on November 02, 2026
Insomnia is not just a sleepless night
Sleeping poorly does not necessarily mean suffering from insomnia. The disorder becomes clinically relevant when difficulty falling asleep, nighttime awakenings, or early morning awakening are associated with impaired daytime functioning and tend to persist over time.
For this reason, the first step should not simply be to look for something that “makes you sleep,” but to understand why sleep has been disrupted.
Stress, anxiety, depression, changes in habits, pain, co-existing medical conditions, use of medications or substances, alterations in circadian rhythms, and behaviors that keep arousal levels high can contribute to insomnia.
Sleep thus becomes a possible indicator of a person’s overall balance.
The role of hyperarousal
One of the most studied models of chronic insomnia is that of hyperarousal, namely a state of persistent physiological and cognitive activation that makes it difficult to transition from wakefulness to sleep.
The problem can manifest as recurring thoughts, worry about not sleeping, muscle tension, constant clock-watching, or excessive attention to bodily sensations.
This can create a vicious cycle: the person fears they will not be able to sleep, arousal increases, sleep worsens, and the next night becomes even more fraught with expectations.
Breaking this cycle is one of the central goals of psychological strategies aimed at insomnia.
Cognitive-behavioral therapy at the heart of the process
When insomnia becomes persistent, the approach with the highest level of evidence is not simply a natural product or a medication taken on one’s own, but cognitive-behavioral therapy for insomnia (CBT-I).
CBT-I addresses the behaviors and cognitive mechanisms that maintain the disorder and may include stimulus control techniques, sleep restriction/compression, cognitive restructuring, sleep education, and relaxation strategies.
The principle is also important from the perspective of personalized medicine: the goal is not only to sedate the symptom, but to change the mechanisms that contribute to maintaining it.
Mindfulness and meditation: reducing mental noise
When the problem is characterized by a strong cognitive component, mindfulness practices can serve as a complementary tool.
The goal is not to “force” sleep, but to change the relationship with thoughts, emotions, and sensations that emerge during the falling-asleep phase.
Available clinical studies show encouraging results. A meta-analysis of randomized studies found an improvement in subjective insomnia parameters after mindfulness-based interventions, while emphasizing the need for further data on the long-term maintenance of the effects.
Randomized studies conducted in older adults with sleep problems have also shown a reduction in the severity of insomnia with structured mindfulness programs, with improvements in some objective sleep parameters as well.
This does not mean that mindfulness should replace CBT-I or other indicated therapies, but that it can be part of an integrated approach, especially when stress and hyperarousal play a significant role.
Yoga, movement, and the nervous system
Sleep is not separate from movement.
Regular physical activity can help regulate sleep-wake rhythms and reduce stress and tension. Among mind-body practices, yoga has been studied in numerous trials.
A recent network meta-analysis of randomized studies highlighted the favorable effects of yoga on several sleep parameters, including total sleep duration, efficiency, wake time after sleep onset, and sleep onset latency, although the quality of the evidence was not uniform for all outcomes.
The point, therefore, is not to propose yoga as a “cure for insomnia,” but to recognize its possible role within a broader strategy that includes movement, stress management, and body awareness.
Phytotherapy: not all plants are equal
Phytotherapy can play a role, but it requires the same attention to personalization that should characterize any sleep intervention.
The literature cites valerian, passionflower, opium poppy, hops, chamomile, lavender, and Withania somnifera.
However, the literature does not allow these plants to be considered equivalent.
For example, a recent umbrella review on valerian concluded that subjective improvements in sleep quality may emerge.
The situation is different for Withania somnifera, for which randomized clinical studies are available. A meta-analysis of five trials, involving a total of 400 participants, showed a statistically significant effect on sleep quality and quantity.
Another randomized study, conducted in healthy people and people with insomnia, found improvements in sleep onset latency, sleep efficiency, and other parameters after eight weeks of treatment with Withania root extract. However, the same authors emphasize the need for further studies to generalize the results.
This is a fundamental point: “natural” does not automatically mean effective, harmless, or suitable for everyone.
The choice of a plant should consider age, clinical conditions, concomitant medications, the characteristics of the disorder, and the quality of the extract used.
Benzodiazepines: caution with self-management
One particularly delicate chapter concerns benzodiazepines.
These medications can play a clinical role in selected situations, but prolonged use must be managed by a doctor due to the risk of tolerance, dependence, and other adverse effects.
When a person takes these medications regularly, any dose reduction must be gradual and supervised by a doctor, based on the individual’s clinical situation.
Phytotherapy, mindfulness, psychotherapy, or other strategies may eventually enter the process as complementary interventions, but they do not automatically constitute a pharmacological substitute.
Sleep and the environment
The starting material devotes a significant portion to the relationship between the environment, neural plasticity, cognitive activity, emotions, and sleep.
This perspective can be translated into more scientifically solid terms by considering the role of the behavioral and social environment in regulating the nervous system.
An environment characterized by movement, social interactions, cognitive stimulation, and meaningful activities can promote physical and mental well-being. Conversely, isolation, sedentary behavior, chronic stress, and overstimulation can contribute to the dysregulation of biological rhythms.
Evening exposure to light and technology can also interfere with the normal process of preparing for sleep, especially when it prolongs cognitive activation in the hours before bedtime.
Sleep, the brain, and neural plasticity
The relationship between sleep and brain plasticity is particularly interesting.
During sleep, changes occur in neuronal activity and brain circuits involved in memory consolidation, emotional regulation, and brain homeostasis.
Deep sleep, characterized by slow oscillations, is particularly important for these processes. Research is also exploring the relationship between neuronal activity, the glymphatic system, brain metabolism, and the removal of metabolites.
It is therefore plausible to consider sleep not as a simple “shutting down” phase of the brain, but as an active biological state, essential for maintaining neurophysiological balance.
BDNF, a brain-derived neurotrophic factor, is also involved in the processes of synaptic plasticity and neuronal adaptation. However, the relationship between BDNF, physical activity, sleep, and plasticity represents a complex field of research and cannot be reduced to the simple equation “increase BDNF = cure insomnia.”
From symptomatology to the person
The most interesting approach emerges when we stop considering all insomnia as the same.
One person may have difficulty falling asleep primarily due to cognitive hyperarousal; another may experience frequent awakenings associated with pain, menopause, medications, or respiratory disorders; another may have a deeply misaligned sleep-wake rhythm.
In these cases, the same solution cannot work in the same way.
Personalization therefore means starting with the phenotype of the disorder, looking for the factors that fuel it, and building a proportionate strategy.
Psychotherapy, CBT-I, mindfulness, physical exercise, yoga, relaxation techniques, sleep hygiene, and, in selected cases, phytotherapy or pharmacological therapy can be different tools in the same toolbox.
They do not necessarily all need to be used.
In fact, as the starting material also suggests, an excess of techniques, products, and information can itself become a source of confusion.
The Moltitudo vision: understanding before intervening
Insomnia is a particularly clear example of how reductive it is to intervene exclusively on the symptom.
A truly personalized approach should ask what is keeping that person awake.
Is it stress? Is it anticipatory anxiety? Is it a hormonal change? Is it pain? Is it sedentary behavior? Is it a behavioral habit? Is it an altered circadian rhythm? Is it the use of substances or medications? Is it a sleep disorder that requires a specialist evaluation?
This is the perspective of signaling medicine: observing the body’s signals, understanding their context, and choosing the most coherent intervention, avoiding turning every disorder into a simple search for the most effective product.
In the Moltitudo vision, sleep thus becomes a gateway to the person as a whole: body, nervous system, emotions, environment, movement, nutrition, and the quality of relationships.
It is not about promising a universal solution to insomnia, but about building a process in which the person returns to understanding their own sleep and the factors that influence it.
PLEASE NOTE
This article is for informational and educational purposes only and does not replace a doctor’s opinion, diagnosis, or prescription of therapies. Persistent or severe insomnia, or insomnia associated with other symptoms, should be evaluated by a healthcare professional. Do not modify, discontinue, or reduce benzodiazepines or other medications on your own.
Supplements and phytotherapeutic products are not medicines and are not intended to prevent, diagnose, treat, or alleviate diseases. Their use, if any, must take into account individual characteristics, possible interactions, and the person’s clinical conditions.
Bibliography
1. Riemann D, Baglioni C, Bassetti C, et al. European guideline for the diagnosis and treatment of insomnia. Journal of Sleep Research. 2017;26(6):675-700.
2. Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine. 2021.
3. Zhang J, et al. Mindfulness-Based Interventions for Insomnia: A Meta-Analysis of Randomized Controlled Trials. Behavioral Sleep Medicine. 2019.
4. Black DS, O'Reilly GA, Olmstead R, Breen EC, Irwin MR. Mindfulness meditation and improvement in sleep quality and daytime impairment among older adults with sleep disturbances. JAMA Internal Medicine. 2015;175(4):494-501.
5. Gong H, Ni C, Shen X, et al. Yoga for stress reduction and sleep quality: systematic evidence from randomized controlled trials. Systematic and meta-analytical literature on the role of yoga in sleep disorders.
6. Marques M, et al. Does valerian work for insomnia? An umbrella review of the evidence. European Neuropsychopharmacology. 2024.
7. Langade D, Kanchi S, Salve J, Debnath K, Ambegaonkar D. Clinical evaluation of the pharmacological impact of Ashwagandha root extract on sleep in healthy volunteers and insomnia patients. Journal of Ethnopharmacology. 2020;264:113276.
8. Cheah KL, et al. Effect of Ashwagandha extract on sleep: a systematic review and meta-analysis. PLoS One. 2021.
9. Recent systematic reviews and network meta-analyses of exercise interventions in adults with insomnia and sleep disorders, including yoga, walking, jogging and Tai Chi.
10. Research literature on slow-wave sleep, synaptic plasticity, BDNF and the neurobiological functions of sleep.
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