Insomnia is the disturbance of a normal sleep pattern e.g. when you cannot get to sleep or wake up after only a few hours sleep.

Sleep is a state of consciousnesses, which gives your body time to rest and build up your strength. While you are asleep, your body goes through different stages at approximately 90 minute cycles. These include light sleep, deep sleep and dreaming (also known as rapid eye movement (REM) sleep.

Difficulties with sleep can appear in a variety of ways:

  • Difficulty getting to sleep (sleep onset insomnia). This is most common in young people.
  • Waking in the night (frequent nocturnal awakening) - most common in older people.
  • Waking early in the morning - the least common type of sleep disturbance.
  • Not feeling refreshed after sleep. You may have trouble functioning normally during the day, feel irritable, tired, and find it difficult to concentrate.
  • Waking when you have been disturbed from sleep by pain or noise.

Insomnia can last for days, months or even years and can be split into three categories:

  • Transient insomnia lasts for 2-3 days.
  • Short-term insomnia lasts for more than a few days but less than 3 weeks.
  • Chronic insomnia can be defined as insomnia most nights for 3 weeks or longer.

Chronic insomnia can lead to mental health problems such as depression, or misuse of alcohol or other medicines in order to gain sleep.

Every individual is different so, it is hard to define what normal sleep is for you. Other factors include your age, lifestyle, diet and environment.

Newborn babies can sleep for 16 hours a day, while children of school age need an average of 10 hours.

Adults usually need, on average, 7 to 9 hours sleep a night. As we get older, its normal to need less sleep. Most people over 70 need less than 6 hours sleep per night; and they tend to be light sleepers.

It is important to know that nearly everyone has problems sleeping at some time or other and it is thought that a third of people in the UK have bouts of insomnia.


Depending on the type of sleeping problem, symptoms can include:

  • Lying awake for a long time at night before getting to sleep.
  • Waking up several times in the middle of the night.
  • Waking up early in the morning (and not being able to get back to sleep).
  • Feeling tired and not refreshed by sleep.
  • Inability to function properly during the day, especially having difficulty concentrating.
  • Irritability due to lack of sleep.


The common underlying causes of insomnia can be split into a number of categories.


Insomnia can be caused by an underlying physical condition causing involuntary movement, pain or discomfort. Examples include:

  • restless leg syndrome,
  • coughing,
  • arthritis, headaches and back pain,
  • hot flushes (due to the menopause),
  • head injury,
  • gastrointestinal disorders, e.g. GORD and ulcers,
  • pruritus (excessive itching), and
  • Parkinsons disease.


Disruptions within the sleeping environment or to bedtime routines can cause insomnia. Factors include:

  • noise,
  • light,
  • snoring,
  • partner moving about,
  • jet lag,
  • activities before bedtime, like reading or exercise.

If you are a night or shift worker, your job can disturb your ability to sleep properly as your natural body clock will be affected. This is because your body is designed to release awake chemicals when theres daylight and sleepy chemicals when it gets dark.
Loss or worry can make sleeping difficult, caused by events such as:

  • bereavement,
  • relationship problems,
  • exam stress,
  • work worries, and
  • anxieties about being unable to sleep.


Underlying mental health problems can affect your sleeping patterns, such as:

  • depression,
  • dementia, or
  • anxiety


Sleeping problems can result from the effects of medicines. Withdrawal from certain medicines such as hypnotics (prescribed for short-term insomnia) may cause re-bound insomnia, which means if you stop taking them; the sleeping problems can come back.
Taking other medicines can produce side effects reduce the quality of sleep, for example:

  • alcohol,
  • antidepressants,
  • appetite suppressants,
  • decongestants,
  • thyroid hormones,
  • beta-blockers and
  • corticosteroids.

Sleep disorders can also affect you getting a good nights sleep including:

  • Narcolepsy this condition causes extreme tiredness and you can fall asleep at any time of the day without being able to control it.
  • Sleepwalking getting out of bed and moving around in your sleep, for example, walking, opening doors and climbing up and down stairs.
  • Sleep apnoea - a disorder in which you have irregular breathing at night and are extremely sleepy during the day.
  • Sleep starts muscle jerks or a sensation of falling when you are just going off to sleep.


Your GP will ask about your sleeping routines, how much alcohol and caffeine you drink each day and your general lifestyle habits, such as diet and exercise.

They will check your medical history for any illnesses or medications that may be contributing to the insomnia. Your GP will ask if you are taking any other substances e.g. drugs.  In many cases, a cause of insomnia can be identified through these simple measures.

If the cause is not immediately obvious, the doctor may suggest you keep a sleep diary to show when you went to sleep, how long for, and whether you were disturbed in the night.

A polysomnography is a physical test for identifying sleeping problems, although this is mainly used to diagnose sleep apnoea. Sensor leads (electrodes) are placed on various places on your body, including the torso and head.  While you are asleep, the test will record:

  • Electrical activity in the brain.
  • Eye and jaw muscle movement.
  • Leg muscle movement.
  • Airflow.
  • Respiratory effort (chest and abdominal movement during breathing).
  • Heart activity (using an electrocardiogram or ECG).
  • Oxygen saturation (amount of oxygen being absorbed by the lungs).

If carried out in a sleep research centre (rather than your home) you may also be videotaped during the test, to compare the electronic readings with what was happening in the room.


The first step is to diagnose any underlying causes and treat the condition. For example, if insomnia is being caused by depression; once the depression is treated, the insomnia will often disappear without further medical help.

Non-drug treatments are usually the preferred first course of action. These treatments can include:

  • Counselling, if the insomnia is related to bereavement or stressful life events etc.
  • Cognitive behavioural therapy (altering behaviour and thinking patterns).
  • Referral to a clinical psychologist.
  • Problem-solving approaches to make you feel in control (for example, keeping a sleep diary).
  • Lifestyle advice. This includes restricting caffeine, nicotine, and alcohol; taking regular exercise; keeping regular times for sleeping and waking; maintaining good sleeping environment.
  • Education about sleep and relaxation.

Sleeping tablets

may be considered:

  • if your symptoms are particularly severe;
  • to ease short-term insomnia, or
  • if the non-drug treatments mentioned above have failed to have an effect.

However, doctors are usually reluctant to prescribe this type of medication as they relieve symptoms but do not treat the cause of sleeplessness. If you experience long-term insomnia, sleeping tablets are unlikely to help and your doctor may consider referring you to a clinical psychologist to discuss other approaches to treatment.

Short-acting benzodiazepines or the newer hypnotic 'Z medicines' are the current preferred medicines for insomnia and are only available on prescription.

Benzodiazepines are tranquillisers and are designed to reduce anxiety and promote calmness, relaxation and sleep. They work by slowing the body down. These medicines should only be considered if your insomnia is severe or causing you extreme distress. All Benzodiazepines have hypnotic effects and can lead to a dependency. If they are to be used to treat insomnia then only the short-acting benzodiazepines should be prescribed:

  • Temazepam
  • Loprazolam
  • Lormetazepam

Z medicines

are another type of sleeping tablet that work in a similar way to Benzodiazepines. They are also short acting medicines:

  • Zopiclone
  • Zolpidem
  • Zaleplon

There is little difference between the Benzodiazepines and Z medicines and so if one does not work it is unlikely that swapping to another will have a different effect.

Hypnotic medicines should only be used in cases when the expected period of treatment will be short term. For example during an illness, or an overnight stay in a busy hospital ward or because of jet lag.

You should be given the smallest, effective dosage possible for the shortest length of time necessary, e.g. for a week at the most. In some cases, your doctor may advise that you only take the medication 2 or 3 nights a week, rather than every night.
These hypnotic medicines have side effects related to the desired effect they have on your sleep pattern and may cause:

  • a kind of drug-induced hangover, or
  • drowsiness during the day.

It is best to take the medicines at night- time before you go to bed. In some people, especially older people, the hangover effects may last into the next day and so you should be cautious if you are likely to be driving the next day.

It is very easy to become dependant on these medicines, even after a short term course and you should take note of any possible side effects before starting treatment. If you start treatment in hospital during a short stay, you should not automatically continue when you leave. Speak to a doctor for advice.

If you are regularly taking sleeping tablets every night, you should consider reducing or stopping them. You are advised not to stop taking the medicine suddenly as withdrawal symptoms can include panic attacks, shaking and rebound insomnia. Speak to your doctor for advice.

Other types of medicines, including barbiturates, sedative antidepressants, and antipsychotic medicines, should not be used to treat insomnia. These medicines are used to treat other conditions and their sedative effects may be helpful to the person who has been prescribed the medicine but are not suitable for treating short-term insomnia on its own.

Antihistamines can be bought over the counter at pharmacies and certain preparations have been sold for their sedative properties, but they have not shown to be of much benefit.

Certain herbal remedies such as, chamomile and passionflower have had some reported positive effects but have not been thoroughly clinically investigated to support their use and long term safety.


In order to get a good nights sleep, there are some simple measures that you can take to help:

Set a specific time for getting up and going to sleep each day. Stick to these times, seven days a week, even if you feel you haven't had enough sleep. This will gradually train your body to sleep at night.

  • Only ever go to bed when you are feeling tired and sleepy.
  • Try to create a bedtime routine, such as a warm bath and warm milky drink every night. These activities will then be associated with sleep and will cause drowsiness.
  • Do not take a nap during the day.
  • If the early morning sunlight or bright street lamps affect you sleeping, use thick blinds, curtains or wear an eye mask to create a dark environment.
  • If noise is a problem, wear ear plugs.
  • Do not use the bedroom for anything other than sleeping or sex. Don't watch television, make phone calls, eat, or work while you are in bed.
  • Rather than worrying about things while you are trying to get to sleep, write a list of your worries and any ideas you have to solve them; then forget about it until the morning.
  • Avoid or limit tea, coffee, chocolate, and cold remedies containing caffeine.
  • Avoid drinking alcohol and smoking as these are also stimulants. Alcohol may make you sleepy at first but will wake you up when the effects have worn off.
  • Don't eat a big meal or spicy foods just before bedtime. A small snack that contains tryptophan (a natural sleep-promoting amino acid) may help, such as turkey, banana and fish.  A warm drink of milk before bedtime may help too.
  • Keeping fit will generally help you to have a good nights sleep. Take daily exercise at least 4 hours before you are planning to go to bed as this will give your body temperature a chance to cool down.
  • Make sure you have a comfortable mattress, a pillow you like, and adequate bed covers for the time of year e.g. quilt for winter.
  • If it takes longer than 20 or 30 minutes to get to sleep, do not lie in bed becoming anxious about sleeping. Instead, get up and go to another room for a short period and do something else such as reading or watching television, then try again.
  • Don't watch the clock as this will only make you anxious e.g. "it's 2.30 I've got to be up at 6.30".

Try these methods for at least 3 4 weeks so that you break your usual sleep patterns.

Be aware that you may feel tired during this period so you must take extra care when you are driving or operating machinery etc.
When you are asleep for the majority of the time you are in bed, try going to bed 15 minutes earlier, but make sure you get up at the same time.

The information shown here is Crown copyright and has been reproduced with the permission of NHS Direct. Last updated June 2007.