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Insomnia


Expert reviewer, Julius Patrick, Senior Clinical Physiologist
Next review due September 2022

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

man looking out window

About insomnia

It’s important to have enough good quality sleep in order to function properly – it helps to rest and repair your body and mind. Most adults need around seven to nine hours’ sleep each night.

Insomnia is thought to affect about a third of people in the UK. You're more likely to have difficulty sleeping as you get older because your sleep pattern changes – half of people over 65 have insomnia at some point.

Symptoms of insomnia

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

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

You might have such problems for a few weeks (short-term insomnia) or they may carry on for longer (long-term insomnia). If you continue to have trouble sleeping over a long time, it can really start to affect all aspects of your life – including work or school, and your social and home life. It can also make you more likely to develop various health problems such as obesity, diabetes, high blood pressure, heart problems and depression.


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


Causes of insomnia

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

  • Environmental factors such as noise, light seeping through your blinds, an uncomfortable bed or feeling too hot or 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 make it difficult to sleep.
  • Something causing you temporary stress or worry such as a new job, work stress, financial concerns or a bereavement in the family may keep you awake.
  • Having a mental health condition such as stress, anxiety or depression may cause insomnia.
  • Jet lag and shift work can disturb your sleep patterns.
  • Drinking alcohol can have a significant impact on your quality of sleep. Many people 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, drinking lots of tea and coffee – can keep you awake.
  • Certain medicines including antidepressants and medicines for high blood pressure and epilepsy can affect how well you sleep.
  • Certain health conditions such as an overactive thyroid, asthma, acid reflux or heart disease can make it hard to sleep. Night sweats due to the menopause may cause insomnia. For more information on this, see our FAQ: Can the menopause cause insomnia?

Self help for insomnia

It’s worth thinking about 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 do’s and don’ts to try.

Dos

  • Establish a regular bedtime routine by going to bed and getting up at roughly the same times every day. Try not to sleep in late to compensate for 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 because this might disturb your sleep.
  • Try to relax before bedtime. You could try having a warm bath, a warm milky drink, reading or listening to soothing music to help you relax. Some people find meditation or mindfulness techniques helpful. There are guides available online that you can try for free.
  • If you can't sleep within half an hour 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, cold, noisy or bright – and you have a supportive, comfy mattress on your bed.
  • Where possible, try to avoid using your bedroom for work.

Don’ts

  • 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.
  • Try to have a break from screen time, including phones and tablets before bed. Using these devices at bedtime is associated with inadequate sleep – particularly in children.
  • Don’t take naps during the day. It can make it difficult for you to sleep at night.

Seeking help for insomnia

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

If there doesn’t seem to be an obvious cause for your insomnia, they may suggest keeping 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 wake 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

Devices that track your sleep can often give you an estimate of the amount of sleep you’re getting. But they’re not always very accurate, so you shouldn’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 tests for insomnia involve?

Treatment of insomnia

If you have any health conditions that could be affecting your sleep, your GP will make sure you’re receiving the right treatment for these. For instance, if you’re waking up due to pain or hot flushes, your GP can prescribe treatment. They will also go through the sleep hygiene measures listed in the section, Self-help for insomnia. They may suggest some of the following treatment options.  

Behavioural therapies

If you’ve been having trouble sleeping for several weeks or more, your GP may suggest referring 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 is often combined with one of the other methods.
  • 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 an appropriate 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.

Medicines

Doctors only recommend medicines for insomnia (sleeping pills) as a last resort, if you’re unable to function during the day because of insomnia. These medicines are often associated with side-effects such as making you feel sleepy 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 take them, you should only use them for as short a time as possible.

The main types of sleeping tablets include the following.

  • Antihistamines, which you can buy over-the-counter from your pharmacy without a prescription. Examples are Nytol, Phenergan and Sominex. These aren’t suitable if you’re pregnant, breastfeeding or have certain health conditions. If you’re in any doubt, check with your pharmacist or doctor before taking them.
  • Hypnotic medicines, which your GP may prescribe for a limited time if your insomnia is having a really severe effect on your day-to-day life. Examples include benzodiazepines, such as temazepam or loprazolam, and non-benzodiazepine ‘z-drugs’, such as zopiclone, zaleplon or zolpidem.
  • Melatonin, which your doctor may prescribe for up to 13 weeks, if you’re over 55 and are having 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.

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 during the day after using them, for example.

Complementary therapies

There isn’t enough good quality research to show whether complementary therapies like acupuncture, homeopathy and herbal remedies help with insomnia, but some people do try them. If you decide to give them a try, make sure you choose a reputable practitioner, registered with the appropriate regulatory body.

Frequently asked questions

  • Yes, insomnia is common during the menopause – often because of symptoms such as hot flushes and night sweats.

    Making a few lifestyle changes can help to reduce hot flushes and night sweats. Try wearing lighter clothing or sleeping in a cooler room. And try to avoid potential triggers, such as spicy food, caffeine, smoking and alcoholic drinks.

    If you're finding it difficult to manage symptoms of the menopause, your GP may suggest trying hormone replacement therapy (HRT). This can help to 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.

  • 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:

    • it taking you less than half an hour to fall asleep
    • you have fewer than three 'mini wakes' (when you briefly wake up for a minute or two) – throughout the night
    • 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.

  • Most people with insomnia can be diagnosed simply by describing their symptoms to their GP.

    If your GP thinks your insomnia may be caused by a specific sleep disorder, they may refer you to a sleep clinic or a specialist for further tests. Such disorders include sleep apnoea and restless leg syndrome. Specific sleep disorder tests include the following.

    • Actigraphy. This can track your sleep habits over extended periods of several days or more. You wear a small, wristwatch-sized device that monitors your movement in relation to times of day.
    • 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, although some private clinics offer a service where it can be performed in your own home.

    Your doctor may use these tests alongside sleep diaries to identify any sleep-related problems that you may have.


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Related information

    • Insomnia. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised April 2015
    • Insomnia. BMJ Best Practice. bestpractice.bmj.com, last updated June 2019
    • Sleeping well. Royal College of Psychiatrists, September 2015. www.rcpsych.ac.uk
    • Sleep. Encyclopaedia Britannica. www.britannica.com, last updated 3 July 2019
    • Healthy living. Oxford handbook of general practice. Oxford Medicine Online. oxfordmedicine.com, published online April 2014
    • Sleeping well. Royal College of Psychiatrists. www.rcpsych.ac.uk, updated July 2014
    • 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
    • How to cope with sleep problems. Mind. www.mind.org.uk, published November 2016
    • Personal communication, Julius Patrick, Senior Clinical Physiologist, 12th August 2019
    • Carter B, Rees P, Hale L, et al. Association between portable screen-based media device access or use and sleep outcomes: a systematic review and meta-analysis. JAMA Pediatr 2016; 170(12):1202–208
    • Lee JM, Byun W, Keill A, et al. Comparison of wearable trackers' ability to estimate sleep. Int J Environ Res Public Health 2018; 15(6):1265. doi:10.3390/ijerph15061265
    • Health app: Sleepio for adults with poor sleep. National Institute for Health and Care Excellence (NICE), November 2017. www.nice.org.uk
    • Hypnotics and anxiolytics. NICE British National Formulary. bnf.nice.org.uk, last updated 3 July 2019
    • Sleeping pills and minor tranquillisers. Mind. www.mind.org.uk, published August 2016
    • Melatonin. NICE British National Formulary. bnf.nice.org.uk, last updated 3 July 2019
    • Menopause. BMJ Best Practice. bestpractice.bmj.com, last reviewed June 2019
    • Insomnia. Medscape. emedicine.medscape.com, last updated 11 September 2018
  • Reviewed by Pippa Coulter, Freelance Health Editor, Bupa Health Content Team, September 2019
    Expert reviewer, Julius Patrick, Senior Clinical Physiologist
    Next review due September 2022



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