What do we look at when you sleep but don't feel rested?

What follows combines several people's visits into one reconstructed account. It is not any one person's story, and anything that could identify someone has been removed.

How do people describe it when they come in?

They spend plenty of time in bed, yet their body feels heavy in the morning. Many also mention having vivid dreams all night.

People like this rarely use the word "insomnia," because they think they do sleep. So we usually find out when they come in for something else and we ask.

Is dreaming a lot the problem?

The dreams themselves aren't so much the problem. We see them as a sign that you aren't sinking far enough into deep sleep and are staying in the shallow stages for a long time.

The body recovers during deep sleep. If that stage is short, you won't feel refreshed even after eight hours in bed. It's a matter of depth, not time.

What do we look at?

We check whether your hands, feet and lower belly are cold while heat rises to your upper body at night, whether your mouth gets dry, and whether you have any time during the day when you let go of tension.

We often see this pattern: cold below, hot above. People say that when they lie down, heat and pressure gather toward the head and their sleep becomes shallow.

Many are always on edge because of work, or hold themselves to high standards. We're not blaming personality — it means the body has adjusted itself to that state.

How do we treat it?

We work on bringing down the heat that has risen to the upper body and warming the lower body. We also loosen the stiff upper body to ease pressure around the head.

For people like this, if we only push toward making them sleep, they can actually feel drained during the day. So we look at daytime energy as well.

There's one thing we especially mention to these patients. Some exercise at night hoping to sleep better, but it raises body temperature and actually works to keep you awake. It's better to move exercise to the daytime.

How did people do?

The heaviness on waking changes first. Comments that the dreams have decreased come later.

Here, too, we don't track progress by the time you fall asleep. We ask, "How did you feel when you woke up?"

What are the limits of this approach?

We don't measure how much your deep sleep has actually increased. We go by how you feel, so there are limits to how accurate this is.

One more thing: if low mood is also part of the picture, working on sleep alone often doesn't resolve it. In that case, we recommend getting mental health care at the same time.

If you have the same symptoms

1. It may be a matter of depth, not time.
2. We see lots of dreaming as a sign of staying long in shallow sleep.
3. We often see a pattern of cold below with heat rising above.
4. Exercising at night to help you sleep actually keeps you awake — move it to the daytime.
5. If low mood is part of it, we recommend getting mental health care as well.

We start by sorting out what kind of insomnia it is. Not being able to fall asleep and waking up during the night point to different places to look.

If poor sleep is wearing down your days, come and see us. We'll start by sorting out whether you can't fall asleep or keep waking up. Each points to a different place to look.

Because there are many possible causes, progress differs from person to person, even with the same care.