Dr. Nishi Bhopal explains why insomnia visits often get stuck in a cycle of “sleep effort,” where patients and clinicians try harder, more medications, more strategies, and sleep worsens. She offers a practical framework built around four treatment shifts: stabilize circadian rhythm with daytime anchors (light, movement, consistent meals), rebuild sleep drive by reducing excess time in bed and avoiding early bedtimes that create conditioned arousal, remove common sleep disruptors (alcohol, heavy evening meals, late caffeine, low daytime light, insufficient darkness), and help patients change their relationship with wakefulness by allowing nighttime awakenings without feeding anxiety. She shares patient examples, a swimming analogy for letting sleep happen, and a script for responding to requests for “another sleeping pill,” emphasizing long-term system change and patience over weeks with small consistent adjustments.