- Causes of insomnia
- Diagnosis
- Introduction
- Self-help for insomnia
- Symptoms of insomnia
- Treating insomnia
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Insomnia
Causes of insomnia
Insomnia can be caused by many different things, including stress, underlying health conditions, and alcohol or drug misuse.
The causes of insomnia are discussed in more detail below.
Stress
Some people develop insomnia in response to a stressful event, and it continues even when the stress has been resolved. This is because they have become used to associating the sleeping environment with being alert.
Worrying about things, such as work and health, is likely to keep you awake at night. Worrying about not being able to fall asleep can also stop you from actually falling asleep, creating a ‘vicious circle’.
Psychiatric problems
Underlying psychiatric problems can often affect a person’s sleeping patterns. For example:
- mental health conditions – such as depression or bipolar disorder
- anxiety disorders – such as generalised anxiety, panic disorder or post-traumatic stress disorder
- psychotic disorders – such as schizophrenia
Health conditions
Insomnia can also be caused by underlying physical conditions including:
- heart disease
- respiratory disease – such as chronic obstructive pulmonary disease or asthma
- neurological disease – 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 restless legs syndrome, narcolepsy or sleep apnoea
- long-term pain
Alcohol and drug misuse
Drinking too much alcohol and taking drugs can affect a person’s sleeping pattern.
Stimulants, such as nicotine and drinking too much caffeine (contained in tea, coffee and energy drinks) can also affect your sleep.
Medication
Some prescribed treatments or medicines available over-the-counter can cause insomnia. These include:
- antidepressants
- epilepsy medicine
- medication for high blood pressure (hypertension), such as beta-blockers
- hormone replacement therapy
- non-steroidal anti-inflammatory drugs (NSAIDs)
- stimulant drugs, such as methylphenidate, which is often used to treat attention deficit hyperactivity disorder (ADHD) or modafinil, which is used to treat narcolepsy (a long-term sleep disorder that disrupts normal sleeping patterns)
- some medicines used to treat asthma, such as salbutamol, salmeterol and theophylline
Jet lag
A disturbed sleep pattern is one of the most common symptoms of jet lag.
After a long-haul flight, you may find it difficult to sleep at the correct times. For example, you may be awake at night and sleep during the day.
Useful Links
- Published Date
- 2013-12-13 12:14:18Z
- Last Review Date
- 2013-12-09 00:00:00Z
- Next Review Date
- 2015-12-09 00:00:00Z
- Classification
- Antidepressants,Anxiety,Anxiety-related conditions,Asthma,Depression,Gastro-oesophageal reflux disease,Heart and vascular diseases,Insomnia,Irritable bowel syndrome,Managing addictions,Mental health conditions,Mental health specialists,Parkinson's disease,Schizophrenia,Sleep disorders
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Insomnia
Introduction
Insomnia
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Insomnia is difficulty getting to sleep or staying asleep for long enough to feel refreshed the next morning, even though you’ve had enough opportunity to sleep.
This video gives expert information about the condition, such as what causes or maintains it and different opportunities to deal with it. Also find out how Jane manages her insomnia.
Media last reviewed: 13/06/2014
Next review due: 13/06/2016
Sleep stages
Sleep is a natural state of unconsciousness that enables your body to rest.
While asleep, your body goes through different sleep stages in a cycle that lasts about 90 minutes. You may go through five cycles in a night. The sleep stages are:
- drowsiness
- light sleep
- deep sleep
- dreaming, also known as rapid eye movement (REM) sleep
Moodzone: sleep problems
Dr Chris Williams explains what you can do to give yourself the best chance of a good night’s sleep. This podcast is one of an eight-part series for Moodzone
Insomnia is difficulty getting to sleep or staying asleep for long enough to feel refreshed the next morning, even though you’ve had enough opportunity to sleep.
Most people experience problems sleeping at some point in their life. It’s thought that a third of people in the UK have episodes of insomnia. It tends to be more common in women and more likely to occur with age.
It’s difficult to define what normal sleep is because everyone is different. Your age, lifestyle, environment and diet all play a part in influencing the amount of sleep you need.
The most common symptoms of insomnia are:
- difficulty falling asleep
- waking up during the night
- waking up early in the morning
- feeling irritable and tired and finding it difficult to function during the day
Read more about the symptoms of insomnia.
What causes insomnia?
Stress and anxiety are common causes of insomnia, but it can also be caused by conditions such as depression, schizophrenia or asthma, some medications, and alcohol or drug misuse.
Read more about the causes of insomnia.
What to do
There is a range of things you can do to help you get to sleep, such as:
- avoiding caffeine later in the day
- avoiding heavy meals late at night
- setting regular times to wake up
- using thick curtains or blinds, an eye mask and earplugs to stop you being woken up by light and noise
This is often referred to as ‘good sleep hygiene’.
Relaxation can also help. Try taking a warm bath an hour before you go to bed or listening to calming music.
Read more self-help tips for insomnia.
When to see your GP
See your GP if you’re finding it difficult to get to sleep or to stay asleep, and it’s affecting your daily life.
Fatigue due to insomnia can affect your mood and create relationship problems with loved ones and work colleagues.
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.
Sleep diary
Your GP may also suggest that you keep a sleep diary. This will help them and you to gain a better understanding of your sleep patterns. It can also help to decide which method of treatment to use.
You should keep a sleep diary for a minimum of two weeks, recording information such as:
- the time you go bed
- how long it takes you to get to sleep
- the number of times you wake up in the night
- what time it is when you wake up
- episodes of daytime tiredness and naps
- what time you eat meals, consume alcohol, take exercise and when you are stressed
Treating insomnia
The first step in treating insomnia is to identify and treat any underlying health condition, such as anxiety, that may be causing your sleep problems.
Your GP will probably discuss things you can do at home (see above) which may help to improve your sleep.
In some cases, cognitive behavioural therapy for insomnia (CBT-I) may be recommended. CBT-I is a type of talking therapy that can help you avoid the thoughts and behaviours affecting your sleep.
Sleeping tablets are a treatment of last resort and are often only used in the short-term with the smallest possible dose. Although they can sometimes relieve the symptoms of insomnia, they don’t treat the cause. If you have long-term insomnia, it’s unlikely that sleeping tablets will help.
Read more about treating insomnia.
Page last reviewed: 09/12/2013
Next review due: 09/12/2015
Useful links
NHS Choices links
External links
Tiredness and fatigue
What makes you tired and how to boost your energy, with self-help tips and an energy diet
Living with insomnia
Find out what easy lifestyle changes you can make to improve your sleep
Why lack of sleep is bad for your health
Sleep deprivation can have profound consequences for your mental and physical health
Children’s sleep
Get advice on dealing with common sleep problems affecting babies, children and teenagers
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Insomnia
Introduction
Insomnia is difficulty getting to sleep or staying asleep for long enough to feel refreshed the next morning, even though you’ve had enough opportunity to sleep.
Most people experience problems sleeping at some point in their life. It’s thought that a third of people in the UK have episodes of insomnia. It tends to be more common in women and more likely to occur with age.
It’s difficult to define what normal sleep is because everyone is different. Your age, lifestyle, environment and diet all play a part in influencing the amount of sleep you need.
The most common symptoms of insomnia are:
- difficulty falling asleep
- waking up during the night
- waking up early in the morning
- feeling irritable and tired and finding it difficult to function during the day
Read more about the symptoms of insomnia.
What causes insomnia?
Stress and anxiety are common causes of insomnia, but it can also be caused by conditions such as depression, schizophrenia or asthma, some medications, and alcohol or drug misuse.
Read more about the causes of insomnia.
What to do
There is a range of things you can do to help you get to sleep, such as:
- avoiding caffeine later in the day
- avoiding heavy meals late at night
- setting regular times to wake up
- using thick curtains or blinds, an eye mask and earplugs to stop you being woken up by light and noise
This is often referred to as ‘good sleep hygiene’.
Relaxation can also help. Try taking a warm bath an hour before you go to bed or listening to calming music.
Read more self-help tips for insomnia.
When to see your GP
See your GP if you’re finding it difficult to get to sleep or to stay asleep, and it’s affecting your daily life.
Fatigue due to insomnia can affect your mood and create relationship problems with loved ones and work colleagues.
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.
Sleep diary
Your GP may also suggest that you keep a sleep diary. This will help them and you to gain a better understanding of your sleep patterns. It can also help to decide which method of treatment to use.
You should keep a sleep diary for a minimum of two weeks, recording information such as:
- the time you go bed
- how long it takes you to get to sleep
- the number of times you wake up in the night
- what time it is when you wake up
- episodes of daytime tiredness and naps
- what time you eat meals, consume alcohol, take exercise and when you are stressed
Treating insomnia
The first step in treating insomnia is to identify and treat any underlying health condition, such as anxiety, that may be causing your sleep problems.
Your GP will probably discuss things you can do at home (see above) which may help to improve your sleep.
In some cases, cognitive behavioural therapy for insomnia (CBT-I) may be recommended. CBT-I is a type of talking therapy that can help you avoid the thoughts and behaviours affecting your sleep.
Sleeping tablets are a treatment of last resort and are often only used in the short-term with the smallest possible dose. Although they can sometimes relieve the symptoms of insomnia, they don’t treat the cause. If you have long-term insomnia, it’s unlikely that sleeping tablets will help.
Read more about treating insomnia.
Useful Links
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- Published Date
- 2013-12-13 12:13:45Z
- Last Review Date
- 2013-12-09 00:00:00Z
- Next Review Date
- 2015-12-09 00:00:00Z
- Classification
- Depression,Insomnia,Mental health conditions
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Insomnia
Self-help for insomnia
Insomnia can often be prevented by changing your daytime and bedtime habits or by improving your bedroom environment.
Making small changes may help you get a good night’s sleep. Try some of the methods below for at least three to four weeks.
Daytime habits
- Set a specific time for getting up each day. 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, at least four hours before you go to bed. This will allow your body temperature to cool down.
Bedtime habits
- Stop drinking tea and coffee four hours before bedtime.
- Avoid drinking alcohol and smoking. Like caffeine, alcohol and nicotine are also stimulants. Alcohol may make you sleepy at first but will wake you up when the effects have worn off.
- Don’t eat a big meal or spicy foods just before bedtime. A small snack containing tryptophan (a natural sleep-promoting amino acid) may help, such as turkey, banana or fish.
- Only go to bed when you’re feeling tired.
- Try to create a bedtime routine, such as taking a bath and drinking a warm, milky drink every night. These activities will be associated with sleep and will cause drowsiness.
- Don’t lie in bed feeling anxious about sleeping. Instead, get up and go to another room for a while and do something else, such as reading or watching television, before trying again.
- Don’t watch the clock because it will only make you anxious.
- Write a list of your worries and any ideas to solve them, then try to forget about it until the morning.
Bedroom environment
- Use thick blinds or curtains or wear an eye mask if the early morning sunlight or bright streetlamps affect your sleep.
- Wear ear plugs if noise is a problem.
- Don’t use the bedroom for anything other than sleeping or sex. Don’t watch television, make phone calls, eat or work while you’re in bed.
- Make sure your mattress is comfortable and that you have a pillow you like, plus adequate bed covers for the time of year.
When you find that you’re asleep for most of the time that you’re in bed, try going to bed 15 minutes earlier but make sure you get up at the same time in the morning.
Useful Links
- Published Date
- 2013-12-13 12:37:49Z
- Last Review Date
- 2013-12-09 00:00:00Z
- Next Review Date
- 2015-12-09 00:00:00Z
- Classification
- Ear,Insomnia,Safe drinking,Sleep health
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Insomnia
Symptoms of insomnia
The symptoms of insomnia depend on the type of sleeping problem you have.
In the UK, up to a third of people are thought to experience insomnia at some point each year. Symptoms can include:
- lying awake for long periods at night before falling asleep
- waking up several times during the night
- waking up early in the morning and not being able to get back to sleep
- feeling tired and not refreshed by sleep
- not being able to function properly during the day and finding it difficult to concentrate
- irritability
A lack of sleep can also affect your mood and cause tiredness and fatigue during the day.
How much sleep do I need?
It’s difficult to define what ‘normal sleep’ is because every individual is different. Many things influence the amount of sleep you need, including your age, lifestyle, diet and environment.
Most healthy adults sleep for about seven to nine hours a night. As you get older, it becomes more difficult to maintain that amount, even though you still need it.
When to visit your GP
You should consider speaking to your GP if a lack of sleep is affecting your daily life and you feel that it’s causing a problem.
Fatigue caused by insomnia can affect your mood and create problems with personal relationships and in the workplace.
Read more about simple methods that may help prevent insomnia.
Useful Links
- Published Date
- 2013-12-13 12:14:04Z
- Last Review Date
- 2013-12-09 00:00:00Z
- Next Review Date
- 2015-12-09 00:00:00Z
- Classification
- Insomnia
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Insomnia
Treating insomnia
The first step in treating insomnia is to find out whether the problem is being caused by an underlying medical condition.
If it is, once the condition has been treated, your insomnia may disappear without the need for further medical help.
Good sleep hygiene
Your GP will be able to advise you about what you can do at home to help you sleep. This is known as good sleep hygiene and includes:
- establishing fixed times for going to bed and waking up (try to avoid sleeping in after a poor night’s sleep)
- trying to relax before going to bed
- maintaining a comfortable sleeping environment (not too hot, cold, noisy or bright)
- avoiding napping during the day
- avoiding caffeine, nicotine and alcohol late at night
- avoiding exercise within four hours of bedtime (although exercise in the middle of the day is beneficial)
- avoiding eating a heavy meal late at night
- avoiding watching or checking the clock throughout the night
- only using the bedroom for sleeping and sex
Read more simple methods that may help prevent insomnia.
If you have long-term insomnia (lasting more than four weeks) your GP may:
- recommend cognitive and behavioural treatments
- prescribe a short course of sleeping tablets for immediate relief or to manage a particularly bad period of insomnia; however, they aren’t recommended for long-term use
Cognitive and behavioural treatments
The aim of cognitive behavioural therapy for insomnia (CBT-I) is to change unhelpful thoughts and behaviours that may be contributing to your insomnia. It may be recommended if you’ve had sleep problems for more than four weeks.
CBT-I can 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 only 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 responses, such as muscle tension and heart rate; the machine produces pictures or sounds to help you control your breathing and body responses
CBT-I is sometimes carried out by a specially trained GP. Alternatively, you may be referred to a clinical psychologist.
You’ll usually have four or five sessions of CBT-I, each lasting about an hour. As part of the treatment you may be asked to keep a daily record of your sleep (a sleep diary).
In the UK, there are a number of places that provide specialist sleep services such as CBT-I. These include:
- Bristol General Hospital (BGU)
- Guy’s and St Thomas’ London
- Newcastle upon Tyne Hospitals (NUTH)
- Oxford University Hospitals (OUH)
- Papworth Respiratory Support and Sleep Centre (RSSC)
The website of the British Sleep Society (BSS) also has a post code search that you can use to find your nearest sleep centre.
Sleeping tablets
Sleeping tablets (hypnotics) are medications that encourage sleep. They may be considered:
- if your insomnia symptoms are very severe
- to help ease short-term insomnia
- if the good sleep hygiene and cognitive and behavioural treatments mentioned above prove ineffective
However, doctors are usually reluctant to prescribe sleeping tablets because although they help relieve the symptoms of insomnia, they don’t treat the cause.
If you have long-term insomnia, sleeping tablets are unlikely to help. Your doctor may consider referring you to a clinical psychologist to discuss other approaches to treatment.
Read more about why sleep medication only offers short-term relief.
You should be prescribed the smallest effective dose possible for the shortest time necessary (for no longer than a week). In some cases, you may be advised to only take the medication two or three nights a week, rather than every night.
Sleeping tablets can sometimes cause side effects, such as a feeling that you’re hungover and daytime drowsiness.
It’s best to take sleeping tablets at night, before you go to bed. Sometimes, particularly in older people, the hangover effects may last into the next day, so be cautious if it’s likely that you’ll be driving the next day (see below for more advice about driving).
It’s very easy to become dependent on sleeping tablets, even after a short-term course. Therefore, if you’re taking sleeping tablets regularly (every night), you should consider reducing them or stopping them altogether. Speak to your GP for advice.
Short-acting benzodiazepines or the newer ‘Z medicines’ (see below) are the preferred medicines for insomnia and are only available on prescription.
Benzodiazepines
Benzodiazepines are tranquillisers that can reduce anxiety and promote calmness, relaxation and sleep.
These medicines should only be considered if you have severe insomnia or it’s causing extreme distress.
Benzodiazepines will make you feel sleepy and can lead to dependency. Therefore, only short-acting benzodiazepines (with short-lasting effects) should be used to treat insomnia. Temazepam is the benzodiazepine that’s often prescribed.
Benzodiazepines can have many potential side effects. See the link to temazepam above for a full list of possible side effects.
Z medicines
Z medicines are a newer type of short-acting medicines that work in a similar way to benzodiazepines. They include:
- zaleplon
- zolpidem
- zopiclone
Zaleplon
Zaleplon is licensed to treat people with insomnia who have difficulty falling asleep.
It should only be used at the lowest possible dose and for a maximum of up to two weeks.
Common side effects of zaleplon (affecting more than one in 100 people) include:
- memory problems
- painful periods (dysmenorrhoea) in women
- pins and needles (paraesthesiae)
- sleepiness
Less common side effects (affecting more than one in 1,000 people) include:
- apathy (lack of interest)
- balance and co-ordination problems
- concentration problems
- changed sense of smell
- dizziness
- hallucinations (seeing things that aren’t real)
Read more about zaleplon.
Zolpidem
Zolpidem is licensed for the short-term treatment of debilitating insomnia or where it’s causing severe stress.
It should only be used at the lowest possible dose and for a maximum of up to four weeks.
Common side effects of zolpidem include:
- diarrhoea
- dizziness, nausea and vomiting
- headaches
- tiredness and sleep problems, such as sleep walking
- stomach pains
Less common side effects include confusion and double vision.
Read more about zolpidem.
Zopiclone
Zopiclone is licensed for the short-term treatment of insomnia including difficulty falling asleep, waking up during the night and long-term insomnia that’s debilitating or causing severe distress.
It should only be used at the lowest possible dose and for a maximum of up to four weeks.
Common side effects of zopiclone include:
- dry mouth
- metallic taste in your mouth
- sleepiness
Less common side effects include:
- dizziness, nausea and vomiting
- drowsiness
- headaches
Read more about zopiclone.
Z medicines can also sometimes cause psychiatric reactions, such as anger, irritability, agitation, aggressiveness, delusion, nightmares and hallucinations.
You should stop taking your medication and see your GP immediately if you experience any of these psychiatric reactions.
There’s little difference between Z medicines and benzodiazepines. If one doesn’t work, swapping to another is unlikely to have a different effect.
The National Institute for Health and Care Excellence (NICE) guidance contains more about the use of zaleplon, zolpidem and zopiclone for the short-term management of insomnia (PDF, 83.3kb).
Antidepressants
Antidepressants are sometimes prescribed for people with insomnia, and can be particularly useful if a person also has a history of depression.
Melatonin (Circadin)
Medicines that contain melatonin have been shown to be effective in relieving insomnia for up to 26 weeks in elderly people.
Melatonin is a naturally occurring hormone that helps regulate the sleep cycle (known as the circadian rhythm).
Circadin is the only medicine containing melatonin. It’s licensed to treat insomnia and is only available on prescription for people who are 55 years of age or over.
Circadin is designed as a short-term treatment for insomnia and shouldn’t be taken for more than three weeks. It’s not recommended for people with a history of kidney disease or liver disease.
Side effects of Circadin are uncommon but can include:
- irritability
- dizziness
- migraines
- constipation
- stomach pain
- weight gain
If you’re finding these side effects troublesome, stop taking Circadin and contact your GP.
Driving
If you have insomnia, it may affect your ability to drive. Medical conditions that cause sleepiness should be reported to the Driver & Vehicle Licensing Agency (DVLA).
GOV.UK has more information about telling the DVLA about a medical condition or disability.
Useful Links
- Published Date
- 2014-03-28 11:23:17Z
- Last Review Date
- 2013-12-09 00:00:00Z
- Next Review Date
- 2015-12-09 00:00:00Z
- Classification
- Anxiety,Benzodiazepines,Bipolar disorder,Cognitive behavioural therapy,Depression,DVLA,Insomnia,National Institute for Health and Clinical Excellence,Sleep health,Sleeping pills
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The 4 comments about ‘Insomnia’ posted are personal views. Any information they give has not been checked and may not be accurate.
suzyqi said on 18 February 2013
i get four hour’s sleep a night if im really lucky i care for my mum so even i do get to sleep i wake far to easy it’s starting to make my life really bad i cry for no reason get upset over anything and fall out with my boyfriend for no reason i can’t carry on this way i know that sleeping tablet’s are not the answer but i have tryed all the self help things and thay dont work i really don’t know what more i can do or how much more i can take
Report this content as offensive or unsuitable comment id 34389
ML12 said on 05 October 2012
hove12 please don’t try to take your life again. I cant pretend to know what your going through but that is not the answer. Please speak to someone, a friend, a counsellor, even me…..If you start believing you can get better, you will.
Report this content as offensive or unsuitable comment id 29584
hove12 said on 17 September 2012
There is no real help on the NHS. 12 years ago I went to see my GP about severe insomnia. When he heard the problem he looked so disinterested he actually started re-aranging his desk papaers and didn’t keep eye contact. He advised a hot bath before bed and milky drink. My insomnia was much to bad to be helped by that. After 8 years of not having 1 goods night sleep I developed a mental and physical illness. All I wanted was some sleep tablets 12 years ago. My life is now in ruins as i have lost almost everything. The NHS needs to offer help for severe insomnia not just a weeks worth of sleep tablets.
Report this content as offensive or unsuitable comment id 28924
Maria de Suecia said on 18 November 2011
1/2 teaspoon of baking soda in a glass of water. Drink 1 hour before sleep to alkalize your blood.
This cured my life wrecking years long insomnia over night.
Eat an alkalizing diet so acidity does not deplete minerals.
Magnesium is essential.
Report this content as offensive or unsuitable comment id 18996