Sleep medications can improve sleep when matched to specific problems, but they're not the foundation of good sleep—behavioral interventions are. Peter Attia explores why 36% of Americans struggle with sleep, the four mechanisms driving insomnia, and how different drug classes affect sleep architecture, dependence risk, and long-term health, including promising new DORAs that may prevent Alzheimer's by preserving deep sleep. Most sleep problems stem from disruptions in sleep pressure, circadian timing, hyperarousal, or sleep architecture; medications only work when matched to the specific mechanism being treated.