If you are having trouble sleeping or staying asleep for long enough you have insomnia. This is a common problem and can be caused by many factors.
Definitions of insomnia vary but generally it means:
- difficulty getting to sleep
- difficulty staying asleep (poor sleep quality) and/or
- waking much too early.
Insomnia often goes away but it is important to talk to your doctor if sleep problems continue.
Why is sleep important?
If you have insomnia there will be some sort of impact during the daytime and should not be taken lightly. It leads to poor performance and a much increased risk of accidents, such as when driving or at work. Concentrating, remembering, making decisions and solving complex tasks can also be greatly impaired.
Lack of sleep over many months or years can also have negative effects on your health and your mood. It has been shown to increase the risk for conditions such as depression, anxiety, heart disease, high blood pressure and diabetes.
The good news is that there are many effective strategies to help improve sleep and, therefore, reduce the risk of these conditions developing.
How much sleep do I need?
Most people need about 8 hours’ sleep but this is only an average – there is no normal amount. Some people feel fine on 5 hours’ sleep while others need 10 hours a night. It also varies for any individual with age and other circumstances. Basically, if you wake feeling reasonably refreshed and can function well throughout the day then you are getting enough sleep.
Often insomnia happens in a time of stress, and it passes, but many other factors can contribute to insomnia, including
- alcohol, nicotine and caffeine consumption
- depression or anxiety
- other medical conditions and medicines
- snoring and sleep breathing difficulties such as obstructive sleep apnoea
- tooth grinding while ‘asleep’
- ongoing pain
- restless legs
- poor sleep hygiene, see Self care below.
Some people have insomnia without any of the above – this is called primary insomnia.
Your doctor will talk to you about your sleep patterns and associated symptoms, your lifestyle and any causes of stress in order to determine what might be causing your sleep problems. In a few situations you may be referred on to a sleep clinic for investigation.
It is especially important to say if you are feeling excessively sleepy during the day or falling asleep at inappropriate times (eg, while driving) as this can indicate a specific sort of sleep problem which needs treatment (as well as being a safety concern).
If there is nothing to suggest the specific reason, you may have primary (unexplained) insomnia, for which behavioural (non-drug) techniques are effective. In some cases medications may be useful, but these are not the only option available for managing insomnia.
If you are feeling very anxious about your sleep it may be useful to see a sleep psychologist as anxiety can further worsen sleep problems.
Medications for primary insomnia include sleeping pills and melatonin.
Sleeping pills have been around for a long time but their use still needs careful monitoring by your doctor. Sleeping pills can help you to fall asleep and stay asleep for a number of hours. If needed, sleeping pills should only be used for short periods (eg, 5 to 10 days), or on an occasional basis. They do not address the underlying causes of insomnia.
Sleeping pills do carry some risks. Some people can become dependent on using them to help them sleep. If taken for longer periods, the medication may become ineffective unless a larger dose is taken. Some people can also get a drug withdrawal effect of ‘rebound insomnia’ when coming off sleeping pills. Combining sleeping pills with alcohol or some other medicines can be dangerous.
Sleeping pills also have some side effects: confusion, sedation, amnesia and impaired co-ordination. These do not occur in everyone but they can lead to falls or being unsafe while driving or performing other tasks, especially if their effects are still felt in the morning.
If you are taking sleeping pills it is important to take them as prescribed by your doctor and not to combine sleeping pills or increase the dose unless you have spoken to your doctor.
Melatonin is a natural hormone that helps regulate your body clock – it provides a cue for feeling sleepy. The natural production of melatonin in the body varies over 24 hours and is suppressed by daylight. Melatonin production declines with age.
Prolonged-release melatonin tablets are a new prescription treatment for primary insomnia if you are aged over 55 years. Melatonin may cause drowsiness but is not thought to have any serious adverse effects and is not thought to cause dependency, or tolerance (where an increased dose is required for the same effect).
This is often called "sleep hygiene", and it refers to aspects of your lifestyle and your bedtime environment that might either interfere with or help promote better sleep.
Tips for improving sleep hygiene include:
- reduce or avoid caffeine, cigarettes and alcohol, especially in the evenings
- go to bed only when you are drowsy
- exercise outdoors early or mid-way through the day
- avoid TV, computer screens, mobile phones for an hour or two before bed – the artificial light interferes with your natural cues to sleep – and keep them out of the bedroom!
- ensure the bed is used only for sleep
- turn around any bedroom clocks – clock-watching makes insomnia worse
- unwind before bed by reading or listening to music
- make sure your bedroom is cool, dimly lit or dark, quiet and as comfortable for sleep as possible
- create your own bedtime ‘ritual’, eg, write down the things on your mind for tomorrow, read a book, make a hot, milky drink or take a warm bath – begin at the same time each night
- avoid large meals late in the evening, but don’t go to bed hungry (have a late snack if you need to).
10 tips to beat insomnia NHS Choices, 2014
Common sleep problems in 13 languages, Health Information Translations, 2015
Tips for getting a good night's sleep Here to Help Canada, 2011