Insomnia – the causes and how to improve it

We all have problems sleeping at times but if you regularly struggle to sleep, you may have insomnia. The condition can be short-term or temporary – doctors may call it ‘acute insomnia’ – when you have difficulty sleeping for a short period of anything up to 3 months.

It’s often the result of things going on in your life, such as bereavement, relationship breakdown, or a big workload. It can even happen when something exciting is happening, like getting married.

Acute insomnia could also have a physical cause, like pregnancy or menopause. Waking in the night to feed or soothe a baby can be another cause, which is a normal part of being a new parent, but some people find it hard to get back to sleep.

Whatever the reason, once the cause of your insomnia clears, your sleep problems usually ease.

For some people, insomnia can be a longer term issue. If you have trouble falling or staying asleep for 3 or more nights a week, for 3 months or more, you’re considered to have chronic insomnia.

You may have trouble sleeping for months at a time. Some people with chronic insomnia have a long history of sleep problems, on and off over years.

Sound familiar? You’re not alone. Research estimates around 1 in 3 adults in Western countries like the US and UK have sleep problems at least once a week and 6-10% have insomnia.

What are the symptoms of insomnia?

Generally, you may have insomnia if you regularly:

• find it difficult to fall asleep
• lie awake at night
• wake up a few times during the night
• wake up early and can’t fall back asleep
• feel tired during the day
• find it hard to take naps in the day, despite being tired
• find it difficult to concentrate during the day
• feel irritable because you’re tired
• have ongoing worries about sleep.

Sleep experts may describe the pattern of your symptoms as a type of insomnia, whether it’s a temporary or longer term problem. These include:

• sleep onset insomnia – you have trouble falling asleep in the first place, even once you’ve been in bed for 20-30 minutes
• sleep maintenance insomnia – you can’t stay asleep through the night. You might nod off at first but wake multiple times, or wake early and struggle to get back to sleep again
• early morning awakening insomnia – you wake earlier than you want to and can’t fall asleep again – some experts see this as a type of sleep maintenance insomnia
• mixed insomnia – a mixture of the above types, as some people alternate between having trouble falling asleep and waking in the night
• comorbid insomnia – this is a term once used to describe insomnia caused by an underlying condition, such as pain, anxiety or sleep apnea. But now doctors understand there’s a two-way relationship between sleep and many other medical conditions. So while an underlying condition might trigger insomnia, lack of sleep may worsen symptoms of the condition, affecting sleep even more.

What causes insomnia?

Anything that affects your sleep can trigger insomnia. Triggers can include things in your environment, like noise, light, and having a bedroom that’s too warm, or drinking caffeine or alcohol too late in the day.

Health issues are also common triggers - for example stress, anxiety, or depression, and hormone changes linked to menstrual cycle or menopause.

Insomnia can become chronic when you start to worry about missing out on sleep. You begin to feel automatically anxious and uptight about sleep, which puts you into a wakeful state at bedtime or if you wake in the night.

You may then start trying to introduce steps to control your sleep anxiety, over-focusing on thoughts and feelings around sleep, which can make things worse.

Once you’re in this cycle, it can be hard to break out of it.

Self-care to improve your insomnia

If you have been dealing with a lack of sleep for a long time, you’ve likely tried lots of things to help, from natural remedies to medicines. But to change your sleeping pattern for good, you need to get to the root of your insomnia with proven steps.

1. Review the basics. Poor sleep hygiene is unlikely to be the only cause of insomnia but it might be part of your problem. Have a look at these science-based tips – and put a routine in place, such as sticking to a regular bedtime, winding down in the evening and ensuring your bedroom is cool, dark, and comfortable.
2. Check for hidden sleep disturbers. Check out these sleep myths to make sure you’re not trying things you think are helpful, but are actually disrupting your sleep pattern. For example, if you think alcohol can help you nod off, but it actually causes problems in later sleep stages, leaving you feeling tired the next day
3. Exercise regularly throughout the day to help you feel sleepy and ready for bed at night.

Can a pharmacist help?

Medicines such as liquids or tablets that can make you sleepy are available without a prescription from a pharmacist.

Some may contain natural ingredients such as lavender or valerian, or contain antihistamines.

Be aware that some of these products may have side-effects, which can affect you if you need to do activities requiring concentration, such as driving.

Check with a healthcare professional before taking medicines for sleep

When to see a doctor

While some people may be able to get sleep habits back on track with self-help, others may need medical help for insomnia. See your doctor if:

• insomnia is regularly affecting your life and you feel you cannot cope
• nothing has helped your insomnia despite changing your habits
• you’ve had trouble sleeping for months (at least 3 nights per week for more than 3 months is considered chronic insomnia).

Why not keep a sleep diary and take it to your appointment so your doctor can see what’s going on and spot patterns over time?

How is insomnia diagnosed?

A diagnosis for insomnia will depend on the situation, but tests to find the cause may include:

• physical examinations including blood tests to check for health problems such as thyroid or other conditions that may be the cause of poor sleep
• a sleep review – looking at your habits around sleeping and waking, and how sleepy you feel during the day. You may be asked to keep a sleep diary if you’re not doing this already
• referral to a sleep center or clinic if a sleep disorder is suspected – tests can be done to monitor your body while you sleep, which may identify conditions such as sleep apnea or restless legs.

What’s the treatment for insomnia?

If insomnia is a long-term or recurring issue for you, the recommended treatment is cognitive behavioral therapy, often shortened to CBT. You might do this in person or digitally.

Your doctor may refer you, or in some cases you can refer yourself.

It aims to help you change your thoughts and feelings about sleep, learn relaxation techniques and break unhelpful habits.

CBT really can make a difference, with a review of studies finding it’s effective for sleep onset and maintenance insomnia, and another suggesting it’s as good as sleeping pills for treating insomnia in people who have sleep problems along with depression.

You have to be committed to CBT for it to work well but it’s worth it, so stick at it.

Some of the strategies you might learn include:

• learning to link your bedroom with sleep and rest instead of wakefulness (stimulus control therapy). This technique usually involves making sure you only use the bedroom for sleep and sex, only go to bed when you’re tired, getting up and going into another room whenever you’re unable to fall asleep (so you don’t end up lying there wakeful), and getting out of bed at a regular time, even if you haven’t had much sleep
• matching the time you spend asleep to the time you spend in bed (sleep restriction). So, if you’re only managing to sleep for 4 hours, that’s the time you allocate to being in bed – again, the idea is to avoid lying in bed feeling stressed. Each week, you slightly increase the length of time you spend in bed until you build up to a normal amount of hours
• reducing your stress around sleep by challenging your thinking. People with chronic insomnia can have unhelpful beliefs about sleep, such as overestimating the negative impact of poor sleep or having unrealistic expectations about how much they should be getting. Therapy can help you develop different beliefs that lower feelings of stress around sleep.

What about sleeping pills?

Sleeping pills are usually only prescribed if your insomnia is very bad and other treatments have not worked.

They can have serious side effects and there’s a risk you can become dependent on them. Plus they do not address the cause of insomnia in the long term. So they would only be prescribed for a few days or weeks at the most.

Read more about How to sleep well, and the basic things you need in place for good sleep.