Insomnia | Rarunga moe

If you have trouble getting to sleep, staying asleep or sleeping for long enough, you may have insomnia (rarunga moe).

Key points about insomnia

  1. Insomnia is a common sleep disorder that often starts in a time of stress. It may pass when the stress does, but sometimes continues after it has gone. 
  2. Other things can also cause insomnia, including alcohol, caffeine and nicotine, mental health issues, other sleep problems, some health conditions and some medicines.
  3. In the short term, insomnia can reduce your performance at work and put you at risk of accidents. In the long term, it can also affect your health and mood.
  4. Although the amount of sleep needed varies by person and age, for most adults about 7–9 hours is recommended.
  5. There are things you can do to help overcome insomnia, including developing good sleep hygiene, cognitive behavioural therapy, sleep apps and, in some cases, medicines.

See your GP as soon as possible if you feel very sleepy during the day while driving or your job involves operating machinery or aircraft.

What is insomnia?

Insomnia is a sleep disorder. It can affect how much sleep you get and the quality of that sleep.

If you have insomnia, you may experience:

  • difficulty getting to or falling asleep
  • difficulty staying asleep (poor sleep quality) 
  • waking up too early.

There are different forms of insomnia. For example, delayed sleep phase syndrome (DSPS) is like jet lag, but doesn’t go away over time. The people with DSPS are the night owls. Read more about sleep and your body clock.

Why is insomnia a problem?

If you have insomnia, you won't get enough good quality sleep and will be tired during the day. This can lead to poor work performance and an increased risk of car and work accidents. It also makes it harder to concentrate, remember things, make decisions and solve difficult problems.

Insomnia over many months or years can also affect your health and mood. It can increase your risk of depression, anxiety, heart disease, high blood pressure and diabetes.

The good news is that there are things you can do to help your sleep and reduce your risk of being affected by problems caused by insomnia.

How much sleep do I need?

The recommended amount of sleep for an adult is between 7–9 hours. The amount of sleep you need varies depending on your age and what else is happening in your life. If you wake up feeling refreshed and can function well throughout the day, you're getting enough sleep. Read more about how much sleep is enough.

What are the causes of insomnia?

Often insomnia starts in a time of stress and passes when the stress does. However, many other things can also cause insomnia.

  Common causes of insomnia:
  • alcohol (overuse or withdrawal)
  • nicotine (smoking)
  • caffeine at night
  • poor bedtime routine and sleep habits
  • shift work
  • noise or light
  • a room that is too hot or too cold
  • uncomfortable beds, or using beds for anything other than sleep or sex
  • recreational drugs such as cocaine or ecstasy
  • mosquitoes or other bugs
  • caring for babies and young children
  • periodic limb movement disorder (where leg movements disturb sleep)

What are the symptoms of insomnia?

Symptoms of insomnia may include:

  • tiredness and fatigue in the day
  • poor concentration and memory
  • loss of interest in usual activities
  • irritability
  • depression and anxiety
  • poor work performance
  • being at risk of work or motor vehicle accidents
  • poor quality of life
  • poor social functioning
  • poor libido.

How is insomnia diagnosed? 

Your doctor will ask you questions about your sleep patterns, sleep routine, sleep habits and whether you have any health conditions. They will also ask you about your general wellbeing and mental health, and whether you have any stress or anxiety.

It's a good idea to record your sleep in a sleep diary for 2 weeks before going to see your doctor.

Your doctor will ask you to fill in a questionnaire, such as the Epworth Sleepiness Score, to find out how severe your insomnia is and whether it has affected your daily functioning. Your partner or family/whānau members may be asked if they have noticed your sleep pattern.

Blood tests may also be done to rule out other conditions that can cause the same symptoms. Some people may be referred to a sleep clinic for further tests and treatment.

How is insomnia treated?

Treatment of insomnia aims to reduce the impact on your daytime functioning and improve your sleep quality. Although insomnia can go away on its own, it's important to talk to your doctor if your sleep problems continue.

Treatment of insomnia includes:

You may be referred to a sleep specialist to find out other causes if these treatments don't work for you.

Sleep hygiene

Sleep hygiene refers to aspects of your lifestyle and bedtime environment that make it easier or harder to get better quality sleep.

Changes you can make to improve your sleep hygiene include:

  • going to bed at the same time every night – this will help set your biological clock so you start to feel drowsy at bedtime
  • creating your own bedtime ritual, eg, writing down the things on your mind that are worrying you or that you need to do tomorrow, making a hot, milky drink or taking a warm bath – start your ritual at the same time each night
  • reducing or avoiding caffeine, cigarettes and alcohol, especially in the evenings
  • avoiding large meals late in the evening – but don’t go to bed hungry (have a late snack if you need to)
  • exercising outdoors early or in the middle of the day (but not too close to your bedtime)
  • avoiding TV, computer screens and mobile phones for an hour or two before bed, as the artificial light interferes with your natural cues to sleep
  • unwinding before bed by reading or listening to music
  • not using your bed for work or catching up on social media
  • making sure your bedroom is cool, dimly lit or dark and as quiet and comfortable for sleep as possible
  • turning around any bedroom clocks – clock-watching makes insomnia worse
  • using mindfulness or relaxation techniques.

Read more tips to improve your sleeping habits.

Cognitive behavioural therapy for insomnia (CBTi)

A type of short-term counselling called cognitive behavioural therapy (CBT) can help you to improve your sleep by teaching you how to manage anxiety and negative thoughts that keep you awake. A special form of CBT that focuses on insomnia, called CBTi, helps you learn how to calm your mind when you’re trying to sleep. CBT can be done by your doctor, a sleep therapist or through online CBT programmes.

Online programmes include:

Sleep apps

There are a variety of sleep apps available for use on your smartphone or tablet that can be helpful if you have insomnia. Some apps track your sleep habits, similar to a sleep diary, to help you develop good sleep routines. Other apps help you to fall asleep by using calming visual graphics and relaxing music.

Medicines for sleep

Medicines for managing sleep problems are usually only considered when lifestyle changes (sleep hygiene) or CBTi have been unsuccessful. Medicines for sleep problems may be effective in the short term but there is no evidence of long-term efficacy or safety. Medicines used to help your sleeping may also be addictive.

Medicines that are used for insomnia include:

Other supplements are also used for insomnia, but the evidence that these are effective is either limited or does not exist. If you have been prescribed medicines for sleep, your doctor will talk to you about your safety to drive, as some of these medicines can have side effects. Read more about medicines for sleep problems.

Talk to your doctor to find out the best treatment option for you.

Sleepiness and driving

Insomnia can cause daytime sleepiness and fatigue. If you need to drive, this can be extremely dangerous. Driver fatigue is one of the most common causes of motor vehicle accidents in New Zealand.

If you experience drowsiness during the day, it is important to stop driving and let your doctor know. Your doctor will need to find out the causes of your sleepiness and treat it accordingly. It is also a legal requirement for you to only drive when you are medically fit, including not driving if you are too tired and sleepy.

The New Zealand Transport Agency has some fatigue resources to make it easier to manage driver fatigue. Also read more about drowsy driving tips.

See your GP as soon as possible if you feel very sleepy during the day while driving or your job involves operating machinery or aircraft.

Learn more

The following links take you to other websites that provide further information on insomnia. Be aware that websites from other countries may contain information that differs from New Zealand recommendations.

Sleep problems Ministry of Health, NZ
Insomnia Sleep Health Foundation, US
Insomnia NHS, UK
Insomnia Patient Info, UK
Insomnia (beyond the basics) UpToDate, US
Tips for getting a good night's sleep Here to Help, Canada
The complete guide to insomnia and how you can manage it How To Sleep, UK

References

  1. Insomnia 3D HealthPathways, NZ, 2020
  2. I dream of sleep: managing insomnia in adults part 1 BPAC, NZ, 2017
  3. I dream of sleep: managing insomnia in adults part 2 BPAC, NZ, 2017
  4. Melatonin: is it worth losing any sleep over? BPAC, NZ, 2015
  5. Overuse of benzodiazepines: still an issue? BPAC, NZ, 2015
  6. Insomnia treatment in New Zealand NZMJ, 2012;125:1349
  7. Melatonin SafeRx, NZ, 2019
  8. Hypnotics SafeRx, NZ, 2019
  9. The assessment and management of insomnia in primary care The BMJ, UK, 2011

Reviewed by

After 45 years of GP experience, and 8 years as an examiner and practice assessor, Dr Bryan Frost has completed a Diploma in Editing and is pursuing a new career. He also has a Diploma in Health Administration, with honours in management, and has also completed a paper in Health Care Law.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Bryan Frost, FRNZCGP, Morrinsville Last reviewed: 26 Feb 2021