Difficulty sleeping (insomnia)
Insomnia is difficulty getting to sleep or staying asleep for long enough to feel refreshed the next morning.
It's a common problem thought to regularly affect around one in every three people in the UK, and is particularly common in elderly people.
If you have insomnia, you may:
- find it difficult to fall asleep
- lie awake for long periods at night
- wake up several times during the night
- wake up early in the morning and not be able to get back to sleep
- not feel refreshed when you get up
- find it hard to nap during the day, despite feeling tired
- feel tired and irritable during the day and have difficulty concentrating
Occasional episodes of insomnia may come and go without causing any serious problems, but for some people it can last for months or even years at a time.
Persistent insomnia can have a significant impact on your quality of life. It can limit what you're able to do during the day, affect your mood, and lead to relationship problems with friends, family and colleagues.
How much sleep do I need?
There are no official guidelines about how much sleep you should get each night because everyone is different.
On average, a "normal" amount of sleep for an adult is considered to be around seven to nine hours a night. Children and babies may sleep for much longer than this, whereas older adults may sleep less.
What's important is whether you feel you get enough sleep, and whether your sleep is good quality.
You're probably not getting enough good-quality sleep if you constantly feel tired throughout the day and it's affecting your everyday life.
Try the sleep self-assessment to see if you have trouble sleeping.
What causes insomnia?
It's not always clear what triggers insomnia, but it's often associated with:
- stress and anxiety
- a poor sleeping environment – such as an uncomfortable bed, or a bedroom that's too light, noisy, hot or cold
- lifestyle factors – such as jet lag, shift work, or drinking alcohol or caffeine before going to bed
- mental health conditions – such as depression and schizophrenia
- physical health conditions – such as heart problems, other sleep disorders and long-term pain
- certain medicines – such as some antidepressants, epilepsy medicines and steroid medication
Read more about the causes of insomnia.
What you can do about it
There are a number of things you can try to help yourself get a good night's sleep if you have insomnia.
- setting regular times for going to bed and waking up
- relaxing before bed time – try taking a warm bath or listening to calming music
- using thick curtains or blinds, an eye mask and earplugs to stop you being woken up by light and noise
- avoiding caffeine, nicotine, alcohol, heavy meals and exercise for a few hours before going to bed
- not watching TV or using phones, tablets or computers shortly before going to bed
- not napping during the day
- writing a list of your worries, and any ideas about how to solve them, before going to bed to help you forget about them until the morning
Some people find over-the-counter sleeping tablets helpful, but they don't address the underlying problem and can have troublesome side effects.
Read more self-help tips for insomnia.
When to see your GP
Make an appointment to see your GP if you're finding it difficult to get to sleep or stay asleep and it's affecting your daily life – particularly if it has been a problem for a month or more and the above measures have not helped.
Your GP may ask you about your sleeping routines, your daily alcohol and caffeine consumption, and your general lifestyle habits, such as diet and exercise.
They will also check your medical history for any illness or medication that may be contributing to your insomnia.
Your GP may suggest keeping a sleep diary for a couple of weeks to help them gain a better understanding of your sleep patterns.
Each day, make a note of things such as the time you went to bed and woke up, how long it took you to fall asleep, and the number of times you woke up during the night.
Treatments for insomnia
Your GP will first try to identify and treat any underlying health condition, such as anxiety, that may be causing your sleep problems.
They'll probably also discuss things you can do at home that may help to improve your sleep.
In some cases, a special type of cognitive behavioural therapy (CBT) designed for people with insomnia (CBT-I) may be recommended.
This is a type of talking therapy that aims to help you avoid the thoughts and behaviours affecting your sleep. It's usually the first treatment recommended and can help lead to long-term improvement of your sleep.
Prescription sleeping tablets are usually only considered as a last resort and should be used for only a few days or weeks at a time.
This is because they don't treat the cause of your insomnia and are associated with a number of side effects. They can also become less effective over time.
Read more about treating insomnia.
Causes of insomnia
Insomnia can be triggered by a number of possible factors, including worry and stress, underlying health conditions, and alcohol or drug use.
Sometimes it's not possible to identify a clear cause.
Stress and anxiety
Some people develop insomnia after a stressful event, such as a bereavement, problems at work, or financial difficulties.
The problem can continue long after the event has passed because they start to associate going to bed with being awake. This develops into an anxiety about sleep itself.
Having more general worries – for example, about work, family or health – are also likely to keep you awake at night.
These can cause your mind to start racing while you lie in bed, which can be made worse by also worrying about not being able to sleep.
Poor sleep routine and sleeping environment
You may struggle to get a good night's sleep if you go to bed at inconsistent times, nap during the day, or don't "wind down" before going to bed.
A poor sleeping environment can also contribute to insomnia – for instance, an uncomfortable bed or a bedroom that's too bright, noisy, hot or cold.
Drinking alcohol before going to bed and taking certain recreational drugs can affect your sleep, as can stimulants such as nicotine (found in cigarettes) and caffeine (found in tea, coffee and energy drinks). These should be avoided in the evenings.
Changes to your sleeping patterns can also contribute to insomnia – for example, because of shift work or changing time zones after a long-haul flight (jet lag).
Mental health conditions
Underlying mental health problems can often affect a person's sleeping patterns, including:
- mood disorders – such as depression or bipolar disorder
- anxiety disorders – such as generalised anxiety, panic disorder or post-traumatic stress disorder
- psychotic disorders – such as schizophrenia
Physical health conditions
Insomnia can also be caused by underlying physical conditions, including:
- heart conditions – such as angina or heart failure
- respiratory conditions – such as chronic obstructive pulmonary disease (COPD) or asthma
- neurological conditions – such as Alzheimer's disease or Parkinson's disease
- hormonal problems – such as an overactive thyroid
- joint or muscle problems – such as arthritis
- problems with the genital or urinary organs – such as urinary incontinence or an enlarged prostate
- sleep disorders – such as snoring and sleep apnoea, restless legs syndrome, narcolepsy, night terrors and sleepwalking
- long-term pain
In women, childbirth can sometimes lead to insomnia.
Some prescriptions or over-the-counter medications can cause insomnia as a side effect.
- certain antidepressants
- epilepsy medicines
- medicines for high blood pressure, such as beta-blockers
- steroid medication
- non-steroidal anti-inflammatory drugs (NSAIDs)
- stimulant medicines used to treat attention deficit hyperactivity disorder (ADHD) or narcolepsy
- some medicines used to treat asthma, such as salbutamol, salmeterol and theophylline
Check the leaflet that comes with any medication you're taking to see if insomnia or sleeping difficulties are listed as a possible side effect.
Self-help tips for insomnia
Insomnia can often be improved by changing your daytime and bedtime habits or by improving your bedroom environment.
Making small changes may help you to get a good night's sleep. Try some of the methods below for a few weeks to see if they help.
See your GP if you're still having difficulty getting to sleep after trying these techniques.
- Set a specific time for getting up each day. Try to stick to this time, seven days a week, even if you feel you haven't had enough sleep. This should help you sleep better at night.
- Don't take a nap during the day.
- Take daily exercise, such as 30 minutes walking or cycling. But don't exercise for at least four hours before going to bed, because this may make it more difficult to fall asleep.
- Stop drinking tea and coffee for a few hours before bedtime.
- Avoid drinking alcohol and smoking, particularly shortly before going to bed.
- Don't eat a big meal just before bedtime.
- Only go to bed when you're feeling tired. If necessary, go to bed later than usual if it means you might be able to fall asleep more quickly.
- Don't use back-lit devices shortly before going to bed, including televisions, phones, tablets and computers.
- Try to create a relaxing bedtime routine, such as taking a bath, listening to soft music, and drinking a warm, milky drink every night. These activities will be associated with sleep and will cause drowsiness.
- Avoid regularly using over-the-counter sleeping tablets. It is not clear how effective these are, they don't tackle the underlying problem, and have potential side effects. Read more about treatments for insomnia.
- Don't lie in bed feeling anxious about lack of sleep. Instead, get up, go to another room for about 20 minutes and do something else, such as reading or listening to soft music, before trying again.
- Avoid watching the clock because it will only make you anxious about how long it's taking you to fall asleep.
- Write a list of your worries and any ideas to solve them before going to bed. This may help you forget about them until the morning.
- Use thick blinds or curtains or wear an eye mask if the early morning sunlight or bright street lamps affect your sleep.
- Make sure your bedroom is at a comfortable temperature for sleeping.
- Wear ear plugs if noise is a problem.
- Don't use your bedroom for anything other than sleeping or sex. Avoid watching television, making phone calls, eating or working while you're in bed.
- Make sure your mattress is comfortable and that you have a pillow you like, as well as adequate bedding for the time of year.
Treatments for insomnia
Insomnia will often improve by making changes to your bedtime habits. If these don't help, your GP may be able to recommend other treatments.
If you've had insomnia for more than four weeks, your GP may recommend cognitive and behavioural treatments or suggest a short course of prescription sleeping tablets as a temporary measure.
If it's possible to identify an underlying cause of your sleeping difficulties, treating this may be enough to return your sleep to normal.
The various treatments for insomnia are outlined below. You can also read a summary of the pros and cons of the treatments for insomnia, allowing you to compare your treatment options.
Good sleeping habits
Your GP will be able to advise you about what you can do at home to help you sleep. This is known as "sleep hygiene" and includes:
- establishing fixed times for going to bed and waking up
- creating a relaxing bedtime routine
- only going to bed when you feel tired
- maintaining a comfortable sleeping environment that's not too hot, cold, noisy or bright
- not napping during the day
- avoiding caffeine, nicotine and alcohol late at night
- avoiding eating a heavy meal late at night
Read more about self-help tips for insomnia.
Cognitive and behavioural treatments
If changing your sleeping habits doesn't help, your GP may be able to refer you for a type of cognitive behavioural therapy (CBT) that's specifically designed for people with insomnia (CBT-I).
The aim of CBT-I is to change unhelpful thoughts and behaviours that may be contributing to your insomnia. It's an effective treatment for many people and can have long-lasting results.
CBT-I may include:
- stimulus-control therapy – which aims to help you associate the bedroom with sleep and establish a consistent sleep/wake pattern
- sleep restriction therapy – limiting the amount of time spent in bed to the actual amount of time spent asleep, creating mild sleep deprivation; sleep time is then increased as your sleeping improves
- relaxation training – aims to reduce tension or minimise intrusive thoughts that may be interfering with sleep
- paradoxical intention – you try to stay awake and avoid any intention of falling asleep; it's used if you have trouble getting to sleep, but not maintaining sleep
- biofeedback – sensors connected to a machine are placed on your body to measure your body's functions, such as muscle tension and heart rate; the machine produces pictures or sounds to help you recognise when you're not relaxed
CBT-I is sometimes carried out by a specially trained GP. Alternatively, you may be referred to a clinical psychologist.
The therapy may be carried out in a small group with other people who have similar sleep problems, or one-to-one with a therapist. Self-help books and online courses may also be used.
Sleeping tablets (hypnotics) are medications that encourage sleep. In the past, they were frequently used to help with insomnia, but they're used much less often nowadays.
They will generally only be considered:
- if your insomnia is severe
- as a temporary measure to help ease short-term insomnia
- if the good sleep habits and cognitive and behavioural treatments mentioned above don't help
Doctors are usually reluctant to recommend sleeping tablets in the long-term because they just mask the symptoms without treating the underlying cause.
They can also cause potentially dangerous side effects, such as drowsiness the following morning, and some people become dependent on them.
If they are recommended, you should have the smallest effective dose possible for the shortest time (usually no more than two to four weeks).
Over-the-counter sleeping pills
A number of sleeping tablets are available to buy over the counter (OTC) from pharmacies. These are usually a type of antihistamine medicine that causes you to feel drowsy.
Taking OTC sleeping tablets regularly isn't usually recommended if you have insomnia, because it's not clear how effective they are, they don't tackle the underlying cause of your sleeping difficulties and they can cause side effects.
In particular, they can cause you to feel drowsy the next morning, which can make activities such as driving and operating machinery dangerous.
Speak to your GP for advice if you find yourself needing to take OTC sleeping tablets regularly.
Benzodiazepines are prescription medicines that can reduce anxiety and promote calmness, relaxation and sleep. Your GP may prescribe them for a short time if you have severe insomnia or it's causing extreme distress.
Examples of benzodiazepines include temazepam, loprazolam, lormetazepam, diazepam and nitrazepam.
Long-term treatment with benzodiazepines isn't usually recommended because they can become less effective over time and some people become dependent upon them.
They can also cause a number of side effects, including:
- drowsiness and dizziness, which can persist into the next day
- finding it difficult to concentrate or make decisions
- feeling emotionally numb
You should avoid driving if you feel drowsy, dizzy, or unable to concentrate or make decisions, as you may not be able to do so safely.
Z–drugs are a newer type of medicine that work in a similar way to benzodiazepines and are similarly effective. They include zaleplon, zolpidem and zopiclone.
As with benzodiazepines, long-term treatment with Z–drugs isn't normally recommended because they can become less effective over time and some people become dependent on them.
They're usually only prescribed for a maximum of two to four weeks.
Side effects of Z-drugs can include:
- drowsiness and dizziness, which can persist into the next day
- feeling and being sick
- increased snoring and breathing problems during sleep
- dry mouth
Z–drugs can also sometimes cause psychiatric reactions, such as delusions, nightmares and hallucinations. Contact your GP if you experience any of these effects.
Read the National Institute for Health and Care Excellence (NICE) guidance on zaleplon, zolpidem and zopiclone for the short-term management of insomnia for more information.
For adults aged 55 or over, a medication called Circadin is sometimes used to help relieve insomnia for a few weeks. It contains a naturally occurring hormone called melatonin, which helps to regulate the sleep cycle.
Circadin is usually only recommended for three weeks at first, but it can be continued for a total of 13 weeks if it helps.
Common side effects of Circadin include:
Treatments that aren't recommended
The following treatments aren't normally recommended for insomnia, because it's not clear how effective they are and they can sometimes cause side effects: