Insomnia: what it is, symptoms, causes and how it is treated

The NHS says insomnia means you regularly have problems sleeping. NHS inform adds that it can mean struggling to get to sleep, difficulty staying asleep, or both. It is a common problem thought to affect around 1 in 3 people in the UK, and it is particularly common in older adults.

Insomnia is judged by how you feel as much as by the clock. The Royal College of Psychiatrists says to judge your sleep by how you feel in the day rather than by the number of hours you sleep at night. If you feel well, alert and rested for most of the day, and on most days, you are getting enough sleep for you.

The NHS draws a line between short-term insomnia (less than 3 months) and long-term insomnia (3 months or longer). NHS inform says episodes can come and go without causing serious problems, but some people have insomnia for months or even years, and persistent insomnia can affect quality of life, mood and relationships.

The NHS says you have insomnia if you regularly have any of the following. NHS inform makes the point that you are probably not getting enough good-quality sleep if you always feel tired throughout the day or if tiredness is affecting your everyday life.

• Finding it hard to go to sleep.

• Waking up several times during the night.

• Lying awake at night.

• Waking up early and being unable to go back to sleep.

• Still feeling tired after waking up.

• Finding it hard to nap during the day even though you are tired.

• Feeling tired and irritable during the day.

• Finding it difficult to concentrate during the day because you are tired.

Treatment depends on the cause and on how long the problem has lasted. NHS inform says that your GP will first try to identify and treat any underlying health condition, and that treating an underlying cause may be enough to return your sleep to normal.

In general the order is: improve sleep habits (sleep hygiene), try self-help or online CBT, see a GP, and consider CBT-I with a therapist. Medicines are a last resort and only short term.

The NHS and NHS inform give very similar practical advice. None of these changes works overnight, so give each one a few weeks and keep the pattern regular.

• Only go to bed when you are sleepy, and wake up and get out of bed at the same time every day.

• Relax for at least an hour before bed, for example with a bath, a book or gentle music.

• Make the bedroom dark and quiet, comfortable and slightly cooler than the rest of the home; use curtains, blinds, an eye mask or ear plugs if needed.

• Exercise regularly during the day, but not within 4 hours of going to bed.

• Do not smoke or drink alcohol, tea or coffee in the hours before bed; the NHS says at least 6 hours.

• Do not eat a big meal late at night.

• Avoid screens right before bed: the NHS says the blue light makes you more awake.

• Do not nap during the day and do not sleep in after a bad night.

• Write your worries and ideas down before bed (NHS inform).

• If you cannot sleep and are growing anxious, NHS inform suggests getting up, going to another room, doing something relaxing and trying again in around 20 minutes.

• Do not watch the clock, and keep the bedroom for sleep (and sex), not TV, work or eating.

NHS inform says insomnia can be triggered by many factors and that it is not always possible to identify a clear cause. The NHS lists the most common causes as 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.

The NHS also lists conditions and medicines that can cause insomnia: mental health conditions such as schizophrenia or bipolar disorder, Alzheimer's disease or Parkinson's disease, restless legs syndrome, an overactive thyroid and the menopause. Many medicines can also cause it. Things that keep you from a good night's sleep include long-term pain, sleepwalking, snoring or interrupted breathing during sleep (sleep apnoea), suddenly falling asleep anywhere (narcolepsy) and nightmares or night terrors, particularly in children.

If you feel unwell or think medication could be behind your sleep problems, NHS inform advises speaking to your GP or pharmacist rather than stopping it yourself.

The NHS says it is common to feel tired, or even exhausted, during pregnancy, especially in the first 12 weeks, and that as the bump gets bigger it can be difficult to get a good night's sleep because lying down may be uncomfortable or you may need the loo a lot. It says feeling tired will not harm you or your baby.

For insomnia remedies in pregnancy the NHS suggests relaxing before bedtime, using relaxation techniques (ask your midwife), avoiding naps in the afternoon or evening, avoiding tea, coffee or cola in the evening and taking some exercise during the day, even if you feel tired. It says the safest position to go to sleep is on your side, left or right, and that you can support the bump with pillows and put a pillow between your knees.

The NHS also says that sleeplessness, when accompanied by other symptoms such as feeling hopeless and losing interest in things you used to enjoy, can occasionally be a sign of depression. Speak to your doctor or midwife; treatment can help. Do not start a sleep medicine in pregnancy without checking with your midwife, GP or pharmacist.

Sleep needs change with age. The NHS gives averages of 9 to 13 hours for children and 12 to 17 hours for toddlers and babies, while NHS inform says older adults may sleep less. The NHS notes that nightmares and night terrors are particularly common causes of sleep disturbance in children. NHS inform points to The Sleep Charity for information to support parents and children.

The NHS says to see a GP if changing your sleeping habits has not helped, you have had trouble sleeping for months, or your insomnia is affecting your daily life in a way that makes it hard for you to cope. NHS inform adds that you should contact your GP practice if you are not looking after yourself or are finding it hard to manage responsibilities.

A GP will try to find out what is causing the insomnia. The NHS says you may be offered CBT, and that you may be referred to a sleep clinic if you have symptoms of another sleep disorder such as sleep apnoea. If poor sleep comes with low mood or thoughts of harming yourself, tell the GP and use NHS 111 or 999 in an emergency.

Do not drive when you feel sleepy; the NHS lists this among the things to avoid.

On the NHS you can start with self-help and online CBT, then see a GP, who can offer CBT or refer you to a sleep clinic if another sleep disorder is suspected.

Private options include CBT-I with an accredited therapist and private sleep clinics. The approach is broadly the same as on the NHS: assess for causes, work on sleep habits and use CBT-I, with medicines kept short term.