Insomnia
Also known as: difficulty sleeping, trouble sleeping
A sleep problem in which a person regularly has trouble sleeping, including finding it hard to get to sleep or waking often in the night.
When to seek care
A GP appointment is the usual route if insomnia continues despite changes to sleep habits. If sleep problems come with thoughts of harming oneself, call 999 or go to A&E if in immediate danger. For urgent mental health help that is not an emergency, use NHS 111 online or call 111 and choose the mental health option. Samaritans are free to call on 116 123 at any time of day or night.
Overview
Insomnia means regularly having trouble sleeping. The NHS says people with insomnia may find it hard to go to sleep, wake several times in the night, lie awake, or wake early and be unable to get back to sleep. It can last for a short time or continue for months or years. Daytime sleepiness, tiredness and difficulty concentrating are among its effects. Stress, anxiety and depression are the most common causes, according to the NHS. Changing sleep habits often helps, and cognitive behavioural therapy for insomnia (CBT-I) is the recommended first treatment.
Causes
- Stress, anxiety or depression are the most common causes
- Noise, a room that is too hot or too cold, or an uncomfortable bed
- Alcohol, caffeine or nicotine
- Jet lag and shift work
- Medical conditions such as restless legs syndrome, an overactive thyroid and the menopause
- Some medicines
- Other sleep disorders, such as sleep apnoea
Risk factors
- Having a lot of stress
- Having a lower income
- Travelling long distances across time zones
- Shift work
Symptoms
What a clinician may find
- Finding it hard to go to sleep, waking several times in the night, or waking early and being unable to go back to sleep
- Daytime sleepiness and a lack of energy
Complications
- Daytime sleepiness and low energy
- Tiredness and difficulty concentrating in the daytime, with a link to car accidents noted by MedlinePlus
- In chronic insomnia, a higher risk of depression and anxiety, and an association with high blood pressure
Diagnosis
A GP will try to find the cause of the sleep problem so that treatment can be matched to it. Clinicians may check for depression, anxiety and other conditions that affect sleep. Sleep diaries and questionnaires such as the Insomnia Severity Index may be used.
Treatment
Cognitive behavioural therapy for insomnia, known as CBT-I, is the recommended first treatment. The NHS says it can be given face to face by a therapist or through an online self-help programme. Changing sleeping habits often helps. GPs now rarely prescribe sleeping pills for insomnia, because they can have serious side effects and people can become dependent on them.
Prevention
The NHS says changing sleeping habits can often help. Its advice includes getting up at the same time every day, going to bed only when sleepy, and not using screens right before bed. The NHS lists caffeine, alcohol and nicotine among the triggers for insomnia.
Key facts
| Fact | Detail |
|---|---|
| Also called | Difficulty sleeping, trouble sleeping |
| Usual first contact | A GP |
| Short-term or chronic | The Sleep Foundation calls it chronic at three nights a week for three months or longer |
| Most common causes | Stress, anxiety and depression |
| Recommended first treatment | Cognitive behavioural therapy for insomnia (CBT-I) |
| Sleeping pills | Rarely prescribed, because of side effects and dependence |
| Possible daytime effects | Sleepiness, tiredness and difficulty concentrating |
What is insomnia?
Insomnia means having trouble sleeping on a regular basis. The NHS says a person has insomnia if they regularly find it hard to go to sleep, wake up several times during the night, lie awake, or wake early and cannot drop off again. NHS inform adds that some people have insomnia for months or even years at a time.
MedlinePlus describes insomnia as acute, meaning short-term, or chronic, meaning ongoing. The Sleep Foundation says it is considered chronic when trouble falling or staying asleep happens at least three nights a week for three months or longer. A South Yorkshire NHS primary care pathway likewise treats short-term insomnia as lasting under three months.
Changing sleeping habits often helps, and the NHS says anyone whose sleep does not improve, or who has had trouble sleeping for months, can speak to a GP about it.
What are the symptoms and daytime effects?
The NHS lists the main experiences of insomnia as finding it hard to go to sleep, waking several times during the night, lying awake, and waking early and being unable to go back to sleep. These problems can affect how a person feels the next day.
MedlinePlus says insomnia can cause daytime sleepiness and a lack of energy. A MedlinePlus article on short-term insomnia adds that it can lead to fatigue and difficulty concentrating. MedlinePlus also links insomnia with car accidents, in a single brief line, and research on professional drivers has found a higher risk of driving accidents among those with insomnia.
A StatPearls review of chronic insomnia lists depression, anxiety and hypertension, which means high blood pressure, among the conditions associated with it. It also states that patients with chronic insomnia have an increased risk of depression and anxiety.
What causes insomnia?
The NHS says the most common causes of insomnia are stress, anxiety and depression. Other triggers include noise, a room that is too hot or too cold, an uncomfortable bed, and alcohol, caffeine or nicotine. Jet lag and shift work can also disturb sleep, and many medicines can cause insomnia.
Some medical conditions can bring on insomnia. The NHS names restless legs syndrome, an overactive thyroid and the menopause among them. An NHS Scotland guide adds that most chronic insomnia stems from other problems, such as mental health conditions, medical conditions, medication, substances, and other sleep disorders such as sleep apnoea.
MedlinePlus lists several risk factors for insomnia, including having a lot of stress, shift work, a lower income and travelling long distances with time changes.
How is insomnia assessed?
The NHS says a GP will try to find the cause of the sleep problem so that treatment can be matched to it. Guidance for GPs describes assessing for and addressing other causes, such as mental health problems. Clinicians may therefore check for depression, anxiety and other conditions that can affect sleep.
Sleep diaries and questionnaires may also be used. A StatPearls review on short-term insomnia describes a sleep diary kept over seven to 14 days as part of assessment. The Insomnia Severity Index is a short questionnaire used to gauge how severe the problem is.
NICE advises that people at higher risk of other sleep disorders, such as sleep apnoea, may need a medical assessment first, before a digital insomnia programme is used. The NHS guidance suggests that if insomnia comes from anxiety or depression, treatment of those conditions, including CBT as appropriate, can be considered.
How is insomnia treated?
The NHS recommends cognitive behavioural therapy for insomnia, known as CBT-I, as the first treatment. It says CBT may be given face to face by a therapist or through an online self-help programme. If changing sleeping habits does not help, a GP may refer someone for CBT-I, although access varies by area.
The NHLBI describes CBT-I as including cognitive therapy, which helps reduce worry about not being able to sleep, along with relaxation approaches and sleep education.
NICE has recommended Sleepio, a digital CBT-I programme, as an option in primary care for people who would otherwise get sleep hygiene advice or sleeping pills. NICE notes there is no direct evidence comparing it with face-to-face CBT-I.
The NHS says GPs now rarely prescribe sleeping pills for insomnia, because they can have serious side effects and people can become dependent on them. The NHLBI says some prescription sleep aids can be habit-forming and should be taken for only a few weeks, and that research has not proven melatonin supplements to be an effective treatment for insomnia.
Living with insomnia and self-care
The NHS lists several habits that may help. These include getting up at the same time every day, going to bed only when sleepy, keeping the bedroom dark and quiet, and not watching television or using devices right before bed, because the blue light can make a person more awake. The NHS also lists caffeine, alcohol and nicotine among the common triggers.
NHS inform suggests that anyone lying awake gets up, goes to another room for about 20 minutes and does something calm, returning to bed when sleepy. It also suggests writing down worries and any ideas for solving them before bed, which may help a person to set them aside until morning.
Because stress, anxiety and depression are common causes of insomnia, the NHS guidance suggests that treating anxiety or depression, where it is the cause, can be considered as part of managing the sleep problem.
When should someone get help?
The NHS says to speak to a GP if changing sleeping habits has not worked, or if there has been trouble sleeping for months. The GP will try to identify the cause and can explain what treatment, including CBT-I, is available locally.
Insomnia and mental health are linked, because stress, anxiety and depression are among its most common causes. If someone is in immediate danger or has seriously harmed themselves, the NHS says to call 999 or go to A&E. For urgent mental health help that is not an emergency, the NHS says to use NHS 111 online or call 111 and choose the mental health option. Samaritans can be reached free on 116 123 at any time of day or night.
Frequently asked questions
Is insomnia always a long-term problem?
No. The NHS and NHS inform say insomnia can last a short time, or continue for months or even years. The Sleep Foundation describes it as chronic when it happens at least three nights a week for three months or longer. Changing sleeping habits often helps, and the NHS says to speak to a GP if it does not.
Are sleeping pills used to treat insomnia?
The NHS says GPs now rarely prescribe sleeping pills for insomnia, because they can have serious side effects and people can become dependent on them. The NHLBI says some prescription sleep aids can be habit-forming and should be taken for only a few weeks. It adds that research has not proven melatonin supplements to be an effective treatment.
What is CBT for insomnia?
CBT-I stands for cognitive behavioural therapy for insomnia. The NHS recommends it as the first treatment, and says it can be given face to face by a therapist or through an online self-help programme. The NHLBI says it includes cognitive therapy, relaxation approaches and sleep education. Access varies by area, and a GP can advise.
Is insomnia linked to mental health?
The NHS names stress, anxiety and depression as the most common causes of insomnia. A StatPearls review of chronic insomnia also reports a higher risk of depression and anxiety. Anyone in immediate danger should call 999 or go to A&E. For urgent mental health help, the NHS says to call 111 and choose the mental health option, and Samaritans are free on 116 123 at any time.
Can insomnia get better?
The NHS says changing sleeping habits can often help. It recommends CBT-I as the first treatment, and NICE has recommended a digital CBT-I programme, Sleepio, as an option in primary care. A GP can look for causes, such as stress, anxiety, depression or another sleep disorder, and match treatment to them.
Connected pages in detail
What each linked page on Anatomy Nexus covers, in a line, for Insomnia.
Symptoms
- Fatigue Persistent tiredness that rest does not fix.
Guides and news
- What is jet lag and what helps? Jet lag is a temporary sleep disturbance after long flights across time zones; the NHS says it usually improves within a few days.