Insomnia means low-quality sleep. It is very common with around one-third of people in the UK suffering from it. Insomnia can occur in many different forms, from difficulties falling to sleep, staying asleep, waking up too early without being able to get back to sleep, or not feeling refreshed from sleep. It leads to significant symptoms in the daytime such as tiredness, difficulties concentrating, and sometimes problems controlling your emotions. Because everyone is unique, the amount of sleep someone requires to function their best varies from person to person and also tends to decrease with age, so there is no set criteria to diagnose insomnia. The diagnosis is made from what a patient describes, the symptoms they experience, and their doctor’s expertise and opinion. The majority of adults need between 6 and 9 hours of sleep per night in order to function well in the daytime, and the average range of time taken to fall asleep is between 10 to 30 minutes. It is normal to wake up from time to time at night so don’t worry if you do and try not to look at a clock as worrying and clock-watching can make getting back to sleep harder. Insomnia is more common in women and older people. The main causes are poor sleep routine or habits (known as sleep hygiene), a loud or light sleeping environment, stress, substance abuse, caffeine or alcohol use, and certain mental health or physical health conditions that can affect sleep.
Insomnia can be classified in different ways. The descriptions tend to be by either the length of time it has been occurring for, or by the cause of the symptoms. If you have had difficulties sleeping for less than 3 months then it is known as short-term insomnia and if your symptoms continue beyond 3 months it moves into being described as chronic insomnia. The reason for these terms is that acute insomnia tends to be due to a specific cause such as a stressful life event, noise, having a newborn baby, or another environmental cause. Chronic insomnia tends to be more linked to other medical conditions such as some mental health conditions or conditions that affect breathing. This brings us into the second way of classifying insomnia which is by the cause. If the insomnia is linked to or caused by another medical condition then this is known as secondary insomnia, if it is not then it is known as primary insomnia.
Fortunately, lots of people can improve their insomnia by simple changes they can make at home. This is known as sleep hygiene and it is about getting the environment and bedroom routine optimised in order to aid your sleep. This includes things you should do, and things you should avoid. On the to-do side of things, routine is key. Aim to go to bed and wake up at the same time every day where possible as it will really help with sleep quality and length. It’s also important to set a daily pre-bed routine that you follow through every night - this needs to include some wind-down time/relaxation (maybe try out the meditation section) so your body has the cues that it is winding down to sleep. If you can’t sleep after 20 mins – get up and start the routine again. Optimize your sleep environment by trying to block out any light and noise as best possible. It is also important not to get too hot at night, so don’t cover yourself in all the duvets. Your core body temperature when asleep naturally drops and this helps aid sleep, if you raise your body temperature in the night it will disrupt and affect your sleep. The things to avoid are caffeine past midday and then alcohol, smoking, large meals or computer, and phone use at night. If sleep hygiene changes have not improved your symptoms and your insomnia is caused by something that is short-term then you can speak with your pharmacist. They can recommend over-the-counter medications that can aid sleep, these usually contain natural ingredients that help aid sleep, however, they are only to be taken for up to 2 weeks so they are not a long-term solution. Longer-term treatment can include a talking therapy called CBT and very rarely sleeping tablets that can be prescribed by your doctor.
You should book to see your doctor if you have tried the sleep hygiene advice for 3 weeks or more and have not seen any improvement, if your day to day life is getting significantly affected due to insomnia symptoms or if you feel insomnia may be caused by a mental or physical health problem.
Your doctor will ask you about your medical history, your current symptoms, and any relevant family history. They may do some physical examinations to rule out a physical health cause of your symptoms and may take some blood tests. They will also discuss your mental health with your and any other stressors or changes in your life. Quite often a doctor will ask you to keep a sleep diary to record your sleep and symptoms, this just helps the doctor get a better picture of what’s going on. The doctor will then discuss with you sleep hygiene and any treatments available such as referring you for talking therapy.