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Insomnia

Expert reviewers, Amy Gallagher, Senior Sleep Physiologist and Dr Ade Adeniyi, Bupa Health Clinics GP
Next review due January 2025

Insomnia is when you find it difficult to get to sleep or stay asleep for long enough to feel refreshed the next morning. If you feel tired and find it hard to concentrate during the day, it can affect your quality of life.

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About insomnia

It’s important to get enough good quality sleep to be able to function properly. Sleep helps to rest and repair your body and mind. Most adults need around seven to nine hours’ sleep each night.

Insomnia affects about a third of people in the UK. You're more likely to have difficulty sleeping as you get older. This is because your sleep pattern changes.

Causes of insomnia

There can be many things that contribute to insomnia. Here are just some of the potential causes. 

  • Your bedroom environment – noise, light seeping through your blinds, an uncomfortable bed, feeling too hot or too cold can all affect your ability to sleep.
  • Lifestyle habits such as an irregular sleep routine, eating late at night, not getting enough exercise or exercising too late at night can all make it difficult to sleep.
  • Something that causes stress or worry such as a new job, work stress, financial concerns or a bereavement in the family may keep you awake.
  • A mental health condition such as stress, anxiety or depression may contribute to insomnia.
  • Jet lag and shift work can disturb your sleep patterns.
  • Drinking alcohol can have a significant impact on your quality of sleep. You may see alcohol as a way to help with sleep problems but the effect it has on your sleep can make the situation worse.
  • Too much caffeine – for instance, from drinking lots of tea and coffee – can keep you awake.
  • Some medicines including antidepressants and medicines for high blood pressure and epilepsy can affect how well you sleep.
  • Some health conditions – for example, an overactive thyroid, asthma, acid reflux or heart disease – can make it hard to sleep. Night sweats due to the menopause may cause insomnia, as can pain from conditions such as osteoarthritis.


What’s keeping you up at night?

One in three Brits are suffering from poor sleep. Take a look over our tips in The Sleep Series to help make sure you’re getting the right amount of sleep each night.


Learn more


Symptoms of insomnia

If you have insomnia, it means that despite having the time and opportunity to get enough sleep, you may:

  • find it difficult to get to sleep
  • find it hard to stay asleep (you might wake up often and find it hard to get back to sleep)
  • wake up early in the morning
  • feel tired, irritable and unable to concentrate the next day
  • have memory problems
  • feel worried about not getting enough sleep

You may have insomnia symptoms for up to a few months (short-term insomnia). Or they may carry on for longer (long-term or chronic insomnia). If you continue to have trouble sleeping over a long time, it can really start to affect all aspects of your life. This includes work or school, and your social and home life. It can also make you more likely to develop various health problems such as:

  • diabetes
  • high blood pressure
  • heart problems
  • depression – while you’re trying to sleep, your mind may race with thoughts about problems and worries
  • obesity

  • Insomnia can also increase your risk of having an accident, perhaps at work or when driving.

    Self help for insomnia

    There are ways to improve your sleep habits and routines to help you to sleep well. This is often referred to as ‘sleep hygiene’. Here are some dos and don’ts to try.

    Dos

    • Try to go to bed and get up at roughly the same times every day. And don’t sleep in late to compensate if you’ve had a bad night’s sleep.
    • Make sure you get some regular exercise, but don't do any strenuous activity within four hours of going to bed. This might disturb your sleep.
    • Try to relax before you go to bed. You could try having a warm bath or a warm milky drink, reading or listening to soothing music to help you relax. Some people find relaxation or mindfulness techniques helpful. There are guides available online that you can try for free.
    • If you can't sleep within 20 minutes or so, get up and do something relaxing like reading until you feel tired enough to sleep. If something is on your mind, write it down and aim to deal with it the next day.
    • Make sure your bedroom is comfortable – not too hot or cold, not too noisy or bright. And make sure you have a supportive, comfy mattress on your bed. The ideal temperature of your bedroom for sleeping is around 18°C.
    • Where possible, avoid working in your bedroom; use it just as a place for sleep and sex.

    Don’ts

    • Don't have any drinks that contain caffeine after midday, or alcohol within two hours of going to bed.
    • Don't smoke before you go to bed.
    • Don't eat a heavy or rich meal within two hours of going to bed.
    • Try not to clock-watch. It might make you feel more frustrated about being awake and stop you getting back to sleep.
    • Try to have a break from screens, including phones and tablets, for two hours before you go to bed. Using these devices at bedtime is associated with poor sleep.
    • Don’t take naps during the day because it can make it difficult for you to sleep at night.

    Getting help for insomnia

    If you’ve tried self-help measures and you’re still having trouble sleeping and feel you need help, it’s worth seeing your GP for advice. Your GP will ask you about your sleep patterns and how lack of sleep is impacting your life. They may also examine you to look for any signs of a physical condition that could affect your sleep. Your GP may be able to tell what might be causing your problems with sleep just from talking to you.

    If there doesn’t seem to be an obvious cause for your insomnia, they may suggest you keep a sleep diary for a couple of weeks. It can be a good idea to do this before your appointment. 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 and for how long
    • what time you get up in the morning
    • if you feel tired during the day or have any naps
    • your mealtimes and how much alcohol and caffeine you drink during the day
    • how much exercise you do or any significant events during the day
    • how you rate your night’s sleep on a scale of 1 to 5 where 1 is very poor and 5 is very good

    Devices that track your sleep can give you an estimate of the amount of sleep you’re getting. But they’re not always accurate, so don’t rely on them. If your GP thinks you might have a specific sleep disorder, they may refer you to a sleep specialist for more tests. For more information, see our FAQ: What do insomnia tests involve?

    If you need help now

    This page is designed to provide general health information. If you need help now, please use the following services.


    If you think you might harm yourself or are worried someone else might come to immediate harm, call the emergency services on 999 or go to your local accident and emergency department.

    Treatment of insomnia

    If you have any health conditions that could be affecting your sleep, your GP will make sure you get the right treatment for these. For instance, if you’re waking up because of pain or hot flushes, your GP can prescribe treatment. They’ll also discuss the sleep hygiene measures listed in our section: Self-help for insomnia. In addition, they may suggest some of the following treatment options.

    Behavioural therapies

    If you’ve been having trouble sleeping and self-help measures haven’t worked for you, your GP may refer you to psychological services to try a behavioural therapy. These may include the following.

    • Cognitive behavioural therapy (CBT) can help you to recognise and deal with any negative thoughts and habits around your sleep. CBT may be combined with another therapy or treatment.
    • Stimulus-control therapy can help you to re-associate your bed and bedroom with going to sleep and to create a regular sleep routine.
    • 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.

    Your GP may refer you to a specialist who can provide these therapies, or they may provide you with self-help materials. In some areas, your GP may be able to give you access to online CBT-based self-help tools such as Sleepio.
    If your GP thinks a health problem is affecting your sleep – for example, sleep apnoea or restless leg syndrome – they may refer you to a specialist sleep doctor.

    Medicines

    Doctors only recommend medicines for insomnia (sleeping pills) as a last resort and if you’re unable to function during the day because of insomnia. These medicines often have side-effects such as drowsiness the next day. They also become gradually less effective the longer you take them. And you can become dependent on them if you take them for a long time. If you do take sleeping pills, use them for as short a time as possible. Ask your doctor for advice on how long this should be.

    The main types of sleeping tablets include the following.

    • Antihistamines that you can buy from your pharmacy without a prescription. Examples are Phenergan and Sominex, as well as diphenhydramine (Nytol), although there isn’t any good evidence for this one. Antihistamines aren’t suitable if you’re pregnant, breastfeeding or have certain health conditions – check with your pharmacist or doctor before you take them.
    • Hypnotic medicines that your GP may prescribe for a limited time (usually three to seven days) if your insomnia is having a severe effect on your day-to-day life. Examples include benzodiazepines such as temazepam or loprazolam, and non-benzodiazepine ‘z-drugs’ such as zopiclone or zolpidem.
    • Melatonin, which your doctor may prescribe for up to 13 weeks if you’re over 55 and have ongoing problems with insomnia. Melatonin is a hormone that your body produces, which helps to control your sleep pattern. It’s worth bearing in mind that it can cause some side-effects like headaches and joint pain, as well as increase your risk of falls.

    If you take sleeping pills, be sure to follow any advice from your doctor or pharmacist and take note of any warnings in the information leaflet. These may include not driving or operating machinery the next day, for example.

    Complementary therapies

    There isn’t enough good quality research to show if complementary therapies such as acupuncture, homeopathy and herbal remedies (such as valerian) help with insomnia. But some people do try them. If you decide to give these therapies a try, make sure you choose a reputable practitioner who is registered with the appropriate regulatory body.

    Frequently asked questions

    • The amount of sleep you need is individual to you, but most adults need about seven to nine hours’ sleep a night. General signs of a good night’s sleep include taking less than half an hour to fall asleep and feeling refreshed once you’ve woken up in the morning.

      See our section: Symptoms of insomnia for more information.

    • Insomnia tests may include actigraphy, which tracks your sleep over several days or more on a wristwatch-sized device that monitors your movement in relation to times of day. Another test is a polysomnography, which records your brain activity, eye movements, sleep quality, heart rate and blood pressure, and breathing overnight.

    • You can change your sleep habits and routines to help you to sleep well. This is called ‘sleep hygiene’. It includes making sure your bedroom is the right temperature and sticking to a regular bedtime routine. If this doesn’t work for you, your doctor may prescribe a medicine or refer you for behavioural therapy such as CBT or relaxation therapy.

      See our sections: Self-help for insomnia and Treatment of insomnia for more information.

    • Many things can cause insomnia. Your bedroom environment may not be right; for example, light coming through your blinds may disturb your sleep. And if you’re stressed or worrying about particular problems, you may have a bad night’s sleep. Jet lag can also disturb your sleep patterns.

      See our section: Causes of insomnia for more information.

    • If something changes in your life, it may bring on insomnia. Perhaps you’ve started a new job or you have demanding deadlines or financial concerns. Or a recent death in the family may affect your sleep. Changes to your sleeping patterns can also bring on insomnia – for example, having a new baby or starting shift work.

      See our section: Causes of insomnia for more information.

    • Insomnia isn’t classified as a mental health condition but the two are linked. About half of people diagnosed with insomnia also have a mental health condition. Research shows that sleep plays a major role in regulating emotion and how we process emotions. There’s evidence that insomnia increases the risk of developing depression and anxiety, for example.



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    Related information


    • Discover more helpful health information websites.

      • Insomnia. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised March 2021
      • Brain basics: understanding sleep. National Institute of Neurological Disorders and Stroke. www.ninds.nih.gov, date last modified 13 August 2019
      • Wilson S, Anderson K, Baldwin D, et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: an update. J Psychopharmacol 2019; 33(8):923–47. doi:10.1177/0269881119855343
      • Insomnia. Patient. patient.info, last edited 30 September 2019
      • Hypnotics and anxiolytics. NICE British National Formulary. bnf.nice.org.uk, last updated 6 October 2021
      • Insomnia. BMJ Best Practice. bestpractice.bmj.com, last reviewed 9 October 2021
      • Riemann D, Baglioni C, Bassetti C, et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res 2017; 26(6):675–700. doi:10.1111/jsr.12594
      • Sleep environment. The Sleep Charity. thesleepcharity.org.uk, accessed 10 November 2021
      • Sohn SY, Krasnoff L, Rees P, et al. The association between smartphone addiction and sleep: a UK cross-sectional study of young adults. Front Psychiatry 2021; 12:629407. doi:10.3389/fpsyt.2021.629407
      • A good night's sleep. National Institute on Aging. www.nia.nih.gov, content reviewed 3 November 2020
      • Baron KG, Abbott S, Jao N, et al. Orthosomnia: are some patients taking the quantified self too far? J Clin Sleep Med 2017; 13(2):351–4. doi:10.5664/jcsm.6472
      • Insomnia. Medscape. emedicine.medscape.com, updated 5 January 2020
      • Health app: Sleepio for adults with poor sleep. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, published 9 November 2017
      • Promethazine hydrochloride. NICE British National Formulary. bnf.nice.org.uk, last updated 6 October 2021
      • Hypnotics. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, last updated 1 September 2019
      • ICD-11 for mortality and morbidity statistics (ICD-11 mms). World Health Organization. who.int, published May 2021
      • Personal communication, Amy Gallagher, Senior Sleep Physiologist, 16 November 2021
    • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, January 2022
      Expert reviewers, Amy Gallagher, Senior Sleep Physiologist and Dr Ade Adeniyi, Bupa Health Clinics GP
      Next review due January 2025

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