Insomnia is a sleep problem in which someone regularly cannot fall asleep, wakes repeatedly in the night, or wakes far too early, despite having the time and opportunity to sleep. The defining feature is the next day: tiredness, low mood, irritability and trouble concentrating.
Key points
- Insomnia is trouble falling asleep, staying asleep or waking too early despite the chance to sleep, and it affects the next day.
- It is short-term under 3 months, and long-term or chronic at 3 nights a week or more for 3 months.
- NICE treats cognitive behavioural therapy for insomnia (CBT-I) as first-line for long-term insomnia, ahead of sleeping tablets.
- Sleep hygiene advice alone is not effective for chronic insomnia, though it is often all people are given.
- Anxiety, depression, PTSD and ADHD disturb sleep, and poor sleep worsens them.
Symptoms
- Lying awake a long time before falling asleep; waking several times in the night, or waking early and unable to get back to sleep.
- Lying awake worrying about not sleeping.
- Still tired after waking and through the day; trouble concentrating or remembering; irritability, low mood, difficulty at work or driving.
Causes and risk factors
- Stress, anxiety and depression; an uncomfortable bedroom, shift work, caffeine, alcohol, some medicines.
- What keeps it going is often different from what triggered it: extra time in bed, napping, clock-watching and worry about the next day.
Treatment
- Cognitive behavioural therapy for insomnia (CBT-I) is first-line for long-term insomnia, combining stimulus control, sleep restriction and work on unhelpful sleep beliefs.
- Sleeping tablets are for short-term use only, a few days or weeks at most, because of tolerance and dependence.
- Daridorexant is licensed for long-term insomnia and reviewed within 3 months; melatonin is prescription-only in the UK.
When to speak to a professional
- Changing your sleep habits has not helped and the problem has lasted weeks or months.
- Poor sleep is affecting your work, studies, relationships or your driving, or someone has told you your breathing stops and starts at night.
If you need help now: Samaritans, call 116 123, free, 24/7. Shout, text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.