About this symptom
Insomnia means regularly having trouble falling asleep, waking several times in the night, waking too early and not getting back to sleep, or still feeling tired after a night's sleep. It can leave you tired, irritable and unable to concentrate in the day.
Adults need seven to nine hours of sleep on average, though needs differ. Stress, worry and low mood are among the commonest causes, with habits and surroundings. Pain, other sleep problems and some medicines can also be behind it.
Possible causes
This is not a diagnosis. These are the causes doctors think about, with the ones that are most urgent to rule out first.
- DepressionPoor sleep or waking very early, with low mood or loss of interest. Poor sleep is often the symptom that first brings people with depression to a doctor.Read about it
- AnxietyLying awake with worry and finding it hard to switch off at bedtime. Stress and anxiety are among the commonest causes of poor sleep.Read about it
- Sleep apnoeaSnoring or pauses in breathing during sleep. A doctor may refer you to a sleep clinic to check.Read about it
- Restless legs syndromeA strong urge to move the legs, often with tingling or an ache, which is worse at night when you rest.
- Overactive thyroidA medical cause of insomnia that a blood test can check.Read about it
- Enlarged prostateGetting up at night to pass urine breaks up sleep. This can happen with an enlarged prostate.Read about it
- MenopauseTrouble sleeping in women around the time of the menopause, one of the conditions linked to insomnia.Read about it
- Habits, caffeine, alcohol or medicinesTea, coffee, alcohol or tobacco late in the day, irregular bedtimes, naps, screens in bed, a noisy or hot room, shift work, or a side effect of a medicine.
When to get help
See a doctor soon if you have:
- Trouble sleeping that has not improved after changing your sleep habits
- Poor sleep on most nights for months
- Poor sleep that makes it hard to cope with daily life, work or study
- Low mood, loss of interest or constant worry along with poor sleep
- Loud snoring or pauses in breathing in your sleep, or an urge to move your legs at night
- Feeling so sleepy in the day that you nod off while driving or working
A few poor nights during a stressful time can be managed at home with the steps below.
What you can do at home
Changing sleep habits is the main long-term treatment, and it often works without medicines.
Do
- Get up at the same time every day, and go to bed only when you feel sleepy
- Relax for an hour before bed, and keep the bedroom dark and quiet
- Be active during the day
- If you cannot sleep, get up and do something calm until you feel sleepy
Do not
- Avoid tea, coffee, alcohol and tobacco for several hours before bed
- Avoid large late meals, hard exercise and screens just before bed
- Avoid daytime naps, and do not sleep in after a poor night
- Do not drive if you feel drowsy
Pharmacy sleep aids do not cure insomnia and can cause drowsiness, so check with a doctor first. Doctors prescribe sleeping pills rarely and briefly, because of side effects and dependence.
What the doctor will do
The doctor will ask about your sleep, daytime tiredness, worries, mood, pain, medicines, and tea, coffee, alcohol and tobacco, and examine you. This is usually enough to diagnose insomnia and find the likely cause.
Tests are not usually needed, but the doctor may check for a cause such as an overactive thyroid, or refer you to a sleep clinic if they suspect sleep apnoea. Treatment starts with the cause and sleep habits, and often includes cognitive behavioural therapy (CBT), a talking treatment that changes thoughts and habits that get in the way of sleep.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Everyone needs eight hours of sleep, and anything less is a problem.”What is true?
Fact
Adults need between seven and nine hours on average, but individual needs vary. What matters is whether you can get through the day without constant tiredness. Trying harder to sleep tends to make it worse.
Myth“A drink of alcohol before bed helps you sleep.”What is true?
Fact
Alcohol is one of the things that can cause insomnia, and the NHS advises avoiding it for hours before bed. Pharmacy sleep aids do not cure insomnia, and sleeping pills risk dependence.
Myth“After a bad night, sleep in or nap in the day to catch up.”What is true?
Fact
Sleeping in and daytime naps tend to keep the pattern going. The NHS advises getting up at the same time every day, staying active in the day and avoiding naps.
Myth“Poor sleep is only a bad habit with no medical cause.”What is true?
Fact
Poor sleep can be linked to stress, depression, anxiety, pain, sleep apnoea, an overactive thyroid and some medicines. If habits do not help, see a doctor to look for the cause.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
How many hours of sleep do I need?
Adults need seven to nine hours on average, though individual needs vary. If you feel constantly tired during the day, you may not be getting enough sleep.
Can I take a sleeping tablet or a pharmacy sleep aid?
Pharmacy sleep aids do not cure insomnia and can cause drowsiness, so check with a doctor first and do not drive if you feel drowsy. A doctor rarely prescribes sleeping pills, and only for a short time, because they can cause serious side effects and dependence.
When should I see a doctor about poor sleep?
See a doctor if changing your sleep habits has not helped, if you have had trouble sleeping for months, or if it makes daily life hard to cope with. Get help straight away for any thought of suicide or of harming yourself.
What is CBT for insomnia?
Cognitive behavioural therapy is a talking treatment that helps you change the thoughts and habits that get in the way of sleep. It can be done in person or through an online programme, and it also helps with related worry or low mood.