Insomnia
Information

Insomnia is the world’s most common sleep problem and can have a significant impact on your life. It can leave you tired, irritable, and unable to function properly day-to-day leading to problems at home, work, school, or in your social life. It can also lead to mental and physical illness.

What is insomnia?

Insomnia is a sleep disorder. Insomnia is generally characterized by a lack of sleep, but exactly how it affects you differs from person to person. For some people insomnia means difficulty falling asleep, for others it means difficulty staying asleep and waking throughout the night or too early.

There are no exact rules about the amount of sleep a person needs: everyone is different. On average, adults need 7-9 hours a night, but someone getting less than this who still feels refreshed in the morning wouldn’t be classed as having insomnia. The important thing is the quality of sleep you get and how you feel given your sleep patterns.

Insomnia can be short-term (1-4 weeks) or long-term (longer than 4 weeks) and is a common condition. It is thought to affect approximately 1 in 3 people at some point in their lives.

Certain people are more at risk of developing insomnia than others, including:

  • people over 60

  • women

  • people with a history of mental disorders

  • those who work night shifts or have irregular shift patterns

  • people who travel a lot through different time zones

What are the symptoms of insomnia?

A person with insomnia may:

  • have difficulty falling asleep

  • struggle to find a comfortable sleeping position

  • wake during the night, often repeatedly

  • wake early in the morning and be unable to go back to sleep

  • feel unrefreshed on waking

  • be irritable and tired during the daytime

“I’m permanently grumpy and short-tempered and I disturb my husband in the night”

HealthUnlocked insomnia survey response, 2018

How is insomnia diagnosed?

If your sleep has been limited and disrupted repeatedly for more than a month, it may be worth talking to your doctor - particularly if your lack of sleep is affecting your daily life. The doctor may ask about your sleep routines, diet and exercise, and physical health - all of which can affect sleep quality. They may also recommend that you keep a sleep journal for several weeks, noting down when you go to bed, when you wake, and estimating how many times you wake during the night. This helps create a clearer picture of your sleeping patterns.

If you are taking medication for another condition, talk to your doctor about whether this could be affecting your sleep. Medications that increase the chance of developing insomnia include:

  • some anti-depressants

  • epilepsy medicines

  • beta-blockers

  • steroid medicines

  • some stimulants used to treat conditions such as ADHD and narcolepsy

The doctor may diagnose sleep disturbance as insomnia if it:

  • causes you significant distress or interferes with areas of life such as day-to-day social activities, work, or education

  • occurs despite plenty of opportunity for restful sleep

  • happens at least three nights a week

  • continues for at least three months

  • isn’t a result of substance misuse

“Make sure you have time to say exactly how insomnia is impacting on your life; be honest with yourself and your doctor, who will work with you to manage symptoms and effects of insomnia”

HealthUnlocked insomnia survey response, 2018

Causes of insomnia

Insomnia can occur seemingly independent of any other condition, or as the result of lifestyle choices. Taking psychoactive drugs, consuming high levels of caffeine, and not getting enough exercise can all contribute to insomnia. Other factors that might result in sleep disturbance relate to where you sleep. Is it noisy? Is the room too hot or too cold or too light? Is the bed comfortable?

Insomnia often develops because of a pre-existing condition, such as depression, anxiety, or another psychological disorder. About 40 percent of people diagnosed with insomnia already have another psychological condition. Some disorders, such as major depressive disorder, are characterized by disruption in our stress response system, the hypothalamic pituitary adrenal (HPA) axis. This can lead to people having increased levels of the ‘stress hormone’ cortisol, and can inhibit restful sleep.

Interrupted sleep is a key feature of sleep apnea, where the throat relaxes so much during sleep that it collapses and interrupts normal breathing. This causes the person to wake up enough to breathe and they may do this repeatedly through the night, sometimes with only minutes between episodes. People with sleep apnea may feel tired all the time but be unaware of the breathing problem that’s causing it.

Other physical conditions such as chronic pain, heartburn, respiratory illnesses (for example COPD and asthma), joint or muscle problems (like arthritis), and neurological conditions (such as Alzheimer’s) all increase the likelihood of insomnia.

Unexpected or potentially stressful life events, such as bereavement, losing a job, or moving home may also result in insomnia.

Individuals who work night shifts, have inconsistent work patterns, or frequently move across time zones and suffer jet lag are more at risk of developing insomnia.

Hormonal shifts, such as those that occur throughout menstruation and during menopause can also result in insomnia. This is one factor that may explain why insomnia is about 1.4 times more common in women than men.

What are the effects of insomnia?

Sleep is vital for our physical and mental health. A lack of sleep can lead to low energy, low mood, irritability, and complex psychological disorders. It can make maintaining a healthy diet and exercise regime challenging and has the potential to lead to various health problems and difficulties in daily life.

It’s often the daytime effects of poor sleep that prompt people to seek medical help. These can include:

  • difficulty concentrating or focusing on tasks

  • having memory problems

  • being clumsy or uncoordinated

  • being irritable and feeling tired

  • dozing off momentarily during activities such as driving

“I am 'cured' now but at the time it left me profoundly exhausted ... more tired when I arose in the morning than when I went to bed”

HealthUnlocked insomnia survey response, 2018

People with insomnia may resort to self-medicating with drugs or alcohol to try to help with sleep. However, the quality of sleep induced by drink or drugs is poor and such self-medication could be a cause insomnia. Long-term use of such substances can also have harmful consequences and lead to addiction.

The knock-on effects of insomnia may affect an individual’s work life, their relationships, and their overall wellbeing. It has also been linked to an increased risk of developing high blood pressure, heart disease, diabetes, depression, stroke, and being overweight.

How is insomnia treated?

The first port of call with any treatment of insomnia is to work on good sleep hygiene. For good sleep hygiene you should:

  • have a regular bedtime

  • reduce screen time before bed including TV, laptops, and phones

  • reduce caffeine intake, especially in the afternoon and evening

  • avoid big meals late at night

  • sleep in a quiet and dark room

  • get up at the same time, even after a poor night’s sleep

  • exercise adequately during the day or early evening. It’s best to avoid vigorous exercise in the four hours before bed

  • avoid napping during the day

Sometimes insomnia is the result of psychological distress, often in the form of unhelpful thought patterns. Many people feel this as an inability to ‘switch off’. Because of this, a talking therapy called cognitive behavioral therapy (CBT) is often recommended as a treatment option for insomnia. There is also a form of CBT, CBT-I, which is specifically for insomnia. Talking therapy can help you address the thoughts and behaviors that might be contributing to your insomnia. CBT-I may include such techniques as:

  • relaxation training to reduce tension

  • stimulus control, helping you to associate your bedroom with sleep

  • sleep restriction therapy, where the amount of time in bed is restricted to the actual amount of time asleep. The aim is to create mild sleep deprivation, and then increase the amount of time in bed as your sleeping improves

Louise Carroll, a CBT specialist therapist, says: “Everyone will have different reactions to their insomnia but it’s encouraging – and to most people, a relief – to find that they can be helped through CBT. It increases confidence in their ability to train the mind and body to cope with sleep issues. The reinforcement of a healthy new way of thinking about sleep also prepares the way for techniques such as mindfulness and self-hypnosis to help calm the mind and let go of thoughts.”

Hypnotherapy has also been shown to help with insomnia. A hypnotherapist can work to uncover the subconscious reasons for insomnia and, once identified, can work with you to overcome the issues. Hypnotherapy for insomnia typically focuses on relaxation to reduce tension, on developing a routine, and helping you maintain healthy habits such as regular bedtimes and waking times.

You may also be taught some self-hypnosis techniques to support yourself at home.

Sleeping pills may help relieve insomnia but aren’t a permanent solution. Though sleeping pills may aid sleep in the short-term, they usually won’t cure your insomnia and do carry the risk of unpleasant side effects. Sleeping pills may make you drowsy in the daytime and impair your day-to-day activities. You can become dependent on sleeping pills, so they should not be the main treatment option. Because of the risks with sleeping pills, your doctor will likely not prescribe them unless your insomnia is very bad and other forms of treatment haven’t worked. They aren’t usually prescribed for more than a few weeks.

Integrative therapist Paul Garden says: “When I work with people who struggle to sleep, first we address the issue of the physiological response to stress and anxiety, which usually means adrenaline and excess cortisol in the system that prevents the body itself from relaxing. Progressive relaxation techniques often have a valuable effect on this factor. Second, and very common, is the issue of overstimulated cognitive activity, usually being experienced as over-thinking and rumination. Mindfulness is an excellent antidote to this, as it allows people to disconnect from the incessant thinking, to stand back from it, and begin to find some space and stillness in which to feel calmer and then drift off, allowing the body and mind to enjoy sleep.”

People whose insomnia is very severe and not responding to treatment may be referred to a sleep clinic for specialized tests or treatments.

Living with insomnia

Good sleep hygiene is at the heart of living with insomnia, but there are more things that might help you sleep better.

Part of good sleep hygiene is sticking to a regular sleeping pattern, so even if you have a disrupted night’s sleep get up at your usual time. You may be relieved to feel you could finally drift off into the morning but sleeping in may make it harder for you to sleep well the following night. It may also mean you are late for work, school, or other appointments, which could cause further worries that might add to your sleep problem.

Often, anxiety, depression, and other psychological disorders are characterized by over-thinking things. If turning things over and over in your mind keeps you up at night, consider writing down your thoughts and concerns before bed and drafting a few potential solutions. This may help you leave your worries to the side until the morning.

Worrying about how long it’s taking you to fall asleep may, frustratingly, make it even harder to drift off. Try not to watch the clock and if you can’t fall asleep, experiment with getting out of bed for twenty minutes or so, going to another room and doing something, such as listening to music or writing things down.

“Be kind to yourself. Do what you can, when you can. When you suffer with something you can't see, it's so difficult to get across to people how you're feeling”

HealthUnlocked insomnia survey response, 2018

If it’s unclear what’s causing your insomnia, it may be helpful to keep a sleep diary. You might consider noting down things such as: what time you went to bed, whether you woke in the night, when you got out of bed in the morning, how much exercise you had done that day, what you had eaten that day, how you felt that day. All of this will help you identify patterns that might be keeping you up at night.

Get a two-week sleep diary from the American Academy of Sleep Medicine

If your insomnia makes you tired during the day, or you take medication to help you sleep, take care when driving, using machinery or doing any potentially dangerous activity. The US National Highway Traffic Safety Administration estimates that driver fatigue is involved in as many as 100,000 annual accidents – and up to 5,000 deaths – in the United States. In the UK, it is estimated that up to 20% of all road accidents involve drowsy drivers.

Support and apps

Understanding insomnia and what you can do about it for yourself are key to handling the condition. Often, changes to your bedtime routine – combined with taking regular exercise and eating healthily – are all that is needed to resolve your insomnia.

“A good diet and regular exercise has helped a lot”

HealthUnlocked insomnia survey response, 2018

Learning about the causes and the things you can try to get back to having full and refreshing sleep are the first steps to recovery. There is a wealth of information and advice to help you. Try sites such as:

Some people find that talking to others with the same problem is a great source of support, information, and advice. Visit the Sleep Support community at HealthUnlocked to connect with people with insomnia and other sleep problems.

Apps

There’s a wide range of free and low-cost smartphone apps that can help manage insomnia and get your sleep back to normal. Some are based on mindfulness, meditation, or hypnotherapy, some play relaxing sounds, and others let you track your sleep patterns.

See Healthline’s review of ‘The Best Insomnia Apps’ for an idea of the sorts of apps available.

An NHS-approved web-based course called Sleepstation uses a seven-week CBT-I course to support you with your sleep problems. It is available free on the NHS in England or you can buy it for £145 including initial assessment.

Another popular app is Calm. Calm is a meditation app and also has a range of ‘sleep stories’ from people like Stephen Fry.

Therapy

Your doctor might be able to refer you for specialized therapy or recommend a therapy for you. In the UK, you can find a hypnotherapist or psychotherapist for insomnia through welldoing.org.