Insomnia

Insomnia is not just a bad night now and then. It describes ongoing difficulty getting good-quality sleep despite having the opportunity to sleep, combined with daytime effects such as fatigue, poor concentration, irritability or low mood.

Short-term insomnia often lasts days or weeks and is linked to stress, illness, travel or life changes. Chronic insomnia is usually defined as trouble sleeping at least three nights a week for three months or more. It often starts with a trigger, but continues because of habits and thought patterns that develop around sleep.

Many people with insomnia feel exhausted yet "wired" at night. Worrying about not sleeping becomes part of the problem, as the bed starts to feel like a place of frustration rather than rest.

Common symptoms of insomnia include:

• Taking a long time to fall asleep
• Waking up during the night and struggling to get back to sleep
• Waking up at 3am or very early and being unable to fall asleep again
• Feeling unrefreshed after sleep
• Daytime fatigue, low energy or sleepiness
• Difficulty concentrating or remembering things
• Irritability, anxiety or low mood
• Worrying about sleep or dreading bedtime

Some people sleep fewer hours than others and feel fine. Insomnia is defined less by the number of hours and more by difficulty sleeping and its effect on daytime life.

Insomnia often has several contributing factors:

• Stress, worry or major life events
• Anxiety, depression, PTSD or other mental health conditions
• Irregular schedules, shift work or jet lag
• Caffeine, nicotine or alcohol, especially later in the day
• Pain, breathing problems, reflux or other medical conditions
• Hormonal changes, such as during pregnancy or menopause
• Some medications
• Habits like long naps, late-night screen use or spending a lot of time awake in bed

Waking up at 3am can happen during stressful periods, when the body's stress system becomes more active, and lighter sleep in the second half of the night makes waking easier. Other sleep disorders, such as sleep apnea or restless legs, can also cause disrupted sleep and should be checked by a doctor.

CBT-I is a structured, short-term therapy designed specifically for insomnia. It is widely recommended as the first-line treatment for chronic insomnia because its benefits tend to last. It usually includes:

• Sleep restriction or compression: temporarily limiting time in bed to strengthen sleep drive
• Stimulus control: using the bed only for sleep and intimacy, and getting up if you cannot sleep
• Cognitive techniques to address worries and unhelpful beliefs about sleep
• Relaxation methods and wind-down routines
• Education about sleep and circadian rhythms

CBT-I can be delivered in person, in groups or through digital programs. A doctor may consider sleep medication for short-term use in some situations, but this decision should be made with a prescriber who can discuss risks and benefits.

Psychologists and clinical psychologists trained in CBT-I are well placed to treat insomnia. A primary care doctor can check for medical causes and other sleep disorders, and may refer you to a sleep specialist. A psychiatrist can help when insomnia is linked to depression, anxiety or bipolar disorder.

Before a first appointment, keep a sleep diary for one or two weeks, noting bedtimes, wake times, awakenings, naps, caffeine and how rested you feel. Expect questions about your routines, stress, health and mood.

Seek help if poor sleep lasts more than a few weeks, affects your daily life or comes with low mood. Sudden severe insomnia with racing thoughts and high energy should be assessed promptly.

Sleep hygiene alone rarely cures chronic insomnia, but these habits support better sleep:

• Keep a regular wake-up time, including weekends.
• Get daylight in the morning and stay active during the day.
• Limit caffeine after midday and avoid alcohol close to bedtime.
• Create a calm, cool, dark bedroom.
• Wind down with a relaxing routine and limit screens before bed.
• If you cannot sleep after about twenty minutes, get up and do something quiet until you feel sleepy.