Health A to Z
Insomnia is difficulty getting to sleep or staying asleep for long enough to feel refreshed the next morning.
It's a common problem thought to regularly affect around one in every three people in the UK, and is particularly common in elderly people.
If you have insomnia, you may:
Occasional episodes of insomnia may come and go without causing any serious problems, but for some people it can last for months or even years at a time.
Persistent insomnia can have a significant impact on your quality of life. It can limit what you're able to do during the day, affect your mood, and lead to relationship problems with friends, family and colleagues.
There are no official guidelines about how much sleep you should get each night because everyone is different.
On average, a "normal" amount of sleep for an adult is considered to be around seven to nine hours a night. Children and babies may sleep for much longer than this, whereas older adults may sleep less.
What's important is whether you feel you get enough sleep, and whether your sleep is good quality.
You're probably not getting enough good-quality sleep if you constantly feel tired throughout the day and it's affecting your everyday life.
Try the sleep self-assessment to see if you have trouble sleeping.
It's not always clear what triggers insomnia, but it's often associated with:
Read more about the causes of insomnia.
There are a number of things you can try to help yourself get a good night's sleep if you have insomnia.
Some people find over-the-counter sleeping tablets helpful, but they don't address the underlying problem and can have troublesome side effects.
Read more self-help tips for insomnia.
Make an appointment to see your GP if you're finding it difficult to get to sleep or stay asleep and it's affecting your daily life – particularly if it has been a problem for a month or more and the above measures have not helped.
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.
Your GP may suggest keeping a sleep diary for a couple of weeks to help them gain a better understanding of your sleep patterns.
Each day, make a note of things such as the time you went to bed and woke up, how long it took you to fall asleep, and the number of times you woke up during the night.
Your GP will first try to identify and treat any underlying health condition, such as anxiety, that may be causing your sleep problems.
They'll probably also discuss things you can do at home that may help to improve your sleep.
In some cases, a special type of cognitive behavioural therapy (CBT) designed for people with insomnia (CBT-I) may be recommended.
This is a type of talking therapy that aims to help you avoid the thoughts and behaviours affecting your sleep. It's usually the first treatment recommended and can help lead to long-term improvement of your sleep.
Prescription sleeping tablets are usually only considered as a last resort and should be used for only a few days or weeks at a time.
This is because they don't treat the cause of your insomnia and are associated with a number of side effects. They can also become less effective over time.
Read more about treating insomnia.
Insomnia can be triggered by a number of possible factors, including worry and stress, underlying health conditions, and alcohol or drug use.
Sometimes it's not possible to identify a clear cause.
Some people develop insomnia after a stressful event, such as a bereavement, problems at work, or financial difficulties.
The problem can continue long after the event has passed because they start to associate going to bed with being awake. This develops into an anxiety about sleep itself.
Having more general worries – for example, about work, family or health – are also likely to keep you awake at night.
These can cause your mind to start racing while you lie in bed, which can be made worse by also worrying about not being able to sleep.
You may struggle to get a good night's sleep if you go to bed at inconsistent times, nap during the day, or don't "wind down" before going to bed.
A poor sleeping environment can also contribute to insomnia – for instance, an uncomfortable bed or a bedroom that's too bright, noisy, hot or cold.
Drinking alcohol before going to bed and taking certain recreational drugs can affect your sleep, as can stimulants such as nicotine (found in cigarettes) and caffeine (found in tea, coffee and energy drinks). These should be avoided in the evenings.
Changes to your sleeping patterns can also contribute to insomnia – for example, because of shift work or changing time zones after a long-haul flight (jet lag).
Underlying mental health problems can often affect a person's sleeping patterns, including:
Insomnia can also be caused by underlying physical conditions, including:
In women, childbirth can sometimes lead to insomnia.
Some prescriptions or over-the-counter medications can cause insomnia as a side effect.
Check the leaflet that comes with any medication you're taking to see if insomnia or sleeping difficulties are listed as a possible side effect.
Insomnia can often be improved by changing your daytime and bedtime habits or by improving your bedroom environment.
Making small changes may help you to get a good night's sleep. Try some of the methods below for a few weeks to see if they help.
See your GP if you're still having difficulty getting to sleep after trying these techniques.
Insomnia will often improve by making changes to your bedtime habits. If these don't help, your GP may be able to recommend other treatments.
If you've had insomnia for more than four weeks, your GP may recommend cognitive and behavioural treatments or suggest a short course of prescription sleeping tablets as a temporary measure.
If it's possible to identify an underlying cause of your sleeping difficulties, treating this may be enough to return your sleep to normal.
The various treatments for insomnia are outlined below. You can also read a summary of the pros and cons of the treatments for insomnia, allowing you to compare your treatment options.
Your GP will be able to advise you about what you can do at home to help you sleep. This is known as "sleep hygiene" and includes:
Read more about self-help tips for insomnia.
If changing your sleeping habits doesn't help, your GP may be able to refer you for a type of cognitive behavioural therapy (CBT) that's specifically designed for people with insomnia (CBT-I).
The aim of CBT-I is to change unhelpful thoughts and behaviours that may be contributing to your insomnia. It's an effective treatment for many people and can have long-lasting results.
CBT-I may include:
CBT-I is sometimes carried out by a specially trained GP. Alternatively, you may be referred to a clinical psychologist.
The therapy may be carried out in a small group with other people who have similar sleep problems, or one-to-one with a therapist. Self-help books and online courses may also be used.
Sleeping tablets (hypnotics) are medications that encourage sleep. In the past, they were frequently used to help with insomnia, but they're used much less often nowadays.
They will generally only be considered:
Doctors are usually reluctant to recommend sleeping tablets in the long-term because they just mask the symptoms without treating the underlying cause.
They can also cause potentially dangerous side effects, such as drowsiness the following morning, and some people become dependent on them.
If they are recommended, you should have the smallest effective dose possible for the shortest time (usually no more than two to four weeks).
A number of sleeping tablets are available to buy over the counter (OTC) from pharmacies. These are usually a type of antihistamine medicine that causes you to feel drowsy.
Taking OTC sleeping tablets regularly isn't usually recommended if you have insomnia, because it's not clear how effective they are, they don't tackle the underlying cause of your sleeping difficulties and they can cause side effects.
In particular, they can cause you to feel drowsy the next morning, which can make activities such as driving and operating machinery dangerous.
Speak to your GP for advice if you find yourself needing to take OTC sleeping tablets regularly.
Benzodiazepines are prescription medicines that can reduce anxiety and promote calmness, relaxation and sleep. Your GP may prescribe them for a short time if you have severe insomnia or it's causing extreme distress.
Examples of benzodiazepines include temazepam, loprazolam, lormetazepam, diazepam and nitrazepam.
Long-term treatment with benzodiazepines isn't usually recommended because they can become less effective over time and some people become dependent upon them.
They can also cause a number of side effects, including:
You should avoid driving if you feel drowsy, dizzy, or unable to concentrate or make decisions, as you may not be able to do so safely.
Z–drugs are a newer type of medicine that work in a similar way to benzodiazepines and are similarly effective. They include zaleplon, zolpidem and zopiclone.
As with benzodiazepines, long-term treatment with Z–drugs isn't normally recommended because they can become less effective over time and some people become dependent on them.
They're usually only prescribed for a maximum of two to four weeks.
Side effects of Z-drugs can include:
Z–drugs can also sometimes cause psychiatric reactions, such as delusions, nightmares and hallucinations. Contact your GP if you experience any of these effects.
Read the National Institute for Health and Care Excellence (NICE) guidance on zaleplon, zolpidem and zopiclone for the short-term management of insomnia for more information.
For adults aged 55 or over, a medication called Circadin is sometimes used to help relieve insomnia for a few weeks. It contains a naturally occurring hormone called melatonin, which helps to regulate the sleep cycle.
Circadin is usually only recommended for three weeks at first, but it can be continued for a total of 13 weeks if it helps.
Common side effects of Circadin include:
The following treatments aren't normally recommended for insomnia, because it's not clear how effective they are and they can sometimes cause side effects: