishi explained that chronic insomnia means trouble falling or staying asleep at least three nights a week for three months or more, along with problems during the day.

She also made a distinction I wish more people heard: "Insomnia is a symptom. It's not necessarily a diagnosis."

Sleep apnea can look like insomnia. So can restless legs, low iron, thyroid problems, medication changes, anxiety, or a schedule that does not leave enough time for sleep. This is why she asks about the whole day, not only the hours spent in bed.

I ask similar questions in my clinic. The pattern matters. Trouble falling asleep tells me something different from waking repeatedly or waking at 3 a.m. and never drifting off again.

Your Sleep Tracker Is Data, Not a Report Card

Dr. Nishi uses an Oura Ring herself. During our conversation, she was taking a break from it.

Her reason was simple. A tracker can show how an evening glass of wine, a late espresso, or an irregular schedule changes your sleep. It becomes less helpful when a score tells you how you are supposed to feel.

Patients come to her worried that they got only 10 percent REM sleep or almost no deep sleep. Those numbers look precise, but a watch or ring does not measure the brainwaves doctors use to identify sleep stages. Dr. Nishi does not use those stage estimates when she evaluates a patient.

She pays more attention to sleep duration, regularity, and how both change with daily life.

I see the other side in my clinic. A patient's ring says they slept well, but they sit in front of me feeling drained. I ask, "Do you feel like you slept well?" The answer is no.

The device can offer information. It does not get the final word on your body.

Eight Hours Is a Guideline, Not a Test You Pass

Most adults have heard that they need eight hours. Dr. Nishi prefers to talk about a range because sleep needs differ from person to person and change with age.

I use a battery analogy with my patients. Some batteries recharge quickly. Others take longer. Both can end up fully charged.

Sleep changes from one night to the next. The trouble starts when one short night becomes evidence that something is wrong. Then you watch the clock and arrive at bedtime braced for failure.

Dr. Nishi calls all that trying "sleep effort." You add melatonin, magnesium, a new gadget, a stricter routine, and more worry. But sleep does not respond well to force.

She quoted a line I have kept since our conversation: "Sleep is like a cat. It only comes to you when you ignore it."

Waking at 3 A.M. Does Not Mean Your Sleep Is Broken

Many people wake briefly in the middle of the night. Sleep gets lighter toward morning, so it is easier to surface.

Dr. Nishi offered an evolutionary way to see it. When people slept outdoors, briefly waking to check the babies or scan for a tiger was useful. You looked around, found that everyone was safe, and went back to sleep.

What often keeps a modern person awake is the reaction that follows. You check the time. You count how many hours remain. You picture tomorrow's meeting. A normal moment of wakefulness turns into an emergency.

Chinese medicine also treats the night as a gradual change between active and restful states. I told Dr. Nishi that when the body has trouble settling, I look at the person's daily rhythm. She recognized the same idea in Ayurveda: day and night work as one rhythm.

The most useful response at 3 a.m. may be the least dramatic one. Notice that you are awake without turning it into a prediction about tomorrow.

Better Sleep Starts Before Bedtime

Dr. Nishi organizes sleep problems around four ordinary parts of life: food, environment, emotions, and medical issues.

Food includes what and when you eat. Environment means a cool, dark, quiet room. Emotions include stress or anxiety that had no space during the day. Medical issues include sleep apnea or restless legs that need proper evaluation.

Small details can keep the mind working. A pile of laundry is still a to-do list. A snoring partner, a moving pet, heat, or street light can interrupt sleep. I added two feng shui habits I grew up with: avoid a mirror directly in front of the bed and a heavy exposed beam overhead.

If your mind has no quiet all day, bedtime becomes its first chance to speak. Dr. Nishi recommends small pockets with no phone, podcast, television, or email. A short walk or a few slow breaths count.

If meditation makes you restless, choose movement. I often suggest yoga, boxing, jiu-jitsu, or a walk after work. Give your body a clear transition out of the working day.

Supplements Can Support Sleep, but They Cannot Do the Sleeping for You

Dr. Nishi is not against medication or supplements. Her concern is the expectation we put on them.

Melatonin is not a sleeping pill, she explained. It is a timing signal for the body clock. Magnesium or ashwagandha may also support some people. None can replace understanding why someone is awake.

"They are a support, but they're not a solution," she said.

Then she gave the clearest explanation in the whole conversation. You can be hungry and still not want to eat if you feel nauseated. In the same way, your body can need sleep while your nervous system stays alert. Sleep makes us vulnerable. If the body thinks it needs to stay on guard, it will.

The body needs to feel safe enough to let sleep happen.

These Two Wrist Points Help You Practice Slowing Down

This is where I brought in acupuncture.

Dr. Nishi had just described an alert nervous system. I responded with what I use in the clinic: acupuncture points that help the body settle. I also teach two neighboring points on the inner wrist that people can press themselves. They are PC7, called Daling, and HT7, called Shenmen.

Turn your palm up and bend your hand slightly toward you. PC7 sits near the center of the wrist crease, in the dip between the two tendons. HT7 sits on the same crease toward the little-finger side, in a small hollow beside the tendon there.

Use your thumb to press one point at a time for one to two minutes on each wrist. Keep the pressure gentle. A mild heavy or tender feeling is enough. Stop if it hurts.

I also suggested a scalp massage. Move slowly and notice where the scalp feels tight.

Dr. Nishi connected this with abhyanga, an Ayurvedic practice using slow strokes along the arms and legs with a little oil. Simple touch forces you to slow down.

The wrist points are a gentle self-care practice, not a substitute for an evaluation when poor sleep is severe, persistent, or affecting your days.

You Do Not Have to Solve Persistent Insomnia Alone

When insomnia has become a cycle, Dr. Nishi uses cognitive behavioral therapy for insomnia, usually called CBT-I. It helps people change the habits and fear that keep the cycle going. She combines it with a gentler, acceptance-based approach because a rigid sleep program can become one more thing to fail at.

Her closing message was direct: if you are struggling with sleep, you do not have to suffer through it. A sleep specialist can help identify what is driving the problem. Acupuncture may be one part of care when it fits the person. Start by treating a difficult night as information rather than a personal failure.

Sleep is not a purchase, a score, or a perfect routine. It is something the body already knows how to do when it no longer feels responsible for keeping watch.

Full conversation with Dr. Nishi Bhopal: Puzzle Exchange.