Short-term (acute) insomnia: what helps and when to seek advice

Insomnia means regularly having problems sleeping, whether that is difficulty dropping off, waking in the night, waking too early or still feeling tired after a night in bed. The NHS calls it short-term when it has gone on for less than 3 months. After that point it is described as long-term.

NHS inform says insomnia is a common problem thought to affect around 1 in 3 people in the UK and is particularly common in older adults, and that episodes can come and go without causing any serious problems. So a rough fortnight is not a diagnosis of something wrong with you. It becomes a clinical concern when it keeps going, affects how you cope or leaves you low or anxious.

CKS says short-term insomnia can occur with stressful events or with changes in sleeping patterns, giving illness, financial difficulties, the birth of a child and environmental disturbance as examples. The Sleep Charity adds that major illness and bereavement are typical triggers.

The NHS list of everyday causes is useful for spotting what may be fuelling a bad spell: stress, anxiety or depression, noise, a room that is too hot or cold, an uncomfortable bed, alcohol, caffeine or nicotine, illegal drugs such as cocaine or ecstasy, jet lag and shift work. Often more than one is present at once, for example a worrying week combined with late coffee and a hot bedroom.

The NHS advises going to bed only when sleepy, getting up at the same time every day, relaxing for at least an hour before bed, keeping the room dark and quiet and exercising regularly during the day. It also advises against napping, sleeping in after a bad night, big late meals and screens right before bed because blue light makes you more awake.

NHS inform adds a specific tip for the moments when you are lying awake and getting anxious: get up, move to a different room, do something calming such as reading or listening to music, and try again after around 20 minutes or when you feel tired. It also suggests not going to bed early to make up for lost sleep, because staying up until you are ready to fall asleep is better than lying in bed worrying.

The Sleep Charity notes that for acute insomnia the focus may be on managing worries and concerns about lack of sleep, and that stimulus control, which means using the bed only for sleep and sex and leaving it if you are not sleeping, may be effective.

The NHS says pharmacy products such as those containing valerian, lavender or an antihistamine cannot cure insomnia but may help you sleep better for 1 to 2 weeks and should not be taken for longer. Some cause drowsiness that can affect driving. It advises checking with a doctor before taking anything for sleep problems.

On prescribed treatment, NICE CKS says a short course (3 to 7 days) of a z-drug may be considered when short-term insomnia causes severe daytime impairment and significant distress and is likely to resolve soon, for example because of a short-term stressor. If it is not likely to resolve soon, CKS says CBTi should be offered as first-line treatment. CKS also says z-drugs should be avoided if possible in older people. The NHS adds that sleeping pills carry a risk of dependence. These are decisions for a prescriber, and nobody should start or share sleeping tablets on their own.

CKS says maladaptive behaviours and thinking are thought to be involved in the development of chronic insomnia. The early weeks are therefore a good time to avoid common traps: long daytime naps, lying in bed for hours trying to force sleep, checking the clock and building up fear of the coming night.

It helps to keep a simple sleep diary. CKS describes a diary kept for one to two weeks as useful for identifying sleep patterns and lifestyle factors. The Sleep Charity suggests taking a completed two-week diary to your GP. Record when you went to bed, roughly when you fell asleep, wakings, final wake time, caffeine and alcohol, and how you felt the next day.

The NHS suggests seeing a GP if changing your sleeping habits has not helped, if you have had trouble sleeping for months or if your insomnia is affecting daily life in a way that makes it hard to cope. The Sleep Charity gives an earlier prompt: more than four weeks of difficulty affecting your wellbeing.

A GP will try to find out what is causing the problem, and the NHS says you may be offered cognitive behavioural therapy, face to face or online, and may be referred to a sleep clinic if you have symptoms of another sleep disorder such as sleep apnoea. CKS recommends that other sleep disorders, including restless legs syndrome, are considered during assessment.

Seek urgent help if you feel unable to keep yourself safe, have thoughts of self-harm or feel overwhelmed. Use NHS 111 and choose the mental health option, contact your GP, or call 999 in an emergency. Do not drive if you feel sleepy.