Insomnia
Insomnia is not one bad night but a repeated inability to fall asleep or stay asleep, with the following day paying for it.
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On this page
- A bad night is not the same as insomnia
- How much sleep is actually needed
- What keeps you from falling and staying asleep
- When there is an illness behind the insomnia
- What works without medicines
- What the chemist sells and what to expect from it
- When you need a doctor and what will be offered
- Online consultation
Medicines commonly prescribed for Insomnia
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: CAPSULE, 40 mgActive substance: duloxetineManufacturer: Eli Lilly Nederland B.V.Prescription requiredDosage form: CAPSULE, 90 mgActive substance: duloxetineManufacturer: Neuraxpharm Spain S.L.Prescription requiredDosage form: TABLET, 5 mgActive substance: zolpidemManufacturer: Teva Pharma S.L.U.Prescription required
Insomnia is not one bad night but a repeated inability to fall asleep or stay asleep, with the following day paying for it. Both halves of that definition matter: someone who sleeps five hours, wakes up refreshed and functions normally has nothing to treat. But if the night goes on trying to sleep and the day passes in a fog of irritability, that is insomnia — even when the hours add up on paper.
A bad night is not the same as insomnia
We call it insomnia when the trouble repeats several nights a week and shows in the daytime. It can look quite different from person to person:
- you lie in bed for an hour or more and sleep does not come;
- you wake several times a night and stay awake for long stretches;
- you wake at four or five in the morning and cannot drop off again;
- you do sleep, apparently, but wake with no sense of having rested;
- you feel heavy-eyed all day and still cannot nap;
- irritability, forgetfulness and difficulty holding your attention or finishing anything build up.
The second-to-last point is telling. In insomnia the nervous system stays overactivated around the clock, and people describe themselves as exhausted but unable to switch off. If instead you drop off instantly and anywhere during the day, the problem is more likely to be simple sleep deprivation or another sleep disorder.
Short-term insomnia lasts under three months, usually has an identifiable trigger — a move, exams, an illness, a bereavement — and leaves with it. Chronic insomnia lasts three months or longer, at least three nights a week, and by then it has taken on a life of its own: the original trigger is long gone and the insomnia has stayed. The distinction is not bureaucratic; it decides what to expect from treatment and whether waiting it out makes any sense.
How much sleep is actually needed
There is no single correct figure, only a range. An adult needs on average seven to nine hours, a school-age child nine to thirteen, a baby or toddler twelve to seventeen including daytime sleep. With age sleep becomes lighter and more broken: older people wake more often at night and rise earlier, and that in itself is not an illness.
Judge by the day rather than by the clock. If you do not collapse in the afternoon and do not need to claw back three extra hours at the weekend, you are getting enough, whatever the arithmetic says. Counting minutes — including with wearables and apps — gets in the way by itself: monitoring your own sleep turns the bed into an examination room.
What keeps you from falling and staying asleep
There is rarely a single cause. Insomnia usually has a trigger and, separately, something that keeps it going afterwards, and the second matters more.
- Stress and anxiety. The mind carries on working in bed, replaying conversations and plans. The classic picture is difficulty getting off to sleep.
- Low mood. In depression, waking in the small hours and being unable to get back to sleep is more typical.
- Caffeine. It stays in the body far longer than it feels: a coffee at four in the afternoon is still working at midnight for some people. Tea, energy drinks and cola contain it too.
- Alcohol. It speeds up dropping off and wrecks the second half of the night: sleep breaks up and early-hours waking begins. The nightcap "to help me sleep" is the commonest mistake here.
- Nicotine is a stimulant, and the night-time craving wakes you on its own.
- Shift work and long-haul flights. The body clock cannot keep up with the rota.
- Conditions in the bedroom: noise, light, stuffiness or cold, an uncomfortable mattress.
- Screens at bedtime. It is not only the light: feeds and messages keep the brain in working mode.
- Illicit drugs, particularly stimulants such as cocaine and amphetamines, disrupt sleep for a long time, including the period after stopping.
Then there are the habits that arise as a response to insomnia and quietly cement it: going to bed early "just in case", lying awake in bed for hours, catching up during the day and at weekends, starting the evening with the thought that tonight will probably go the same way. The circle closes on itself: the harder you try to sleep, the less it works.
When there is an illness behind the insomnia
Sometimes sleep is not the primary problem, and without sorting out the cause no amount of sleep hygiene will help. It is worth considering if the insomnia arrived with no obvious trigger or refuses to shift.
- Sleep apnoea. Snoring with pauses in breathing, waking short of breath, feeling wrung out with a headache in the morning, daytime sleepiness. Untreated apnoea raises blood pressure and the risk of heart attack and stroke, so mention these things to a doctor plainly.
- Restless legs syndrome. An unpleasant dragging sensation in the legs at rest that forces you to move them and eases on walking. Sometimes iron deficiency lies behind it, and a blood test looks for it.
- Chronic pain of any origin, from osteoarthritis to neuralgia.
- An overactive thyroid. Palpitations, sweating, tremor and weight loss on a normal appetite join the sleeplessness.
- The menopause. Hot flushes and night sweats wake you repeatedly.
- Getting up to pass urine because of prostate trouble, diabetes or heart failure.
- Neurological conditions such as Parkinson's disease and dementia, which disturb the sleep-wake rhythm itself.
- Mental health conditions: anxiety disorders, bipolar disorder, schizophrenia. In a manic phase the need for sleep drops and the person feels no tiredness at all — that is a warning sign, not a stroke of luck.
- Medicines. Some blood pressure drugs, hormones, asthma treatments, certain antidepressants and evening diuretics all disturb sleep. Do not stop anything prescribed on your own: it is a reason to review the regimen with your doctor.
In children, poor sleep more often comes down to nightmares, night terrors and sleepwalking, or simply to the lack of a fixed bedtime.
What works without medicines
The main treatment for chronic insomnia is not a tablet but a reorganisation of the behaviour around sleep. It works more slowly, but what it achieves stays once the treatment has finished.
- One fixed waking time. This matters more than bedtime and more than weekends. Go to bed when you genuinely feel sleepy; get up by the alarm however the night went.
- Do not lie in bed awake. If sleep has not come in about twenty minutes, get up, go to another room and do something calm in dim light, then return when your eyes start closing. The point is to break the association between the bed and being awake.
- Do not extend time in bed. Eight hours lying down for six hours of sleep only makes that sleep more broken.
- Move the clock out of sight. Counting down "four hours left" raises anxiety and finishes off any chance of sleep.
- An hour of winding down: low light, a bath or shower, a book, quiet tasks. Jumping straight from a screen to the pillow does not work.
- Daylight and movement in the morning. A walk in daylight sets the body clock more powerfully than any evening ritual. Hard exercise is best kept out of the last three or four hours before bed.
- Supper neither late nor heavy, caffeine no later than the middle of the day, and no alcohol as a sleeping aid.
- Naps short and early — about twenty minutes, before mid-afternoon. A long late nap steals from the night.
- A dark, quiet, cool bedroom. Blackout curtains, an eye mask and earplugs are simple things that are often underrated.
One warning: after a sleepless night do not drive and do not operate machinery that demands attention. Sleep loss blunts reactions much as alcohol does, and the person affected does not notice it happening.
What the chemist sells and what to expect from it
Over-the-counter sleep products come in two kinds. Herbal ones — valerian, lavender, lemon balm, passionflower — have weak evidence behind them and usually do little harm. The others contain a sedating antihistamine: it genuinely makes you drowsy, but the effect wears off within days, and the next morning brings heaviness, a dry mouth and slowed thinking. They suit older people poorly, because they worsen attention, memory and balance, and a fall at that age is costly; they are not for men with difficulty passing urine or for anyone with glaucoma.
Melatonin deserves separate mention. It acts less as a sleeping tablet than as a signal to the body clock, which is why its place is above all in jet lag and disrupted rhythms. How it is supplied varies from country to country, and its use is worth discussing with a doctor.
One rule covers all of them: a pharmacy product is meant for a week or two, to break a bad patch, not for continuous use. If you cannot sleep without a tablet for months on end, the problem has not been solved, only postponed. And always tell the pharmacist what you already take: combining several sedating products is more dangerous than any of them alone.
When you need a doctor and what will be offered
Book an appointment if sleep has not improved despite changed habits; if the problem has dragged on for months; if it is stopping you coping with work, study or the household; if you fall asleep during the day against your will. Seek help the same day if thoughts of not wanting to live have appeared, if the insomnia comes with deep low mood and hopelessness, or if someone has noticed you stop breathing in your sleep.
The first thing a doctor does is look for the cause: questions about your routine, mood, pain, medicines, alcohol and snoring, and blood tests where they are needed, including thyroid function and iron. It is common to be asked to keep a sleep diary for two or three weeks — when you went to bed, how long sleep took, how often you woke, how the day went. The diary describes the pattern far more accurately than memory does.
For chronic insomnia, first-line treatment is cognitive behavioural therapy: a short programme of a few sessions, face to face or online, which examines the thoughts and habits that keep you awake and rebuilds the routine. It does not act faster than a tablet, but its effect lasts for years after the course ends. Where apnoea or narcolepsy is suspected, behaviour is no longer the question and an overnight study in a sleep unit is.
Sleeping tablets from the benzodiazepine family and related drugs are prescribed rarely and briefly — for days or a few weeks, in severe insomnia and when everything else has failed. The caution is not red tape: dependence develops quickly, the insomnia returns worse than before when they are stopped, and daytime drowsiness and unsteadiness linger. If you have been on one for a long time, do not stop abruptly; a doctor works out the tapering plan.
Online consultation
Insomnia is one of those subjects where the conversation counts for more than the examination, so an online appointment works at full strength here. The doctor will go through how your nights are built: whether the trouble is falling asleep or staying asleep, what time you wake, what runs through your head at that hour, how the day then goes. They will ask what medicines you take, how much coffee and alcohol you drink, whether you snore or have been seen to stop breathing, and whether your mood has changed. By the end it will be clear whether resetting your routine is enough, whether a behavioural programme is warranted, whether blood tests are needed or whether it is time to study your sleep in a specialist unit.
This material is for information only and does not replace medical advice.
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