What Is Insomnia? Signs, Causes and How It Is Treated

Most people have a bad night's sleep now and then. Insomnia is different: it is when poor sleep happens regularly, even though you have the time and the chance to sleep, and it starts to affect how you feel and function during the day. It is one of the most common health problems in the UK, and it is very treatable.

This guide explains what insomnia is, how to tell whether you have it, why it happens and how it is treated, including cognitive behavioural therapy for insomnia (CBT-I), the treatment with the strongest evidence.

Quick answer

Insomnia means regularly finding it hard to fall asleep, stay asleep or sleep long enough to feel refreshed, despite having the opportunity to sleep, with effects such as tiredness, irritability or poor concentration during the day. Insomnia lasting less than three months is called short-term insomnia and often follows stress or a life event. Difficulty sleeping on at least three nights a week for three months or more is called chronic insomnia. NICE recommends CBT-I as the first treatment for chronic insomnia, ahead of sleeping tablets, and most people improve within a few weeks of starting it.

What is insomnia?

Insomnia is a sleep disorder in which you have trouble getting to sleep, staying asleep or both, and it affects your daytime life. The key point is that you have enough time in bed. If you sleep well whenever you get the chance but are simply not giving yourself enough hours, that is sleep deprivation rather than insomnia, and the answer is more time for sleep.

Around one in ten adults has long-term insomnia, and many more have short spells of it. It is more common in women, in older adults, in shift workers and in people living with pain, anxiety or depression.

How do I know if I have insomnia?

You may have insomnia if you regularly:

• Take 30 minutes or more to fall asleep
• Wake several times in the night and struggle to get back to sleep
• Wake much earlier than you want to and cannot get back to sleep
• Still feel tired after waking
• Cannot nap during the day, even though you feel exhausted
• Feel irritable, low or anxious, or find it hard to concentrate during the day
• Worry about sleep in the evening or dread going to bed

Keeping a sleep diary for one to two weeks is the best way to see the pattern. Note when you go to bed, roughly how long it takes to fall asleep, how often you wake, when you get up, any naps, and your caffeine and alcohol intake. Your GP may ask for the same information.

Short-term and chronic insomnia

• Short-term insomnia lasts from a few nights up to three months. It is usually triggered by something identifiable, such as stress at work, a bereavement, illness, a new baby or travel, and it often settles once the trigger passes.
• Chronic insomnia means difficulty sleeping on at least three nights a week for three months or more. By this stage the original trigger has often faded, and the problem is kept going by habits and worry about sleep, such as going to bed early to catch up, lying awake for long periods and watching the clock.

What causes insomnia?

It helps to think of insomnia in three parts. Some people are naturally lighter sleepers or more prone to worry. A trigger, such as stress, illness, pain, menopause symptoms, shift work or a new medicine, then disrupts sleep. Finally, the ways we try to cope, such as long lie-ins, daytime naps, spending longer in bed, alcohol at night and anxious clock-watching, keep the problem going after the trigger has gone. That last part is what treatment targets.

For a fuller list of everyday causes and what to do on the night, see our guide to why you cannot sleep.

How is insomnia treated?

The first step is to treat anything that is directly disturbing your sleep, such as pain, an overactive thyroid, anxiety, depression, menopause symptoms or a medicine side effect. For chronic insomnia, NICE recommends cognitive behavioural therapy for insomnia (CBT-I) as the first treatment.

What CBT-I involves

• Sleep restriction. Limiting your time in bed to roughly the hours you actually sleep, then extending it gradually as your sleep becomes more solid. It feels tough for the first week or two but is one of the most effective parts.
• Stimulus control. Going to bed only when sleepy, getting up if you cannot sleep after about 20 minutes, and keeping a fixed wake-up time every day, so your bed becomes linked with sleep again.
• Cognitive techniques. Recognising and changing unhelpful thoughts about sleep, such as believing one bad night will ruin the next day.
• Relaxation. Breathing and relaxation exercises to lower arousal before bed.
• Sleep hygiene. Practical changes to caffeine, alcohol, light, exercise and the bedroom. On its own this is rarely enough for chronic insomnia, but it supports the rest.

CBT-I is usually delivered over four to eight sessions, face to face, in a group or through a digital programme. NICE has recommended a digital CBT-I programme, Sleepio, for people with insomnia, and it is available through the NHS in some areas. Ask your GP what is available locally.

Can insomnia be cured?

For most people, yes. Short-term insomnia often resolves on its own once the trigger has passed, especially if you avoid compensating with long lie-ins and naps. Chronic insomnia responds well to CBT-I: most people fall asleep faster, wake less and feel better during the day, and unlike sleeping tablets the benefits last after treatment ends. There is no single quick fix, and it can take a few weeks before you notice a clear difference. Some people have occasional relapses during stressful periods, and the same techniques work again.

What about sleeping tablets and sleep aids?

• Prescribed sleeping tablets, such as zopiclone, are only recommended for short periods during a crisis, because they lose their effect, can cause drowsiness the next day and may lead to dependence.
• Melatonin is prescription only in the UK and is mainly used short term in adults aged 55 and over.
• Daridorexant is a newer prescribed medicine that NICE recommends for some adults with long-term insomnia when CBT-I has not worked or is not available.
• Over-the-counter sleep aids, which usually contain a sedating antihistamine, are meant for occasional short-term use only and can leave you groggy. Herbal remedies have limited evidence.

Always discuss medicines with your GP or pharmacist, and do not stop a prescribed medicine suddenly without advice.

Do complementary therapies help?

Yoga, tai chi and acupuncture have shown benefits for sleep quality in some studies, although the evidence is weaker than for CBT-I. Regular daytime exercise improves sleep for most people. These approaches work best alongside the behavioural changes above rather than instead of them.

When to seek medical help

Call 999 or go to A&E if:

• You or someone else is in immediate danger, or you feel you may act on thoughts of ending your life
• Someone has taken more sleeping tablets than prescribed, or mixed them with alcohol or other sedating medicines, and is very drowsy, confused or hard to wake

Get same-day help, from your GP or NHS 111 (choose the mental health option), if:

• Poor sleep comes with very low mood, hopelessness or thoughts of harming yourself
• You suddenly need very little sleep and feel unusually energetic, with racing thoughts or behaviour that is out of character

See your GP if:

• Poor sleep has lasted three months or more, or is affecting your work, relationships or safety
• You snore loudly and someone has noticed pauses in your breathing, or you wake gasping
• You feel very sleepy during the day or have fallen asleep while driving. Do not drive until you have had advice
• You have an uncomfortable urge to move your legs in the evening
• You think a medicine, menopause symptoms or another health condition may be affecting your sleep

You can also call Samaritans free, at any time, on 116 123.

Frequently asked questions

Can insomnia go away on its own?

Short-term insomnia often settles within a few weeks once the trigger passes. Insomnia that has lasted three months or more is less likely to resolve without help, but it responds well to CBT-I.

Is insomnia a mental health condition?

Insomnia is classed as a sleep disorder. It is closely linked with anxiety and depression, which can cause it and be made worse by it, so treating one often helps the other.

How long does CBT-I take to work?

Most programmes run for four to eight weeks. Many people notice improvement within two to four weeks, although sleep can feel worse briefly at the start of sleep restriction.

Does insomnia run in families?

A tendency to sleep lightly or to worry can run in families, which may make insomnia more likely. Genes are only part of the picture, and treatment works whether or not others in your family have it.

Sleep support in Chiswick

Support for insomnia is available at Omnia Lifestyle in Chiswick, W4, close to Turnham Green station, on bus routes 94, E3 and 272. Limited parking is available on request when booking. We look at your sleep pattern, routine, stress and health, may ask you to keep a sleep diary, and can combine psychological support from Prof (Dr) Diwakar Sukul, Chartered Clinical Psychologist, with acupuncture, Ayurvedic evening routines and yoga, referring to your GP where needed.

Read more about poor sleep and insomnia, see why you cannot sleep, daily habits for better sleep, how to cope with anxiety and what Shirodhara is, explore clinical psychology, acupuncture, Ayurveda and yoga, or book an appointment.

This article is general information, not medical advice. If you have any of the warning signs listed above, seek medical attention.