Insomnia

Difficulty sleeping despite the opportunity to. Treatable, and sleeping tablets are rarely the answer.

What it is

Around a third of UK adults have insomnia symptoms at some point, and roughly one in ten has chronic insomnia: trouble sleeping at least three nights a week for three months or more.

The important distinction is between the thing that started it and the thing keeping it going. A bereavement, a new baby or a period of shift work might start it. What maintains it is usually what happens next: going to bed earlier to catch up, lying awake trying, napping, and the anxiety about sleep itself.

That is why the treatment with the best evidence is not a tablet. It is CBT for insomnia, and NICE recommends it first.

Signs you might notice

Taking more than 30 minutes to fall asleep, or long waking periods in the night.

Waking too early and not getting back off.

Daytime effects: fatigue, irritability, poor concentration, low mood.

Increasing time spent in bed, and decreasing time spent asleep in it.

Dread about bedtime.

How it can affect day-to-day life

The costs compound. Poor sleep worsens depression, anxiety and chronic pain, each of which worsens sleep.

Sleeping tablets work for a few weeks and then largely stop working, while dependence and next-day impairment continue. In older people they substantially raise the risk of falls.

Untreated insomnia is a strong predictor of a future depressive episode, which is a good argument for treating it in its own right.

Supporting someone well

Fix the wake time first, seven days a week, regardless of how the night went. This is the single most powerful change and the least popular.

Cut time in bed to roughly the time actually spent asleep, then extend slowly as sleep consolidates. Counterintuitive, and it works.

Get out of bed if awake more than about 20 minutes. Bed should mean sleep, not lying there trying.

Daylight in the morning. Caffeine stopped by early afternoon. Alcohol recognised as a sleep destroyer, not a sleep aid.

Use a proper CBT-I programme. Sleepio and similar are available free in some NHS areas.

Fiducia Life records sleep alongside mood, which is what makes the link between the two visible rather than assumed.

Where to get help

Ask a GP for CBT for insomnia rather than for tablets. If tablets are offered, ask what the plan is for stopping them.

Rule out the treatable causes: sleep apnoea, restless legs, pain, an overactive thyroid, and medication timing.

Loud snoring with pauses in breathing needs a sleep study, not sleep hygiene advice.