Insomnia
- Dr Ade Adeniyi, Lead physician, Bupa
Insomnia is when you find it difficult to get to sleep or stay asleep for long enough to feel refreshed the next morning. It’s a common problem that can affect your daily life. You may feel tired and find it hard to concentrate during the day.
About insomnia
Sleep helps to rest and repair your body and mind. Getting enough good quality sleep is important. Everyone needs a different amount of sleep to function properly. But most adults need around seven to nine hours’ sleep each night.
Most people find it hard to get to sleep from time to time. If you have insomnia, you regularly:
- find it hard to get to sleep
- wake up in the night and find it hard to get back to sleep
- wake up early in the morning
- feel tired and irritable during the day
Insomnia affects about a third of people in the UK. You’re more likely to have difficulty sleeping as you get older.
Types of insomnia
There are two main types of insomnia. Which type you have depends on what’s causing your sleep problems.
- Primary insomnia is usually linked to stress – it isn’t caused by an underlying health problem.
- Secondary insomnia is caused by an existing medical condition such as depression, a nerve problem, chronic pain or taking certain medicines.
You can also have:
- acute or short-term insomnia – your symptoms last for up to six weeks
- long-term or chronic insomnia – when your symptoms happen several times a week for over six weeks
Causes of insomnia
Lots of things can affect your sleeping patterns. Insomnia can be caused or worsened by:
- your bedroom environment – for example, noise, light seeping through your blinds, an uncomfortable bed, feeling too hot or too cold
- lifestyle habits – for example, an irregular sleep routine, eating late at night, not getting enough exercise, exercising too late at night
- life events or stresses – for example, a new job, work stress, financial concerns, a bereavement
- a mental health condition such as anxiety or depression
- jet lag and shift work
- drinking lots of alcohol
- too much caffeine – for example, from drinking lots of tea and coffee
- some medicines such as antidepressants and medicines for high blood pressure and epilepsy
Some health conditions can affect how well you sleep too. These include:
- other sleep conditions such as snoring, restless leg syndrome, sleep apnoea
- an overactive thyroid
- asthma
- acid reflux
- heart disease
- chronic pain conditions such as osteoarthritis
Night sweats due to the menopause can also cause insomnia.
Symptoms of insomnia
If you have insomnia, you can’t get enough sleep. You may:
- find it difficult to get to sleep at night
- find it hard to stay asleep (you may wake up a lot and find it hard to get back to sleep)
- wake up earlier than you want to in the morning
- feel tired, irritable, and unable to concentrate the next day
- have memory problems
- worry about not getting enough sleep
If your sleeping troubles last for a long time, this can 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
- obesity
Insomnia can also increase your risk of having an accident, perhaps at work or when driving.
Self help for insomnia
Improving your sleep habits and routines may help you sleep better. This is called ‘sleep hygiene’. Here are some dos and don’ts for you 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 two hours of going to bed. This might disturb your sleep.
- Try to relax before you go to bed. For example, to help you relax you could try a warm bath or a warm milky drink, reading or listening to soothing music. Some people find relaxation or mindfulness techniques helpful. There are free guides available online.
- If you can't sleep within 15 to 30 minutes or so, get up and do something relaxing until you feel tired enough to sleep. You could try reading a book in a dimly lit room. If something’s 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 too cold, not too noisy or too bright. And make sure you have a supportive, comfy mattress on your bed. The ideal temperature of your bedroom for sleeping is around 16 to 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 containing caffeine after midday.
- Don’t drink alcohol within six hours of going to bed – it can affect how well you sleep.
- Don't smoke before you go to bed.
- Don't eat a heavy or rich meal near bedtime.
- 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 this 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, it’s worth speaking to your GP. Your GP will ask you about your sleep patterns and how these are affecting your life. They may also examine you to look for any signs of a physical problem 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, your GP 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 such as:
- 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
- how you rate your night’s sleep – for example, on a scale of 1 to 5 where 1 is very poor and 5 is very good
Devices that track your sleep can estimate how much sleep you’re getting. But they’re not always accurate, so don’t rely on them.
Your GP may suggest you have some blood tests to rule out any underlying medical conditions that could affect your sleep – for example, a thyroid problem. If your GP thinks you might have a specific sleep disorder, they may refer you to a sleep specialist for more tests. These include:
- actigraphy – this tracks your sleep over several days or more on a wristwatch-sized device that monitors your movement in relation to times of day
- polysomnography – this records your brain activity, eye movements, sleep quality, heart rate and blood pressure, and breathing overnight
If you need help now
This page is designed to provide general health information. If you need help now, please use the following services.
- Samaritans. 116 123 (UK and ROI) - This helpline is free for you to call and talk to someone.
- NHS Services has a list of where to get urgent help for mental health.
- Mind website. Click the ‘Get help now’ button on the page. This is a tool that is designed to help you understand what’s happening to you and how you can help yourself.
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 your insomnia is caused by an underlying health condition such as chronic pain or night sweats, your GP will discuss the best way to treat it. They’ll also discuss the sleep hygiene measures mentioned in our section on self-help for insomnia. They may also suggest other insomnia treatments such as cognitive behavioural therapy (CBT) or medicines.
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. Behavioural therapies include the following.
- Cognitive behavioural therapy for insomnia (CBTi) is the first treatment to try. It can help you to recognise and deal with any negative thoughts and habits around your sleep. CBTi 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. CBTi isn’t available everywhere in the UK. But 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 if CBTi hasn’t worked and you can’t function during the day because of your insomnia. These medicines often have side-effects such as drowsiness the next day. They also become less effective the longer you take them. 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.
Sedating antihistamines are available to buy from your pharmacy without a prescription for short-term insomnia. Research shows that these sleep aids don’t usually work very well and can cause some side-effects. These can make you feel like you have a hangover the next day. They’re not suitable if you’re pregnant, breastfeeding, or have certain health conditions – check with your pharmacist or doctor before you take them. These medicines include:
- promethazine (Phenergan, Sominex)
- diphenhydramine (Boots Sleepeaze, Nytol)
If you’ve had insomnia for fewer than four weeks, your GP may prescribe hypnotic medicines for a limited time. But only if your insomnia has a severe effect on your day-to-day life. The first choice is non-benzodiazepine ‘z-drugs’ such as zopiclone or zolpidem, which you usually take for 3 to 7 days.
Your doctor may prescribe melatonin for up to 13 weeks if you’re over 55 and have ongoing problems with insomnia. Melatonin is a hormone your body makes. It helps to control your sleep pattern. Melatonin can cause some side-effects, such as joint pain and back pain. It can also cause dizziness and drowsiness, which may increase your risk of falls.
Your GP may prescribe a new medicine called daridorexant for long-term insomnia. But this medicine can cause a lot of side-effects including dizziness, extreme tiredness, headaches, and drowsiness in the day. It also isn’t suitable for everyone. Doctors may prescribe daridorexant on the NHS if:
- you’ve had insomnia for three nights or more each week for at least three months, and it’s affecting your daily life
- cognitive behavioural therapy for insomnia (CBTi) hasn’t worked or isn’t suitable or available
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.
Complementary therapies
There isn’t enough good-quality research to show if complementary therapies (for example 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.
Inside health: Insomnia
Insomnia | Q&A | Watch in 3:39 minutes
Dr Zoe Williams talks to sleep expert Professor Jason Ellis about the causes of Insomnia and what help is available.
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.
Everyone needs a different amount of sleep. But most adults need about seven to nine hours’ sleep a night. If you have insomnia, you find it hard to get to sleep or stay asleep and you may feel tired during the day.
For more information, see our section on symptoms of insomnia.
Changing your sleep habits and bedtime routine may help you to sleep well. This is called ‘sleep hygiene’. If this doesn’t work for you, your doctor may prescribe a medicine or refer you for CBTi or relaxation therapy.
For more information, see our sections on self-help for insomnia and treatment of insomnia.
Lots of things can cause insomnia. Your bedroom may be too bright or too hot or too cold. If you’re stressed or worrying about particular problems, you may have a bad night’s sleep. Some medical conditions can cause insomnia too.
For more information, see our section on causes of insomnia.
If something changes in your life, this can affect how well you sleep. You may have just started a new job or have demanding deadlines or financial worries. Having a new baby or a recent death in the family may affect your sleep too.
For more information, see our section on causes of insomnia.
Insomnia is a sleep disorder. It isn’t classified as a mental health condition but the two can be linked. About half of people diagnosed with insomnia also have a mental health condition. Insomnia is a common sign of depression. Having insomnia can also make you more likely to develop depression.
Anxiety
It’s normal to feel anxious sometimes. But if your anxiety is severe, it can interfere with your everyday life.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is a type of talking therapy. It helps you change how you think, feel and behave.
Benefits of exercise
Not only does regular exercise help you manage your weight and reduce your risk of developing diseases, it can help prevent and treat mental health problems
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- Victoria Goldman, Freelance Health Editor
