Insomnia: causes, self-help and treatment in the UK

What counts as insomnia?

According to the NHS, you have insomnia if you regularly:

• find it hard to get to sleep,
• wake several times in the night or lie awake,
• wake early and can’t get back to sleep,
• still feel tired after waking, and feel tired, irritable or unable to concentrate in the day.

The daytime part matters. Some people naturally need less sleep and feel fine. Insomnia is when poor sleep happens often and affects your days. If it has lasted less than 3 months it’s short-term insomnia; 3 months or more is long-term insomnia.

How common is it?

Very common. In a study of 2,363 adults from five GP practices in Staffordshire, 37% reported insomnia symptoms. Among those who didn’t have it at the start, about 15% developed it within a year. Of those who had insomnia at the start, 69% still had it a year later, and new insomnia was linked to anxiety, depression and pain.

What causes it?

The NHS lists the most common triggers as stress, anxiety or depression, noise, a room that’s too hot or cold, an uncomfortable bed, alcohol, caffeine or nicotine, jet lag and shift work. Pain, menopause, an overactive thyroid, restless legs, sleep apnoea and many medicines can also cause it.

What starts insomnia isn’t always what keeps it going. After a few bad nights, people often go to bed earlier, lie in, nap and lie awake worrying about sleep. These understandable habits weaken the body’s sleep drive and teach the brain to link bed with being awake, so insomnia continues after the original trigger has gone. That is what CBT for insomnia targets.

What can you do yourself?

• Get up at the same time every day, even after a bad night, and don’t lie in.
• Go to bed only when sleepy, not just because it’s bedtime.
• Get up if you can’t sleep. Do something calm in dim light and return when sleepy.
• Avoid napping while you’re trying to reset your sleep.
• Cut caffeine for at least 6 hours before bed, and keep alcohol low.
• Wind down for an hour before bed, with the bedroom dark, quiet and cool.

More on these in our guide to sleeping better.

What will a GP offer?

A GP will look for causes such as depression, pain or sleep apnoea and treat those. For insomnia itself, the main treatment is CBT for insomnia, face to face or through an online programme. NICE recommends the Sleepio app as an option in primary care, and it’s available on the NHS in some areas.

GPs rarely prescribe sleeping pills now. The NHS says they’re only given for a few days or weeks at most, when insomnia is very bad and other treatments haven’t worked. A pharmacist can suggest short-term sleep aids, but the NHS says these should not be used for more than 1 to 2 weeks.

Why treating it matters

Insomnia isn’t just tiring. In the OASIS trial at 26 UK universities, 3,755 students with insomnia were given digital CBT for insomnia or usual care. As well as sleeping better, those treated had fewer paranoid thoughts and hallucinatory experiences, and less depression and anxiety, suggesting poor sleep feeds mental health problems. See sleep and mental health.