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Insomnia

Insomnia is when it’s difficult for you to get to sleep or to stay asleep for long enough to feel refreshed the following morning. This normally happens even if you’ve had enough time to sleep. Insomnia can affect your quality of life and how you feel during the day. For example, you might feel tired and find it hard to concentrate.

Up to one in three people in the UK are thought to have insomnia at some point in their lives. More women get insomnia than men. As you get older, you're more likely to have difficulty sleeping – half of people over 65 have insomnia at some time.

There are two types of insomnia.

  • Primary insomnia has no obvious cause.
  • Secondary insomnia is caused by another health condition.

Insomnia can also be described further as either short-term or long-term.

  • Short-term insomnia lasts for between one and four weeks.
  • Long-term insomnia lasts for more than four weeks.

Stages of sleep

Sleeping is part of our natural behaviour − we don't choose to sleep, it happens automatically. Without it you won’t be able to function. It’s as important to your body as eating, drinking and breathing. Sleeping helps to rest and repair your body and mind.

Sleep is made up of two main stages – the first is called non-rapid eye movement (non-REM) sleep. During non-REM sleep you will move around more, but your brain won’t be as active. This type of sleep usually has three stages.

  • Pre-sleep is when your muscles are relaxed and your heart rate and breathing slow down.
  • Light sleep is when you're lightly asleep and can still be woken up easily and won't feel confused.
  • Slow wave sleep is when you’re in deep sleep. If someone does wake you, you may feel disorientated and confused. Slow wave sleep is the time when you might sleepwalk or talk in your sleep.

The second stage is called rapid eye movement (REM) sleep. This is when your eyes move from side-to-side and your brain is very active, but your muscles are totally relaxed. You dream mostly during REM sleep.

The stages of sleep happen in cycles, usually lasting between one to two hours. You will move from pre-sleep, light sleep, to slow wave sleep, then to REM sleep and back again during the course of a night. You may have up to five cycles of sleep during a typical night.

The amount of sleep you need varies from person to person. Most adults need seven to eight hours but some people can manage with much less. Depending on how old you are, you may need little or more sleep. A baby needs about 17 hours a day, whereas an older child needs about nine to 10 hours a day.

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Details

  • Symptoms Symptoms of insomnia

    Symptoms of insomnia may include:

    • difficulty getting to sleep
    • difficulty staying asleep (waking up often and finding it hard to get back to sleep)
    • waking up early in the morning
    • feeling tired, irritable and unable to concentrate the next day

    If you consistently can’t sleep, you may start to feel worried and depressed.

    If you have any of these symptoms, see your GP for advice.

  • Diagnosis Diagnosis of insomnia

    If your sleep problems are affecting your quality of life, see your GP. They will ask about your symptoms and may examine you, as well as ask about your medical history.

    Most people don’t need to have special sleep tests. Your GP will often be able to diagnose if you have insomnia from your sleep pattern. To understand this, they might ask you to keep a sleep diary for at least two weeks. You will record things like:

    • the time you go to bed
    • how long it takes you to get to sleep
    • how often you wake up during the night
    • what time you wake up
    • if you feel tired during the day and if you’ve had any naps

    Your GP might also ask you to record what you're doing during the day and just before you go to bed. This could be things like when you have your meals or whether you have drinks with caffeine in them.

    If your GP thinks there’s an unusual cause for your insomnia they may refer you to a sleep specialist for more tests. See our FAQs section for more information.

  • Treatment Treatment of insomnia

    Self-help

    Good sleep hygiene can help you to develop a healthy sleep routine. Sleep hygiene simply means good sleep habits. To help you get a good night’s sleep, below are some do’s and don’ts to try.

    Do’s

    • Take regular exercise, but don't do strenuous activity within four hours before you go to bed as this may disturb your sleep.
    • A warm bath, a warm milky drink, reading or listening to soothing music may help you relax before you go to sleep.
    • Go to bed at the same time each night and get up at the same time each morning. This will help you develop a sleep pattern. 
    • Only go to sleep when you’re feeling sleepy. If you can't sleep, go to a different room and read, listen to quiet music or do something relaxing until you feel sleepy.
    • Make sure your room isn't too hot or cold, or too noisy. Have a supportive mattress on your bed. Wear ear plugs or an eye mask if it helps you filter out any noise or light.
    • Use your bedroom for sleep and sex only and not for work.
    • If something is on your mind, but you can’t do anything about it right away, write it down before you go to sleep. You can then sort it out the next day.

    Don’ts

    • Don't have drinks that contain caffeine or alcohol within six hours before going to bed.
    • Don't smoke before going to bed.
    • Don't have heavy or rich meals, especially within a few hours before you go to bed.
    • Try not to look at your clock. This is because it might make you feel more frustrated about being awake and stop you getting back to sleep.
    • Turn off or put away electronic devices that have screens, for example phones, tablets and televisions.
    • Don’t take naps during the day. Napping during the day can make it difficult for you to sleep at bedtime.

    Behavioural therapies

    The following therapies can help you learn about improving your sleep.

    • Cognitive behavioural therapy (CBT) can help you to deal with any worries that may lead to sleep problems. It can also help you develop positive ideas about sleep, reducing any worrying about the consequences of not getting enough sleep. CBT teaches you to understand what healthy sleep is and how to deal with any negative thoughts about sleep.
    • Stimulus-control therapy can help you to connect your bed with going to sleep and to create a regular sleep routine. It may involve you getting out of bed and doing something relaxing if you’re unable to fall asleep within 15 to 20 minutes.
    • Relaxation therapy can help you relax your muscles and clear your mind of distracting thoughts.
    • Sleep-restriction therapy limits the amount of time you spend in bed to the time when you’re actually asleep. You may go to sleep later and wake up earlier to make you spend more time in bed asleep.

    Medicines

    Some medicines can treat insomnia, but they may not work for very long and can sometimes make you feel drowsy the following day. Once you start taking medicines to help you sleep, you may also find that you need to take more and more to get the same effect. These medicines can be addictive and may cause side-effects. Elderly people in particular have a greater risk of having side-effects like confusion, which can lead to falls and injuries.

    If you have severe insomnia, your GP may prescribe you a hypnotic medicine, such as temazepam or zopiclone. You can take these medicines for up to two weeks. It’s important that you don’t drive, operate machinery or work at heights if you still feel sleepy the morning after taking hypnotics.

    Over-the-counter medicines, such as promethazine, are also available from your pharmacist without a prescription. These types of medicines are called sedative antihistamines. They’re less likely to be addictive, but still have other side-effects such as day-time drowsiness.

    If you’re over 55, your GP may prescribe you melatonin for up to 13 weeks. Melatonin is a hormone that your body produces, which helps to control your sleep pattern. It’s worth bearing in mind though that melatonin can cause side-effects like irritability, headaches and dizziness.

    If you’d like more information about your treatment options, speak to your GP. He or she will happily discuss these further to help you make a decision that’s right for you.

    Complementary therapies

    Doctors have considered some complementary therapies like acupuncture, homeopathy and herbal remedies as a treatment option for insomnia. But there is some uncertainty about how well they work. At the moment, there’s not very much scientific proof that they help, though lots of people feel they help them.

    If it’s something you’d like to try, your GP or pharmacist may be able to offer some advice. If you consult a complementary therapy practitioner try to check that they are suitably qualified and registered with a recognised body. Remember to ask about side-effects, and if you are taking other prescribed medicines to ask your doctor about any known drug interactions.

    For more information about acupuncture and insomnia, please see our FAQs section.

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  • Causes Causes of insomnia

    The causes of insomnia aren’t always obvious. A number of things can lead to it. Some of the main ones are listed below.

    • Environmental factors such as noise, an uncomfortable bed or being too hot or cold.
    • Lifestyle habits, for example not having a regular sleep routine, eating late at night, not getting enough exercise, or exercising too late at night.
    • Problems that affect your mental health, such as stress, anxiety and depression.
    • Jet lag and shift work can also disturb your sleep patterns.
    • Smoking, alcohol and drinks that contain caffeine, for example tea and coffee.
    • Some medicines can affect how well you sleep. Some examples include antidepressants or certain medicines that treat high blood pressure or epilepsy.
    • Physical health problems, including overactive thyroid, asthma, digestion problems (such as acid reflux), heart disease or the menopause. For more information on whether the menopause can cause insomnia, please see our FAQs section.
  • FAQs FAQs

    Can the menopause cause insomnia?

    Answer

    Yes, symptoms of the menopause, such as hot flushes and night sweats, can sometimes cause insomnia.

    Explanation

    The menopause occurs when your ovaries stop producing eggs. The average age of natural menopause for women in the UK is 52. During menopause, the levels of certain hormones, such as oestrogen, in your body decrease. This can cause hot flushes and night sweats. These symptoms can last for between two and five years. Hot flushes and night sweats can wake you up in the night and cause you to have trouble sleeping.

    Cutting down the amount of spicy food you eat and hot or alcoholic drinks you have might help to reduce hot flushes and night sweats. Keeping your bedroom cool and well ventilated with fresh air may also help.

    If you're worried that you're not getting enough sleep, see your GP for advice. He or she may prescribe hormone replacement therapy (HRT) to help control your symptoms, which may help you to sleep. HRT is available in a number of forms, for example as tablets, skin patches, or an implant. There are risks and benefits of taking HRT, so it’s important to talk them through with your GP.

    Does acupuncture work as a treatment for insomnia?

    Answer

    At the moment, there isn’t enough proof to suggest that acupuncture can help to improve insomnia.

    Explanation

    Acupuncture is a type of complementary medicine that involves inserting fine needles into your skin at certain points on your body. It’s based on the idea that the acupuncture needles trigger changes in your body which may help to promote sleep.

    Experts have looked at how well acupuncture works for insomnia. There isn’t enough proof from the research that’s been done that can tell us whether it works or not and how safe it is.

    If it’s something you’re interested in trying, finding out a bit more about what it involves can help you make a decision. It’s important that you go to a reputable practitioner if it’s something you’d like to try. Also let the acupuncturist know if you’re taking any medicines. It’s important not to stop taking any medicines that you have been prescribed by your GP without seeking medical advice first.

    Will over-the-counter medicines help with my insomnia?

    Answer

    Over-the-counter remedies may help with your insomnia, but they should only be taken occasionally.

    Explanation

    There are several remedies that you can buy from your pharmacy without a prescription. These usually contain antihistamines. They may help with your insomnia, but they can often make you feel sleepy the next morning. For this reason, don't drive or operate machinery the day after you have taken them.

    Don’t take these remedies for long periods of time because you can start to become tolerant to them. This means that they won't work as well as they did when you started using them. You may also need to take higher doses to get the same effect. If you’re taking an over-the-counter remedy that contains antihistamines, there’s also a chance you may develop side-effects, such as a headache.

    Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    How do I know whether I’m getting a good night's sleep or not?

    Answer

    The amount of sleep you need is individual to you but, in general, most adults need seven to eight hours sleep a night.

    Explanation

    It should take you less than half an hour to fall asleep. You should generally sleep for between seven and eight hours a night, but this can vary. You may wake up for a couple of minutes every two hours or so but you shouldn’t be aware of these 'mini wakes'. Once you have woken up in the morning you should feel refreshed.

    If you’re having trouble getting to sleep and feel that it’s affecting how you feel in general, see your GP for advice.

    What do tests for insomnia involve?

    Answer

    Most people can be diagnosed with insomnia simply by describing their symptoms to their GP. To understand your sleep pattern, he or she may ask you to keep a sleep diary for at least two weeks. If your GP thinks something else is causing your insomnia, they may refer you to a sleep specialist at a sleep clinic for some tests.

    Explanation

    Your doctor may use tools such as the Pittsburgh Sleep Quality Index or the Epworth Sleepiness Scale to identify if you have insomnia. These tests can also be used to assess how severe it is. You may be asked to fill out a questionnaire. This will provide your doctor with information about your sleep habits and the quality of your sleep. If you’ve already had treatment for insomnia and it hasn’t worked, there are other tests that can help find out what may be the problem. These include the following.

    • A polysomnography test can record your brain activity, eye movements, sleep quality, heart rate, and blood pressure as well as assess your breathing. You will usually need to stay overnight at a sleep clinic for this test. This test may be able to diagnose other causes of insomnia such as obstructive sleep apnoea.
    • An actigraphy test can track your sleep habits over weeks or even months. You wear a small, wristwatch-sized device that monitors your movement while you’re asleep.

    These tests will allow your doctor to watch your sleep patterns and identify sleep-related problems that you don't know you have or can't describe.

    For more information about tests for insomnia, speak to your GP.

  • Resources Resources

    Further information

    Headspace This tool describes itself as gym membership for your mind using meditation and mindfulness techniques. You can start off with free 10-day introduction to meditation and then choose to subscribe for access to more exercises covering a range of topics. You can use it on your phone or computer, depending on what suits you best.
    Mental Health Foundation The Mental Health Foundation is a charity that carries out research and offers information about many areas of mental health. If you have problems with your sleep, this page is for you. It has details of some reasons that are behind having trouble sleeping and suggestions of things you can try to help yourself sleep better.
    Mind The charity Mind has information to support people with a mental health condition and those who care for them. Their sleep content has tips on practical things you can do to help yourself if you’re not sleeping well.

    Sources

    • Insomnia. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published July 2009
    • Insomnia. PatientPlus. www.patient.co.uk/patientplus.asp, published 28 September 2011
    • Sleep matters: The impact of sleep on health and wellbeing. Mental Health Foundation.
    • www.mentalhealth.org.uk, published January 2011
    • Insomnia. BMJ Best Practice. www.bestpractice.bmj.com, published 11 September 2013
    • Simon C, Everitt H, van Dorp, F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press; 2010:196 (printed version)
    • Sleep disorders. Oxford handbook of psychiatry (online). Oxford Medicine Online. www.oxfordmedicine.com, published March 2013 (online version)
    • Sleeping Well. Royal College of Psychiatrists. www.rcpsych.ac.uk, published October 2013
    • Insomnia. Medscape. www.emedicine.medscape.com, published 27 May 2013
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 23 June (online version)
    • Melatonin. The Merck Manuals. www.merckmanuals.com, published August 2013
    • Cheuk DKL, Yeung WF, Chung KF, et al. Acupuncture for insomnia. Cochrane Database of Systematic Reviews 2012, Issue 9. doi: 10.1002/14651858.CD005472.pub3
    • Sarris J, Byrne GJ. A systematic review of insomnia and complementary medicine. Sleep Med Rev 2011; 15(2):99−106. doi:10.1016/j.smrv.2010.04.001
    • Menopause. BMJ Best Practice. www.bestpractice.bmj.com, published 24 December 2013
    • Menopause. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published June 2013
    • Menopause. PatientPlus. www.patient.co.uk/patientplus.asp, published 21 October 2013
    • Polysomnography. Medscape. www.emedicine.medscape.com, published 2 May 2014
    • Actigraph. Medscape. www.emedicine.medscape.com, published 11 February 2013
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