Insomnia is difficulty getting to sleep, staying asleep, waking too early, or sleeping in a way that does not feel refreshing. It becomes clinically important when it causes daytime problems such as tiredness, poor concentration, low mood, irritability or reduced ability to function.
Short periods of poor sleep are common during stress, illness, travel or life changes. Insomnia can also last for months or years, especially when worry about sleep becomes part of the pattern.
Symptoms
Symptoms include taking a long time to fall asleep, waking repeatedly during the night, waking early and being unable to return to sleep, feeling unrefreshed, daytime tiredness, poor concentration, irritability and reduced performance at work, study or daily tasks.
People may also develop anxiety around bedtime, clock-watching and avoidance of sleep routines because they expect another bad night.
Causes
Insomnia can be linked to stress, anxiety, depression, pain, breathing problems, restless legs, hot flushes, shift work, caring responsibilities, alcohol, caffeine, nicotine, some medicines and irregular sleep routines.
The relationship can go both ways. Poor sleep can worsen mental and physical health, while mental and physical health problems can worsen sleep.
Assessment
Assessment usually starts with the sleep pattern, duration of symptoms, daily impact, medicines, caffeine and alcohol use, mental health, pain, breathing symptoms and work pattern. A sleep diary can help show timing, naps, wake periods and triggers.
Sleep studies are not needed for most insomnia, but may be considered if sleep apnoea, periodic limb movement disorder or another sleep condition is suspected.
Self-Help and Sleep Routine
Useful measures include keeping a regular wake time, winding down before bed, reducing caffeine later in the day, avoiding large meals or alcohol shortly before bed, keeping the bedroom quiet and comfortable, and using the bed mainly for sleep and sex.
If someone cannot sleep and becomes anxious in bed, NHS inform advises getting up, going to another room, doing a quiet relaxing activity, and trying again after around 20 minutes or when sleepy.
Daytime naps can make night sleep harder for some people. Exercise can help sleep, but vigorous exercise close to bedtime may be unhelpful.
Psychological Treatment
Cognitive behavioural therapy for insomnia, often called CBT-I, is a structured treatment that targets habits and thoughts that keep insomnia going. It can include stimulus control, sleep scheduling, relaxation work and changing unhelpful beliefs about sleep.
CBT-I is often preferred for persistent insomnia because it can have longer-lasting benefits than short-term sleeping tablets.
Medication
Medicines may sometimes be used for short-term relief or specific situations, but they can cause side effects and dependence, and some can make sleep problems worse if used poorly. Choice depends on age, other conditions, current medicines, pregnancy status, risk of falls, driving and the likely cause of insomnia.
Melatonin or other medicines may be appropriate in selected cases, but persistent insomnia is usually better managed by addressing the sleep pattern and underlying causes.
When to Seek Help
Someone should seek help if insomnia lasts for weeks, affects daily life, is linked to low mood or anxiety, follows a new medicine, happens with loud snoring or breathing pauses, or causes unsafe sleepiness while driving or working.
See Also
References
Discussion log
Use comments for sourcing notes, corrections, and disputed details.
No comments yet.