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. Read more about how much sleep is enough?
What causes insomnia?
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.
How is insomnia treated?
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.
Changes to your bedtime routine
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.
- 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).
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. A type of short-term counseling called cognitive-behavioral therapy (CBT) helps you to control worries, anxiety and negative thoughts that keep you awake. With CBT you can learn how to calm your mind when you’re trying to sleep. Ask your doctor if CBT is an option for you.
Medications for primary insomnia include sleeping tablets and melatonin.
Sleeping tablets (also called hypnotics)
Sleeping tablets or medicines that encourage sleep are not used often because they have the potential to cause harm. Using sleeping tablets on a long-term, ongoing basis produces problems, such as dependency, increased risk of falls, confusion and difficulties with driving.
- Research has shown that taking sleeping tablets for more than 10 nights in a row can make sleeping difficulties worse. They do not address the underlying causes of insomnia.
- 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 may be used in some cases such as, if your insomnia is severe, as a temporary measure to help ease short-term insomnia. They should only be prescribed for about 5 to 10 days, or on an occasional basis.
- Examples of sleeping tablets include benzodiazepines such as alprazolam (Xanax®), diazepam, lorazepam (Ativan®), nitrazepam (Nitrados®), oxazepam (Ox-Pam®) and temazepam (Normison®). Zopiclone acts in a similar way to benzodiapzepines. Read more about benzodiazepines.
Over-the-counter sleeping tablets
Some sleeping tablets can be bought over the counter (OTC) from pharmacies. These are usually a type of antihistamine medicine that causes you to feel drowsy. Because these medicines don't address the underlying cause of your sleeping problems and they can cause side effects, they are not recommended. Taking these sleeping tablets can cause you to feel drowsy the next morning, which can make activities such as driving and operating machinery dangerous.
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.. It is thought to be part of our sleep-wake cycle. Melatonin production declines with age.
- A tablet form has been created and used to help with sleep problems in the elderly, shift workers and those with jet lag. While popular, there is limited studies about its long-term safety and interactions data is lacking. Therefore it is only approved for use in people over 55 years.
- It can cause daytime drowsiness and impaired concentration so care is needed. It should not be given to children or teens as we do not know if it is safe.
- Read more about melatonin.
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