Types of insomnia
There are two types of insomnia.
- Primary insomnia has no obvious cause.
- Secondary insomnia is caused by another health condition.
It can also be either short-term or long-term.
- Short-term insomnia lasts for between one and three weeks.
- Long-term (chronic) insomnia lasts longer than four weeks.
Stages of sleep
Sleeping is part of our natural behaviour − we don't choose to sleep, it just happens. Without it you can’t function. It’s as important to your body as eating, drinking and breathing as it helps to rest and repair your body and mind.
There are different stages of sleep. You can read about these in our topic: The science of sleep. We also have a blog about Understanding sleep.
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 can’t sleep and this goes on for a long time, it can really start to affect your quality of life. And you may even feel anxious or depressed about it. If this is happening to you, it’s a good idea to contact your GP for advice.Diagnosis of insomnia
Diagnosis of insomnia
Your GP will ask about your symptoms and your medical history and may examine you.
Most people don’t need to have special sleep tests. Your GP will often be able to diagnose if you have insomnia from you describing your sleep pattern. To enable you to describe it well, it’s a good idea to keep a sleep diary for a couple of weeks before your appointment. Record things like:
- the time you go to bed
- how long it takes you to get to sleep (roughly)
- how often you wake up during the night
- what time you wake up
- if you feel tired during the day
- if you’ve had any naps
It’s also a good idea 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 dinner, or whether you have drinks with caffeine in them. Alternatively, you can track your sleep on electronic devices and watches and show your GP the data.
If your GP thinks you might have a different type of sleep disorder to insomnia, they’ll ask you some more questions. And may refer you to a sleep specialist for more tests. For more information, see our FAQ: Sleeping tests.
Treatment of insomnia
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, here are some dos and don’ts to try.
- Take regular exercise, but don't do any strenuous activity within four hours of going to bed as this might disturb your sleep.
- Have a warm bath, a warm milky drink, read or listen to soothing music – it 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, get up and do something relaxing like reading until you feel tired enough to sleep.
- Make sure your sleeping environment is set up well for sleep. Make sure your room isn't too hot or cold, or too noisy. Have a supportive, comfy mattress on your bed. Wear earplugs or an eye mask if it helps you filter out any noise or light.
- Just use your bedroom for sleep and sex, and not for work.
- If something is on your mind, write it down before you go to sleep. You can then sort it out the next day.
- Don't have any drinks that contain caffeine or alcohol within six hours of going to bed.
- Don't smoke before you go to bed.
- Don't eat a heavy or rich meal late at night.
- Try not to clock-watch. It might make you feel more frustrated about being awake and stop you getting back to sleep.
- Don’t use any electronic devices, such as phones, tablets and televisions in your bedroom.
- Don’t take naps during the day. It can make it difficult for you to sleep at night.
For more tips and advice, see our topics on How to get a good night's sleep and Top tips to a dreamy night’s sleep.
Some therapies can help you learn about how to improve your sleep.
- Cognitive behavioural therapy (CBT) can help you to deal with any worries that may lead to sleep problems. 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 might involve you only going to sleep when you’re tired, for example.
- 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 actually go to sleep. You can then gradually increase the time you spend in bed as your sleep improves.
There are medicines to treat insomnia, but only consider them a last resort if you’re unable to function during the day due to insomnia. Your doctor will usually give you a maximum course of two weeks.
Medicines might not work for long and can sometimes make you feel drowsy the next day, so don’t drive if they affect you this way. Once you start taking medicines to help you sleep, you might also find that you need to take more and more to get the same effect. Some medicines can be addictive and can cause side-effects so think carefully before taking them. Older people are more at risk of having side-effects like confusion, which can lead to falls and injuries.
If you’d like more information about your treatment options, speak to your GP. They’ll help you make a decision that’s right for you.
There are several over-the-counter remedies that you can buy from your pharmacy without a prescription. These usually contain antihistamines. Although they may help with your insomnia, you should only take them occasionally. They’re less likely to be addictive compared to prescription medicines, but still have other side-effects such as headache and feeling sleepy the next morning. Don't drive or operate machinery the next day.
If your insomnia is really bad, your GP may prescribe you a hypnotic medicine, such as eszopiclone, zaleplon zolpidem and temazepam. Some doses can make you feel sleepy the next morning so you might not be able to drive, operate machinery or work at heights. Check with your doctor what dose you have and if it will impair your activities.
The aim is to only take hypnotics for a short time (up to two weeks).
If you’re over 55, your doctor 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 that melatonin can cause side-effects like irritability, headaches and dizziness.
Doctors have considered some complementary therapies like acupuncture, homeopathy and herbal remedies as a treatment option for insomnia. But they aren’t sure about how well they work. At the moment, there’s not much scientific proof that they help. But that said, you might find they help you so you might decide to give them a try.
If you do try them, have a look at our topic: What are complementary therapies and do they work? We also have information about acupuncture and insomnia in our FAQ: Acupuncture for insomnia.
Causes of insomnia
The cause of insomnia isn’t always obvious. Lots of things can lead to it – just some of these include:
- environmental factors such as noise, light seeping through your blinds, an uncomfortable bed or feeling too hot or cold
- lifestyle habits, such as an irregular sleep routine, eating late at night, not getting enough exercise, or exercising too late at night
- an overactive mind – if you’re worrying about events in your life such as a new job, or a bereavement in the family, for example, it can disrupt your sleep
- problems with your mental wellbeing, such as stress, anxiety and depression
- jet lag and shift work, which can disturb your sleep patterns
- smoking, alcohol and drinks that contain caffeine such as tea and coffee
- medicines, such as antidepressants and medicines for high blood pressure and epilepsy, as these can affect how well you sleep
- your age – insomnia is more likely to affect you as you get older
- physical health problems, such as an overactive thyroid, asthma, acid reflux, heart disease or the menopause – see our FAQ: Menopause and insomnia
FAQ: Can the menopause cause insomnia?
Yes, symptoms of the menopause, such as hot flushes and night sweats, can sometimes cause insomnia.
During the menopause the levels of hormones, such as oestrogen, in your body decrease. This can cause hot flushes and night sweats, which can wake you up in the night and make it difficult to sleep.
If you cut down the amount of spicy food you eat, caffeine and alcoholic drinks, it might help to reduce hot flushes and night sweats.
If you're worried that you're not getting enough sleep and have tried self-help treatments (see above), contact your GP for advice. They might prescribe you hormone replacement therapy (HRT) to help control your symptoms, which in turn, may help you to sleep. There are risks and benefits of taking HRT, so it’s important to talk these through with your GP.
FAQ: Does acupuncture work as a treatment for insomnia?
At the moment, there isn’t enough proof that acupuncture can help to improve insomnia.
Acupuncture involves a practitioner 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. If it’s something you’re interested in trying, make sure you go to a reputable practitioner. Check if they’re registered with the Complementary and Natural Healthcare Council (CNHC) – the UK voluntary regulator for complementary healthcare. Remember to let the acupuncturist know if you’re taking any medicines for insomnia.
FAQ: How do I know if I’m getting a good night's sleep?
The amount of sleep you need is individual to you, but most adults need about six to eight hours sleep a night. General signs of a good night’s sleep include:
- it taking you less than half an hour to fall asleep
- being unaware of any 'mini wakes', which are when you wake up for a couple of minutes every two hours or so
- feeling refreshed once you’ve woken up in the morning
If you’re having trouble getting to sleep and feel that it’s affecting your life, contact your GP for advice.
FAQ: What do tests for insomnia involve?
Most people can be diagnosed with insomnia simply by describing their symptoms to their GP. To understand your sleep pattern, it’s a good idea to keep a sleep diary for a couple of weeks before you visit them. If you sleep with a partner, ask them for any insights too. Or use a sleep tracker device. If necessary, your GP will refer you to a sleep specialist at a sleep clinic for some tests.
Your doctor will ask some standard questions to identify if you have insomnia, and how severe it is. They might ask you to fill out a questionnaire. This will give them a good idea about your sleep habits and quality of 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, and assess your breathing. You’ll usually need to stay overnight at a sleep clinic for this test. It may be able to diagnose other causes of insomnia such as obstructive sleep apnoea.
- An actigraphy test can track your sleep habits over several days, 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. Using them alongside a sleep diary can be very useful.
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.
- Insomnia. BMJ Best Practice. bestpractice.bmj.com, last updated 27 January 2017
- Qaseem A, Kansagara D, Forciea MA, et al. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2016; 165(2):125–33. doi: 10.7326/M15-2175
- Insomnia. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised April 2015
- Healthy living. Oxford handbook of general practice (online). Oxford Medicine Online. oxfordmedicine.com, published April 2014
- Insomnia. Medscape. emedicine.medscape.com, updated 1 August 2016
- Sleeping well. Royal College of Psychiatrists. www.rcpsych.ac.uk, updated July 2014
- Wilson SJ, Nutt DJ, Alford C, et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders. J Psychopharmacol 2010; 24(11):1577–601. doi: 10.1177/0269881110379307
- Hysing M, Pallesen S, Morten Stormark K, et al. Sleep and use of electronic devices in adolescence: results from a large population-based study. BMJ Open 2015; 5(1):e006748. doi: 10.1136/bmjopen-2014-006748
- Hypnotics. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, reviewed January 2017
- Antihistamines. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, reviewed January 2017
- Melatonin. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, reviewed January 2017
- Menopause. BMJ Best Practice. bestpractice.bmj.com, last updated 19 January 2016
- Menopause and its management. PatientPlus. patient.info/patientplus, last checked 24 February 2016
- Menopause. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised October 2015
- 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
- What should I look for when choosing or employing a complementary therapist? Complementary and Natural Healthcare Council. www.cnhc.org.uk, accessed 17 February 2017
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Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, February 2017
Expert reviewed by Dr Ari Manuel, Consultant in Sleep Medicine, University of Aintree Hospital
Next review due February 2020
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