Most people have a bad night of sleep now and then, often because of stress, travel or illness. When trouble sleeping becomes regular and affects daily life, it may be insomnia. In Part 6 of Sleep Science, we explain what insomnia is, why it happens and what helps.
What is insomnia?
Insomnia means having difficulty falling asleep, staying asleep or waking too early, despite having the opportunity to sleep, and feeling its effects during the day, such as tiredness, poor concentration or low mood.
- Short-term insomnia: often triggered by stress, life events, illness or changes in routine. It may last days or weeks.
- Chronic insomnia: commonly defined as sleep difficulties on at least three nights a week for at least three months.
Insomnia is one of the most common sleep problems, affecting a significant share of adults at some point.
Common causes and triggers
- Stress, worry and major life changes.
- Irregular schedules, shift work or jet lag.
- Caffeine, alcohol and nicotine (see Part 4).
- Pain, breathing problems or other health conditions.
- Some medicines.
- Mental health conditions such as anxiety and depression.
- A noisy, bright or uncomfortable sleep environment.
The vicious cycle
Insomnia often begins with a trigger but continues because of habits and worries. People may go to bed earlier, stay in bed longer or nap more to "catch up". They begin to dread bedtime, and the bed becomes linked with frustration rather than sleep. Worry about not sleeping can itself keep the mind alert.
CBT-I: the first-line treatment
Major medical guidelines in many countries recommend cognitive behavioural therapy for insomnia (CBT-I) as the first-line treatment for chronic insomnia in adults. It is a structured programme, often delivered over several weeks by trained professionals, and increasingly through digital programmes. Common elements include:
- Stimulus control: going to bed only when sleepy, getting up if unable to sleep, and using the bed only for sleep and intimacy.
- Sleep restriction or sleep scheduling: temporarily limiting time in bed to match actual sleep time, then gradually increasing it. This should be done with professional guidance, as it can increase daytime sleepiness at first.
- Cognitive techniques: challenging unhelpful thoughts about sleep, such as "If I don't get eight hours, tomorrow will be a disaster."
- Relaxation training: breathing exercises, progressive muscle relaxation and similar methods.
- Sleep education: the sleep habits covered in Part 3.
Studies show CBT-I can produce lasting improvements for many people, often with longer-term benefits than sleeping pills.
What about sleeping pills?
Doctors may sometimes prescribe medication for short periods or specific situations. These medicines can have side effects and are generally not recommended as a long-term solution for most people. Never start, stop or combine sleep medicines without medical advice.
Simple steps you can try now
- Keep the same wake-up time every day, even after a bad night.
- Avoid long naps.
- Get out of bed if you cannot sleep, and return when sleepy.
- Set aside "worry time" earlier in the evening to write down concerns.
- Reduce caffeine and alcohol.
When to see a doctor
See a doctor if insomnia lasts for several weeks, affects your daily life, or comes with symptoms such as low mood, anxiety, pain, loud snoring or breathing pauses. A doctor can check for underlying causes and refer you for CBT-I.
In Part 7, we look at snoring and sleep apnoea.
Sleep Science: the full series
- Part 1: How Sleep Works
- Part 2: How Much Sleep You Need
- Part 3: Better Sleep Habits
- Part 4: Caffeine, Alcohol and Food
- Part 5: Screens, Light and Melatonin
- Part 6: Insomnia (you are here)
- Part 7: Snoring and Sleep Apnoea
- Part 8: Naps, Shift Work and Jet Lag
This article is for general information only and is not medical advice. If you have ongoing sleep problems, loud snoring, breathing pauses or daytime sleepiness, please speak to a doctor.
