Insomnia
Also known as Sleeplessness, Chronic insomnia disorder
This article is general health information for the selected condition. It is not a diagnosis and does not replace clinical judgement. If you have questions or need treatment advice, please consult a qualified healthcare professional.
What is insomnia?
Insomnia is persistent difficulty falling asleep, staying asleep or waking too early, despite adequate opportunity to sleep, with consequences for daytime function. Chronic insomnia is treated most effectively with cognitive behavioural therapy rather than medication, which is recommended first line ahead of sleeping tablets.
Causes
- Conditioned arousal in which bed becomes associated with wakefulness
- Stress, anxiety and depression
- Irregular sleep schedules and shift work
- Caffeine, alcohol and nicotine
- Pain, nocturia or restless legs
- Some medicines and stimulants
Symptoms
- Difficulty falling asleep at the start of the night
- Waking repeatedly and struggling to return to sleep
- Waking earlier than intended
- Daytime fatigue and low energy
- Irritability and low mood
- Impaired concentration and memory
- Worry and frustration about sleep itself
Risk factors
- Female sex
- Increasing age
- Shift or night work
- Mental health conditions
- Chronic pain
- High stress occupations
Diagnosis
- Clinical sleep history with a sleep diary over two weeks
- Screening for depression, anxiety and substance use
- Assessment for sleep apnoea and restless legs syndrome
- Review of medicines and caffeine intake
- Actigraphy or polysomnography only in selected cases
Treatment
- Cognitive behavioural therapy for insomnia as first line
- Stimulus control, using bed only for sleep
- Sleep restriction therapy to consolidate sleep
- Consistent wake time including at weekends
- Reducing caffeine, alcohol and evening screen use
- Short term hypnotics only when necessary
- Treating underlying pain, mood or breathing disorders
Self care
- Get up at the same time every day, including weekends
- Only go to bed when sleepy and get up if awake for long
- Use the bed for sleep and sex only
- Avoid caffeine after midday and limit alcohol
- Keep the bedroom cool, dark and quiet
- Avoid clock watching through the night
- Get daylight exposure in the morning
When to see a doctor
Book an appointment if:
- Poor sleep at least three nights a week for over three months
- Daytime function significantly affected
- Relying on alcohol or medication to sleep
- Loud snoring or witnessed breathing pauses
- Low mood or anxiety alongside poor sleep
- Restless or twitching legs at night
Some symptoms need emergency care rather than an appointment. See the warning signs listed above.
Prevention
- Keep consistent sleep and wake times
- Manage stress and treat anxiety and depression
- Limit caffeine, alcohol and evening screens
- Treat pain and nocturia that fragment sleep
- Address shift work patterns where possible
Outlook
Chronic insomnia responds well to cognitive behavioural therapy for insomnia, with benefits that persist after treatment ends, unlike sleeping tablets. Most people achieve meaningful improvement within four to eight sessions. Relapse can occur during stress, but the techniques remain effective when reapplied.
Common questions
Why is therapy preferred over sleeping tablets?
Cognitive behavioural therapy for insomnia produces improvements that persist after treatment ends, whereas hypnotics work only while taken and carry risks of tolerance, falls and next day impairment.
Should I stay in bed if I cannot sleep?
No. Lying awake strengthens the association between bed and wakefulness. Get up, do something quiet in dim light, and return only when sleepy.
Does everyone need eight hours?
Sleep need varies, with most adults falling between seven and nine hours. Daytime function is a better guide than a fixed number, and anxiety about hitting a target can itself worsen insomnia.
References
Important: Dard AI is not a medical device and does not diagnose, treat, or replace clinician judgement. This article is general information only. Always consult a qualified healthcare professional about diagnosis and treatment, and seek emergency care for severe or rapidly worsening symptoms.