Insomnia is difficulty getting to sleep or staying asleep for long enough to feel refreshed the next morning, even though you've had enough opportunity to sleep.

Most people have problems sleeping at some point in their life. It's thought that a third of people in the UK have bouts of insomnia. Insomnia tends to be more common in women and more likely to occur with age.

It's difficult to define what normal sleep is as everyone is different. Your age, lifestyle, environment and diet all play a part in influencing the amount of sleep you need. 

The most common symptoms of insomnia are:

• difficulty falling asleep
• waking up during the night
• waking up early in the morning
• feeling irritable and tired and finding it difficult to function during the day

Read more about the symptoms of insomnia.

Stress and anxiety are a common cause of insomnia, but it can also be caused by conditions such as depression, schizophrenia or asthma, some medications and alcohol or drug misuse. 

Read more about the causes of insomnia.

What to do

There are things you can do to help you get to sleep, such as avoiding caffeine later in the day or heavy meals late at night, trying to set regular times to wake up and using thick blinds or curtains, an eye mask and earplugs to prevent light and noise from waking you up.

When to see your GP

You should consider visiting your GP if a lack of sleep is affecting your daily life and you feel that it's a problem. Fatigue due to insomnia can affect your mood and create problems within your personal relationships and work environment.

Keeping a sleep diary may help you and your GP understand your sleep patterns.

Treating insomnia

The first step in treating insomnia is to diagnose and treat any underlying health condition, such as anxiety, that may be causing your sleep problems. 

Your GP is likely to discuss self-help tips for insomnia, which can help you sleep better (this is referred to as good sleep hygiene).

Cognitive behavioural therapy (CBT) may sometimes be recommended, as it can help you to avoid thoughts and behaviours that are affecting your sleep. CBT is a type of talking therapy that can be carried out by your GP or a clinical psychologist.

Sleeping tablets are usually the last resort and are often only used in the short-term with the smallest possible dose. This is because they can sometimes relieve the symptoms of insomnia but they don't treat the cause. If you have long-term insomnia, sleeping tablets are unlikely to help.

Read more about treating insomnia.

The symptoms of insomnia depend on the type of sleeping problem that you have. A lack of sleep can affect your mood and cause tiredness and fatigue during the day.

It's thought that up to a third of people in the UK have symptoms of insomnia at some point in the year, which can include:

• lying awake for a long time at night before falling asleep
• waking up several times in the middle of the night
• waking up early in the morning and not being able to get back to sleep
• feeling tired and not refreshed by sleep
• not being able to function properly during the day and finding it difficult to concentrate
• being irritable

How much sleep do I need?

As every individual is different, it's difficult to define what ‘normal sleep’ is. Factors that influence the amount of sleep you need include your age, lifestyle, diet and environment.

For example, newborn babies can sleep for 16 hours a day, while school-age children need to have an average of 10 hours sleep.

Most healthy adults sleep for an average of seven to nine hours a night. As you get older, it's normal to find sleep more difficult to maintain, although you still need the same amount of sleep.

When to visit your GP

You should consider visiting your GP if a lack of sleep is affecting your daily life and you feel that it's a problem. Fatigue caused by insomnia can sometimes affect your mood and create problems within your personal relationships and work environment.

Read more about simple methods that may help prevent insomnia.

Insomnia can be caused by many different things, including stressful events, psychiatric problems, underlying physical conditions, and drug and substance misuse. It can also be a side effect of certain medications.

Stressful events

Some people experience insomnia in response to a stressful event, and it continues even when the stress has been resolved. This is because they have learnt to associate the sleeping environment with being alert.

Worrying about work, money or health, a loved one becoming ill or dying, and even noise and light are all causes of Stress and are likely to keep you awake at night. 

Psychiatric problems

Underlying mental health problems can affect your sleeping patterns. They include:

• mood disorders, such as depression or bipolar disorder
• anxiety disorders, such as generalised anxiety, panic disorder or post-traumatic stress disorder
• psychotic disorders, such as schizophrenia

Physical condition

Insomnia can be caused by underlying physical conditions, including:

• heart disease 
• respiratory disease, such as chronic obstructive pulmonary disease or asthma
• neurological disease, such as Alzheimer's or Parkinson's disease
• hormone problems, such as an overactive thyroid
• joint or muscle problems, such as arthritis
• problems with the genital or urinary organs, such as urinary incontinence or an enlarged prostate
• sleep disorders, such as restless legs syndrome, narcolepsy or sleep apnoea
• chronic (long-term) pain

Drug and substance misuse

Alcohol and drug misuse, nicotine and drinking too much caffeine (contained in tea, coffee, energy drinks) can also affect your sleeping patterns.

Medication

Some prescribed treatments or medicines that are available over the counter can cause insomnia. These include:

• antidepressants 
• epilepsy medicine
• medication for high blood pressure (hypertension), such as beta-blockers
• hormone replacement therapy 
• non-steroidal anti-inflammatory drugs (NSAIDs)
• stimulant drugs, such as methylphenidate, which is often used to treat attention deficit hyperactivity disorder (ADHD) or modafinil, which is used to treat narcolepsy (a long-term sleep disorder that disrupts normal sleeping patterns)
• some medicines that are used to treat asthma, such as salbutamol, salmeterol and theophylline

You should consider visiting your GP if you're finding it difficult to get to sleep or to stay asleep and it's affecting your daily life.

Investigating the problem

You're likely to be asked about your sleeping routines, how much alcohol and caffeine you drink each day, and your general lifestyle habits, such as diet and exercise.

Your GP will also check your medical history for any illness or medication that may be contributing to your insomnia. 

Keeping a sleep diary (see below), can help you and your GP understand the pattern of your insomnia, which may help to decide the method of treatment. 

Read more about how insomnia is treated.

Keeping a sleep diary

You should keep a sleep diary for a minimum of two weeks. It should record information such as:

• the time you go bed
• the time it takes to get to sleep
• the number of times that you wake up during the night
• the time at which you wake up
• episodes of daytime tiredness and naps
• the times of meals, alcohol consumption and significant events during the day, such as exercise and stress

The first step in treating insomnia is to find out whether the problem is being caused by an underlying medical condition.

If it is, once the condition has been treated your insomnia may disappear without the need for further medical help.

Your GP should advise you on what you can do at home to help you sleep. This is often referred to as good sleep hygiene, and includes:

• establishing fixed times for going to bed and waking up (avoid sleeping in after a poor night's sleep)
• trying to relax before going to bed
• maintaining a comfortable sleeping environment (not too hot, cold, noisy or bright)
• avoiding napping during the day
• avoiding caffeine, nicotine and alcohol late at night 
• avoiding exercise within four hours of bedtime (although exercise in the middle of the day is beneficial)
• avoiding eating a heavy meal late at night
• avoiding watching or checking the clock throughout the night
• using the bedroom mainly for sleep and sex if possible

Read more about simple methods that may help prevent insomnia.

If you have long-term insomnia (lasting more than four weeks):

• your GP will advise you about good sleep hygiene
• your GP may recommend cognitive and behavioural treatments
• you may be prescribed a short course of sleeping tablets for immediate relief or to manage a particularly bad period of insomnia (although they aren't recommended for long-term use) 

Cognitive and behavioural treatments

Cognitive behavioural therapy (CBT) aims to change unhelpful thoughts and behaviours that may be contributing to your insomnia. CBT is usually recommended if you've had sleep problems for more than four weeks. It includes:

• stimulus-control therapy, which aims to help you associate the bedroom with sleep and establish a consistent sleep/wake pattern
• sleep restriction therapy – you limit the amount of time spent in bed to the actual amount of time spent asleep, creating mild sleep deprivation; sleep time is then increased as your sleeping improves
• relaxation training – this aims to reduce tension or minimise intrusive thoughts that may be interfering with sleep
• paradoxical intention – you try to stay awake and avoid any intention of falling asleep; it's only used if you have trouble getting to sleep, but not maintaining sleep
• biofeedback – sensors connected to a machine are placed on your body to measure your body’s responses, such as muscle tension and heart rate; the machine produces pictures or sounds to help you control your breathing and body responses

Sometimes, CBT is carried out by a specially trained GP. Alternatively, you may be referred to a clinical psychologist.

Sleeping tablets

Sleeping tablets (hypnotics) are medications that encourage sleep. They may be considered:

• if your symptoms are particularly severe
• to help ease short-term insomnia
• if the non-drug treatments that are mentioned above fail to have an effect

However, doctors are usually reluctant to prescribe sleeping tablets as they relieve symptoms but don't treat the cause of your insomnia. If you have long-term insomnia, sleeping tablets are unlikely to help. Your doctor may consider referring you to a clinical psychologist to discuss other approaches to treatment.

Read more about why sleep medication only offers short-term relief.

You should be given the smallest effective dose possible for the shortest length of time necessary (for no longer than a week). In some cases, you may be advised to only take the medication two or three nights a week, rather than every night.

Sleeping tablets can cause the following side effects:

• a feeling that you're hungover
• drowsiness during the day

It's best to take sleeping tablets at night, before you go to bed. In some people, particularly older people, the hangover effects may last into the next day, so be cautious if you're likely to be driving the next day.

It's very easy to become dependent on sleeping tablets, even after a short-term course. 

If you're regularly taking sleeping tablets every night, consider reducing or stopping them. Speak to your doctor for advice.

Short-acting benzodiazepines or the newer 'Z medicines' (see below) are the preferred medicines for insomnia and are only available on prescription.

Benzodiazepines

Benzodiazepines are tranquillisers that are designed to reduce anxiety and promote calmness, relaxation and sleep.

These medicines should only be considered if your insomnia is severe or causing you extreme distress. All benzodiazepines make you feel sleepy and can lead to a dependency. If they're needed to treat insomnia, only the short-acting benzodiazepines (with short-lasting effects) should be prescribed, such as:

• temazepam 
• loprazolam 
• lormetazepam

Z medicines

Z medicines are a newer type of sleeping tablet that work in a similar way to benzodiazepines. They're also short-acting medicines and include:

• zopiclone 
• zolpidem 
• zaleplon 

There's little difference between the benzodiazepines and Z medicines. If one doesn't work, then swapping to another is unlikely to have a different effect.

For more information, see the NICE guidance about the use of zaleplon, zolpidem and zopiclone for the short-term management of insomnia.

Melatonin (Circadin)

Medicines that contain melatonin have been shown to be effective in relieving insomnia for up to 26 weeks in elderly people. Melatonin is a naturally occurring hormone that helps regulate the sleep cycle (known as the circadian rhythm).

At present, Circadin is the only medicine that contains melatonin. It's licensed to treat insomnia. Circadin is only available on prescription for people who are 55 years old or over.

Circadin is designed as a short-term treatment for insomnia and shouldn't be taken for more than three weeks. It's not recommended for people with a history of kidney disease or liver disease.

As yet, there's not enough evidence to say whether it's safe to take Circadin during pregnancy or while breastfeeding, so its use isn't recommended under these circumstances.

Side effects of Circadin are uncommon but include:

• irritability
• dizziness
• migraines 
• constipation 
• stomach pain
• weight gain

If you find these side effects troublesome, stop taking Circadin and contact your GP.

Insomnia can often be prevented by changing your daytime and bedtime habits or by improving your bedroom environment. Making small changes may help you get a good night's sleep.

Try some of the methods below for at least three to four weeks.

Daytime habits

• Set a specific time for getting up each day. Stick to this time, seven days a week, even if you feel you haven't had enough sleep. This should help you sleep better at night.
• Don't take a nap during the day.
• Take daily exercise, such as 30 minutes walking or cycling, at least four hours before you're planning to go to bed. This will allow your body temperature to cool down.

Bedtime habits

• Stop drinking tea and coffee four hours before bedtime.
• Avoid drinking alcohol and smoking because alcohol and nicotine are also stimulants. Alcohol may make you sleepy at first but will wake you up when the effects have worn off.
• Don't eat a big meal or spicy foods just before bedtime. A small snack that contains tryptophan (a natural sleep-promoting amino acid) may help, such as turkey, banana or fish.
• Only go to bed when you're feeling tired.
• Try to create a bedtime routine, such as taking a bath and drinking a warm, milky drink every night. These activities will be associated with sleep and will cause drowsiness.
• Don't lie in bed feeling anxious about sleeping. Instead, get up and go to another room for a short period and do something else, such as reading or watching television, and then try again.
• Don't watch the clock because this will only make you anxious.
• Write a list of your worries and any ideas to solve them, then try to forget about it until the morning.

Bedroom environment

• Use thick blinds or curtains or wear an eye mask if the early morning sunlight or bright streetlamps affect your sleep.
• Wear ear plugs if noise is a problem.
• Don't use the bedroom for anything other than sleeping or sex. Don't watch television, make phone calls, eat or work while you're in bed.
• Make sure that you have a comfortable mattress, a pillow that you like and adequate bed covers for the time of year.

When you find that you're asleep for most of the time that you're in bed, try going to bed 15 minutes earlier, but make sure you get up at the same time.