Tests, Fixes, and Ideas That Are Shaping My Longevity Strategy

Falling back asleep after a middle-of-night waking is less about technique and more about whether your nervous system was prepared before you got into bed. The capacity to re-enter sleep depends on parasympathetic baseline—your autonomic nervous system’s ability to rapidly shift from sympathetic activation back to vagal dominance. When this baseline is strong, brief nighttime

Waking after 5-6 hours and drifting in and out for the rest of the night typically isn’t a sleep hygiene problem—it’s a sleep architecture problem. The issue sits in the second half of the night, where three mechanisms tend to break down: cholinergic-GABAergic imbalance (disrupting the REM/non-REM switching that governs sleep stage transitions), insufficient daytime

A guide for midlife adults who don’t fit the “classic” apnea mold. Guest post collaboration between Chris Gouveia, MD (SleepDocs) and Kat Fu, M.S., M.S. (The Longevity Vault).

Chris Gouveia, MD is a board-certified ENT surgeon and sleep apnea specialist practicing in the Bay Area of California. He completed his medical training at UCSF and his sleep fellowship at Stanford University, where co-author Kat Fu also completed her second masters degree. Dr. Gouveia treats a wide spectrum of OSA and sleep-disordered breathing, with a focus on personalized care. He shares clinical insights and evidence-based analysis on the business, tech, and finance of sleep health through his newsletter at sleepdocs.substack.com.

If you picture someone with obstructive sleep apnea, the stereotype is familiar: a heavier middle-aged man, snoring loudly and nodding off at stoplights.

That patient exists.

But in clinic, that’s increasingly not the person I see.

Instead, I see the 52-year-old marathoner who wakes up feeling like he has a hangover without drinking, the 61-year-old executive whose bloodwork looks great but who lives with constant brain fog, and the 58-year-old teacher who eats well, walks every day, does “everything right”—and still feels like sleep never truly restores her.

You’ve probably seen “CBT-I” mentioned as the non-drug treatment for insomnia. Cognitive Behavioral Therapy for Insomnia (CBT-I) is a structured, skills-based approach that changes habits, thoughts, and scheduling around sleep.

Insomnia becomes more common with age; roughly 20–30% of older adults live with insomnia, often for years. It’s linked with memory and concentration problems, mood changes, higher fall risk, and worse outcomes in conditions such as heart disease and chronic pain.

Major guidelines, including those supported by the American Academy of Sleep Medicine, recommend CBT-I as the first-line treatment for chronic insomnia, especially in older adults where sedative-hypnotic drugs can raise fall and confusion risk.

At the same time, CBT-I has trade-offs:

It asks you to follow a very regular schedule and temporarily cut time in bed (“sleep restriction”), which can be tiring in the short term.

It takes effort: sleep diaries, behavioral changes, and challenging long-held beliefs about sleep.

Access can be limited – there are not many clinicians trained in CBT-I, and traditional one-to-one therapy is time-intensive and expensive.

In this review, we’ll walk through four recent peer-reviewed studies (2023–2025) that help answer practical questions for adults in midlife and beyond:

What can CBT-I actually do for sleep and daytime function?

How does it seem to work in the brain?

What’s realistic to expect – and by when?

Who tends to benefit most, and where are the limits?

How can you use this evidence to decide whether CBT-I is a good fit for you?

Let’s get started.

Become the CEO of your sleep—so you can have more energy to do the things you love

Your brain produces its own sleep-supporting compound—allopregnanolone—that acts on the same GABA-A receptors targeted by drugs like Valium, but with a broader and more sophisticated mechanism. Unlike benzodiazepines, which only bind synaptic receptors to create short bursts of sedation (often suppressing deep sleep and REM), allopregnanolone also activates extrasynaptic δ-containing receptors that generate steady, background

You already know that sleep is not just about feeling rested.

Poor or fragmented sleep affects memory, mood, blood sugar, blood pressure, and how much reserve you feel you have for the things you care about most. For many, the options that get suggested first are medications or supplements, and movement often does not enter the conversation.

Exercise, however, is one of highest impact health (& sleep improvement) strategy you fully control.

It interacts with your circadian rhythm, your stress response, your muscles, and your brain. It can potentially deepen your sleep, shorten how long you lie awake during your sleep, and reduce the emotional “charge” around insomnia.

It also has its own direct links to brain health and dementia risk.

Over just the last few years, research on exercise and sleep has accelerated: large wearable-device datasets, pooled analyses of dozens of trials, and brain-imaging work now give a more 3-dimensional view of how movement interacts with your sleep than we have ever had before.

When you look at this newer research as a whole, every decision to move a bit more becomes a positive step you are taking towards sleeping, thinking, and functioning better in the years ahead.

In this article, we’ll cover

– How different exercise types can influence your sleep quality and sleep structure

– What large, recent pooled data sets suggest about how much & what kind of exercise seems most effective for sleep

– Which exercise modes—can influence brain circuits in a direction that looks more like good sleepers.

– What an Alzheimer’s study suggests about exercise and sleep architecture at the level of brain pathology.

– Finally, we’ll cover 5 actionable strategies to help you translate all of this into an exercise approach that supports better sleep, more daytime energy, and longevity.

Let’s get started.

Sleep struggles in your 50s, 60s, and beyond aren’t “just aging”—and, they’re often solvable.