What insomnia is
Insomnia is a sleep problem in which you have trouble falling asleep, staying asleep, or you wake up too early and cannot get back to sleep, even though you have the time and a chance to sleep. As a result you feel tired, irritable, and find it hard to concentrate during the day.
Short-term insomnia lasting a few days or weeks is common during stress, travel, illness or grief. When poor sleep happens at least three nights a week for three months or more, doctors call it chronic insomnia. Most adults need about seven to nine hours of sleep, though needs vary.
Common causes of insomnia
Insomnia usually has more than one cause. Often a stressful event starts it, and then worry about sleep and unhelpful habits keep it going, even after the original stress has passed. Older adults naturally sleep more lightly, which makes waking at night more common.
- Stress, anxiety, depression or grief
- Late-night phone, TV or laptop use
- Tea, coffee, energy drinks, alcohol and smoking, especially in the evening
- Shift work and irregular sleep times
- Pain, breathlessness, acidity, frequent urination at night or menopause symptoms
- Sleep apnoea, restless legs and some medicines, such as certain BP, asthma or steroid medicines
Effects on health
Ongoing poor sleep does more than make you tired. It can affect mood, memory and work performance, and increases the risk of accidents while driving or operating machinery. Over time, long-term poor sleep is linked with higher risk of high blood pressure, diabetes, weight gain and depression.
Loud snoring with pauses in breathing, choking or gasping at night, and heavy daytime sleepiness may point to obstructive sleep apnoea. This is a different condition, more common in people who are overweight, and it needs specific treatment. It should not be treated with sleeping pills, which can make breathing pauses worse.
How the doctor assesses it
The doctor will ask about your sleep pattern, daily routine, stress, mood, medicines and any other health problems. Keeping a sleep diary for one to two weeks, noting bedtime, wake time, night waking, naps, caffeine and alcohol, is very helpful. In most cases, no special tests are needed to diagnose insomnia.
If an underlying problem is suspected, the doctor may order blood tests such as thyroid function, blood sugar, haemoglobin or iron levels, or refer you for an overnight sleep study to check for sleep apnoea. Treating the underlying cause, such as pain, acidity or low mood, often improves sleep on its own.
Treatment options for insomnia
The most effective long-term treatment is cognitive behavioural therapy for insomnia (CBT-I). It teaches ways to change thoughts and habits that keep you awake, and its benefits last after treatment ends. It is now available with trained therapists and through guided programmes.
Sleeping pills can help for a short time in some situations, but they may cause dependence, morning drowsiness, falls in the elderly and memory problems. They should be taken only on a doctor's prescription, never borrowed from others, and never stopped suddenly without advice. Antihistamine sleep aids can cause next-day drowsiness and are not suitable for older adults.
Sleep habits that help
Good sleep habits, called sleep hygiene, form the base of all insomnia treatment and are safe for everyone, including pregnant women and older adults. They take a few weeks of steady practice to show full benefit, so keep going even if the first nights are hard. Try to follow these steps every day.
- Wake up at the same time every day, including weekends
- Keep the bedroom dark, quiet, cool and used only for sleep
- Stop screens at least an hour before bed
- Avoid tea, coffee and colas after mid-afternoon, and avoid alcohol
- Get daylight and exercise during the day, but not late at night
- If you cannot sleep after about 20 minutes, get up, do something calm in dim light, and return when sleepy
When to see a doctor for insomnia
See a doctor if poor sleep lasts more than a few weeks, affects your daily life, or comes with low mood, anxiety, loud snoring or breathing pauses. Pregnant women, elderly people and those with liver or kidney disease should not use any sleep aid without medical advice. A doctor or pharmacist can review your medicines and help you plan safe, effective treatment.
Medicines doctors commonly use
Only your doctor can decide which medicine, dose and combination is right for you.
- Z-drugs such as zolpidemHelp you fall asleep for short-term use in selected cases.Only on a doctor's prescription; can cause dependence, sleepwalking and next-day drowsiness.
- Benzodiazepines such as clonazepam or alprazolamCalm the brain and help sleep in some situations.Only on a doctor's prescription; habit-forming and risky in the elderly; never stop suddenly.
- MelatoninMay help with sleep timing problems such as jet lag or in some older adults.Use only as advised by a doctor or pharmacist.
- Sedating antidepressantsUsed when insomnia comes with depression or anxiety.Only on a doctor's prescription; do not start or stop on your own.
See a doctor urgently if
- See a doctor urgently if you have thoughts of harming yourself or feel hopeless.
- See a doctor soon if you snore loudly, stop breathing or choke during sleep.
- See a doctor soon if you fall asleep suddenly during the day, especially while driving.
- See a doctor soon if poor sleep has lasted more than a month and affects work or relationships.
- See a doctor soon if you have had trouble stopping a sleeping pill or need more for the same effect.
Tests that may help
This article is general health information, not medical advice. Do not start, stop or combine medicines on your own — always follow your doctor's prescription and ask your pharmacist if unsure.