The Sleep Fix

Diane Macedo's argument is that much of the conventional advice given to people who cannot sleep makes the problem worse, because the effort to fix sleep is itself one of the things keeping them awake. She writes from a long personal struggle with insomnia and from extensive interviewing of sleep specialists, and the book is structured around what she found that actually helped.

The mechanism she keeps returning to is the difference between sleep drive and sleep effort. Pressure to sleep builds with time awake and is released by sleeping; circadian timing determines when that pressure most easily converts into sleep. Spending more time in bed to catch up weakens the association between bed and sleep and dilutes sleep pressure, which is why the intuitive response to insomnia tends to entrench it. From there she covers the central techniques of cognitive behavioural therapy for insomnia — consolidating time in bed, a fixed wake time, getting out of bed when awake and frustrated — along with the anxiety generated by sleep trackers, and the symptoms that should send a reader to a clinician rather than a book, including possible sleep apnoea and circadian rhythm disorders.

It is for people with insomnia who want the mechanics explained in narrative form by someone who has been through it.

On the evidence: the book's centre of gravity is CBT-I, which is the recommended first-line treatment for chronic insomnia and is better supported than any alternative in this category, so the core guidance rests on solid ground. Its limits are those of reported journalism. It presents no original data, depends on the experts consulted, and ranges across many topics at varying depth. As an accessible and reassuring introduction it works well; readers who want a structured course may do better with a dedicated CBT-I programme or clinician-guided treatment.