What is insomnia: symptoms, causes & treatments
Sleep plays a vital role in good health and well-being. Getting enough quality sleep with a healthy sleep cycle can help protect your mental health and physical health.1 However, sleep problems, such as insomnia, affects around 1 in 3 people in the United Kingdom.2,3
In this article we will explore what is insomnia, how to recognise the symptoms, what causes insomnia, and what treatments and advice are available.
What is insomnia?
Insomnia means you regularly have sleep problems.4 Insomnia is not simply defined by a difficulty in getting to sleep. It can also be a difficulty staying asleep, early waking, or not feeling well-rested after an adequate number of hours sleeping.2
Insomnia can affect anyone, but it’s considerably more common in women and older adults.2 It can last a few days, weeks, or continue long term.
What are the symptoms of insomnia?
The symptoms of insomnia can be separated into night-time and daytime symptoms. Night-time symptoms include:4
- Trouble falling asleep
- Waking up several times during the night
- Lying awake at night
- Waking up early and not being able to go back to sleep
- Still feeling tired after waking up
The impact of sleep disorders is often not just limited to the night though. Poor sleep can impact your day too. If you suffer from sleeplessness you might find yourself having the following symptoms during the day:2,6
- Decreased mood or irritability
- General malaise
- Cognitive impairment
- Daytime sleepiness
- Difficulty with attention, concentration or memory
Types of Insomnia
There are several different types of insomnia that you might find yourself suffering from. Each type is characterised by how long it lasts, how it affects your sleep, and the underlying cause.5
Also known as short-term insomnia, is when you experience the symptoms of disruption to your regular sleep for less than 3 months.2 Acute insomnia typically lasts a few days or weeks and is usually caused by a life event. This can include a stressful change in a person’s job, receiving bad news, or travel.5
Also known as long-term insomnia is when you experience insomnia symptoms for at least 3 nights per week for 3 months or more.2
Is a type of insomnia that occurs with another condition.5 Mood disorders such as depression and anxiety are common conditions that occur alongside sleep disorders. Other conditions include COPD, diabetes, chronic pain, PTSD, Schizophrenia, rheumatic disorders and multiple sclerosis.6
Is reported when someone has difficulties in falling asleep (usually taking more than 30 minutes to fall asleep).7
Is characterised by the inability to stay asleep. People with maintenance insomnia wake up during the night and have difficulty returning to sleep.5,7
EARLY-MORNING AWAKENING INSOMNIA
Is when people wake up earlier than intended in the morning.7
What causes insomnia?
There can be numerous reasons to have disturbed sleep.
Short-term (acute) insomnia can occur as a result of stressful events such as bereavement, illness, changes in employment, exams, pending deadlines or financial difficulties.2,6
Changes in sleeping patterns due to the birth of a child or environmental disturbance (such as excess noise or light or extremes of temperature) are also linked to short-term insomnia.2
According to the Great British Sleep survey the top 5 physical factors affecting sleep were:8
- Bodily discomfort
- Room temperature
The causes of chronic insomnia are not yet fully understood, but it is thought to be a result of poor sleep habits. These include daytime napping or prolonged time in bed,2 and unhelpful cognitive processes (how we think).
In the Great British Sleep survey a ‘racing mind’ was identified as the main cause of sleeplessness.8 Chronic insomnia is found to commonly co-exist with medical conditions like depression, anxiety, COPD, chronic pain, cancer, diabetes, neurodegenerative diseases and musculoskeletal conditions.2,6
Find out more information on the connection between mental health and sleep with our article on anxiety and sleep.
Poor sleep has also been linked to the misuse or dependence of substances like caffeine, nicotine, alcohol, opioids (e.g. codeine) and drugs like cocaine and amphetamines.6
Common causes and risk factors that can contribute to insomnia include:2,6,8,9
Mind & mood
Racing mind, stress, anxiety, depression, PTSD, bipolar disorder, panic disorder, schizophrenia
Anxiety, depression, diabetes, COPD, high blood pressure, cardiovascular disease, frequent urination, chronic pain, gastroesophageal reflux disease, sleep apnoea, overactive thyroid, menopause
Changing shift patterns, night shift work, poor sleep routine, jet lag, eating late, alcohol, smoking, caffeine, recreational drugs
Bereavement, redundancy, work pressures, retirement, new baby, exams, financial troubles
Antidepressants, heart and blood pressure medication (anti-hypertensives, diuretics), asthma medication (inhalers & corticosteroids), anti-epileptic drugs, pain medication (opioids), NRT
Poor sleeping surface, room temperature (too hot/ too cold), noisy environment, partner (snoring, sleep talking, sleep walking)
How can I treat insomnia?
The first step to improving your sleep and managing sleep problems is making changes to your sleep habits.10 There are 3 general principles to getting a better nights’ sleep:
QUIET MIND – establishing a relaxing bedtime routine,10 with fixed times for going to bed,10 can help quieten the mind. A hot bath or relaxation techniques can be helpful before bed.1 Use the hour before bed for quiet time – try to avoid using mobile devices, tablets or TV’s.1 Only go to bed when you feel tired.10
RELAXED BODY– avoid strenuous activity too close to bedtime,1 relaxation exercises in the early evening may help reduce wakefulness and promote sleep.2 Avoid eating heavy meals or consuming stimulants, like caffeine, nicotine and alcohol late at night.1,2
SLEEP FRIENDLY ENVIRONMENT – a comfortable sleeping environment is important for a good nights’ sleep.2 An environment that is quiet, dark and not too hot or cold is helpful.2
If establishing good sleeping habits does not help manage your sleep pattern, then you may want to try talking to your pharmacist about over the counter sleeping aids.
Over the counter treatments for insomnia
There are different types of over the counter sleeping aids available to help manage short-term/ temporary disrupted sleep. These are split into traditional herbal remedies and sedating antihistamines.
Herbal Sleeping Aids
Herbal sleeping aids are traditional herbal medicines.
They contain ingredients which are known for their sedating and calming properties such as valerian, passion flower and hops.11 The sedating effects of these products can take a while to be felt and so should be taken continuously for 2 – 4 weeks.11
There are also sedating antihistamines available by talking to a pharmacist. These will contain antihistamine ingredients like diphenhydramine and promethazine.
Histamine compounds have a key role in how awake we feel.14 So antihistamines (that work by blocking the normal actions of histamines) are effective in reducing the time taken to fall asleep, and increasing the depth and quality of sleep.13
Prescription sleeping aids to treat insomnia
Prescription sleeping aids (hypnotics) are medications that encourage sleep. In the past, they were frequently used to help with insomnia, but they’re used much less often nowadays.10
They will generally only be considered if your insomnia is severe or as a temporary measure to help ease short-term insomnia.10
Benzodiazepines are type prescription sleeping aid that can reduce anxiety, promote calmness, relaxation and sleep.10 Examples of benzodiazepines include temazepam, loprazolam, diazepam and nitrazepam.10
Another group of prescription sleeping aids are the ‘Z-drugs’ – these include zaleplon, zolpidem and zopiclone.10 As with benzodiazepines, long-term treatment with Z–drugs aren’t normally recommended because they can become less effective over time, and some people become dependent on them.10 They’re usually only prescribed for a maximum of two to four weeks.10
Cognitive and behavioural treatments for insomnia
If you have tried good sleeping behaviours and over the counter sleeping aids but your insomnia is still troubling you then your GP may refer you for a type of cognitive behavioural therapy that’s specifically designed for people with insomnia.10
The aim of Cognitive Behavioural Therapy for Insomnia is to change unhelpful thoughts and behaviours that may be contributing to your sleep disorder.Sup>10 It’s an effective treatment for many people and can have long-lasting results.
When should I see my GP about insomnia?
If you are concerned about your sleep problems, the NHS recommends you see your GP if:4
- Changing your sleeping habits has not worked
- You have had long term trouble sleeping for months
- Your sleep problems are affecting your daily life in a way that makes it hard for you to cope
- National heart, lung and blood institute – [Accessed 20/03/2020]
- NICE Clinical Knowledge Summary for Insomnia January 2020 – [Accessed 20/03/2020]
- NHS – Sleep problems in the UK highlighted – [Accessed 20/03/2020]
- NHS – insomnia [Accessed 20/03/2020]
- Sleep Foundation – insomnia [Accessed 20/03/2020]
- European guidelines for the diagnosis and treatment of insomnia 2017
- Hoheagen et al. Sleep, Volume 17, Issue 6, September 1994, Pages 551–554
- Great British Sleep Survey 2012 – [Accessed 20/03/2020]
- Perrigo Sleep Health Training Online Module UK2019_0604 (Approved September 2019)
- NHS Scotland – insomnia [Accessed 20/03/2020]
- Nytol Herbal Tablets SmPC
- Nytol One-a-night sales data (no.1 sleeping aid)
- Nytol one-a-night SmPC
- Histamine in the regulation of wakefulness