Insomnia is a sleeping disorder which is characterised by difficultly getting to sleep, waking up repeatedly throughout the night, waking up early and not being able to get back to sleep, and waking up in the morning feeling still tired. Missing just one night’s sleep can impair your focus and concentration the next day, but doing so continually for a week or more can affect your work, life and relationships. Insomnia may be caused by an underlying health condition, due to living with pain, or suffering from emotional difficulties like stress or anxiety, but often it is simply a case of having bad sleep hygiene. However, it you have tried to improve your sleeping habits and are still having difficulty sleeping, your doctor may prescribe you a sleeping tablet. There are two categories of sleeping tablet: fast acting and slow release. Fast acting tablets get you to sleep quicker but have a higher risk of being addictive, whereas slow release tablets take a few hours to have their effect. You should not use either type of tablet on a long term basis as it can lead to tolerance and dependence, which may mean it is incredibly hard for you to ever sleep without a tablet.
Insomnia is a very common sleep disorder which affects around a third of adults at any one time. It can leave you feeling exhausted and irritable the following day, impairing your concentration and making driving or operating heavy machinery dangerous as you may be unable to focus properly. There are two types of tablet you can take to manage the problem, if altering your sleep routine to your doctor’s recommendations doesn’t resolve the issue. There are slow release tablets, which help you to dose off after a few hours, and there are fast acting tablets which will have an impact more quickly, but come with a higher risk of being active.
Please note that our doctors are unable to prescribe sedative medications such as zopiclone, zolpidem, zaleplon, Sonata, Stilnoct, and Zimovane. This is due to a change in online prescribing guidelines.
Our doctors are also unable to prescribe any benzodiazepine medications.
If you feel you need any of these medications, please make an appointment with your doctor to discuss your symptoms and the most appropriate treatment.
What is insomnia?
Insomnia is a problem which means you have difficulty sleeping or getting to sleep. Most people experience insomnia on some level during their lives, even if only for a very short time. A lot of the time, insomnia can be solved by simply changing sleeping habits. However, in other cases it can be a serious long-term problem that can have a huge detrimental impact on your life, making it difficult to hold down a job and maintain relationships. There are different types and severities of insomnia, which may require different solutions. Symptoms of insomnia include:
- Laying awake at night finding it hard to get to sleep
- Waking up several times during the night, and having difficulty getting back to sleep once you do
- Waking up early in the morning (more than 30 minutes before your alarm) and not being able to get back to sleep
- Feeling tired after waking up and throughout the day
- Not being able to nap in the day, even if you're feeling tired
- Being so tired during the day that you become irritable and have difficulty concentrating
At any one time, around one third of people are suffering from mild insomnia. Women suffer from insomnia around twice as much as men, and it's a more common condition in older people. You can better understand your insomnia if you know what kind you have: primary or secondary, and acute or chronic.
How much sleep do I need?
The amount of sleep you require depends greatly on your age and your lifestyle, and it can vary week to week. Training for a marathon? Your body will need more sleep to repair your muscles better. Having a stressful week at work? You brain will need more sleep so it has time to relax. If you have a job that allows you to work from home and nap during the day, you may find you need less sleep at night. As a general rule, the NHS recommends that toddlers and babies get 12 to 17 hours' sleep a day, that children get 9 to 13 hours' sleep, and adults tend to need 7 to 9 hours’ sleep.
However, sleep experts will argue that the quality of the sleep you get is just as, if not more, important than the amount you get. Six hours’ unbroken, deep sleep is far more restorative and better for you then nine hours' sleep where you are being woken frequently and only sleeping lightly.
When you wake up can also be an important factor in how tired you feel the next day. We sleep in cycles of around 45 minutes, and waking up in the middle of one of these cycles can leave you feeling more groggy and exhausted than if you'd woken up naturally at the end. Finding out what conditions help you sleep best and how much sleep you need is a huge investment that can have a valuable impact on your life. If you live in an environment where you can't get enough sleep at night (for example, you have several young children), try and find out what the ideal time for you to nap in the day is, so you can make up the sleep elsewhere.
What types of insomnia are there?
Insomnia can be divided into some broad categories: primary or secondary, and acute or chronic.
What is primary insomnia?
Primary insomnia is characterised by your sleep problems not having an underlying cause or being a symptom of another illness. It may be caused by issues such as poor sleeping habits (also known as battery sleep hygiene), sleeping in a noisy environment or one that has too much light, or consuming stimulants such as alcohol and coffee too close to bedtime. These factors can make it harder for the body to get the rest it needs.
What is secondary insomnia?
Conversely, secondary insomnia is where your sleep problems are caused by something else. It may be a symptom of another illness, or a side effect of a medication you are taking. Arthritic pain, heartburn, depression, anxiety and stress are all illnesses which can cause insomnia.
What is acute insomnia?
Acute insomnia is sometimes an short-term insomnia, and is where the problem doesn't last for more than four weeks. This is the more common type of insomnia, and can usually be killed by fixing your sleeping habits. It may be caused by short term problems such as exams, deadlines, work stress or grief. In some circumstances such as not getting enough sleep due to stress, your insomnia can make the trigger worse: you're stressed at work, so you are not sleeping, which makes you more stressed at work. Although acute insomnia doesn't last long, it's still worth seeking treatment for if it's affecting your life.
What is chronic insomnia?
If your insomnia lasts for more than four weeks, it becomes known as long-term or chronic insomnia. This is when it can become a serious issue as the repercussions it can have on your daily life can become dangerous. If you drive to work in the mornings, not getting enough sleep can make this very dangerous, and the same applies if you operate heavy machinery as part of your job. The stress, irritability and lack of concentration that insomnia can cause may make it difficult for you to hold down a job and maintain good relationships.
What causes insomnia?
There are many factors which can cause you to be sleeping badly, and the cause will affect the severity of the problem and how you fix it. Below are some major causes of insomnia:
- Poor sleeping conditions caused by environmental factors such as too much light, noise, or an uncomfortable mattress
- Long-term mental health conditions such as anxiety or depression
- Other mental health disorders such as PTSD (post-traumatic stress disorder), bipolar disorder, schizophrenia, OCD (obsessive compulsive disorder), dementia or ADHD (attention deficit hyperactive order)
- Consuming stimulants too too close to sleeping such as alcohol, caffeine or nicotine. Although alcohol may feel like it helps you to sleep as it is a depressant and it makes you drowsy, it can cause the quality of sleep you get to be poor and very disrupted
- A disruption to your usual sleep pattern such as working night shifts, suffering from jetlag, or having a newborn baby
- Short-term stress caused by factors such as moving house, pressure at work, or going through a divorce
- Grief caused by the death of a loved one
- Severe pain from illnesses such as arthritis, toothache, period pain, or migraines
- As a side effect of certain medications such as some antidepressants, epilepsy medications, and steroid medications
- Some neurological conditions
- Heart disease
- Nocturnal sleeping disorders
This is not an exhaustive list of causes of insomnia, and if you speak to your GP they may be able to help you identify an underlying problem.
What treatment can I get for insomnia?
In a lot of cases, insomnia can be fixed by practising good sleeping habits. When you speak to your GP this will be the first advice they give you. These lifestyle changes, which may sometimes be referred to as having good sleep hygiene, can help you to get the best sleep you can. Even if you don't suffer from insomnia, following this advice can help you sleep better and leave you feeling more productive and focussed the next day. Tips for good sleep hygiene include:
- Setting regular times for going to bed at night and getting up in the morning. Even if you find it hard to fall asleep and get up at these times at first, over time your body will learn when it needs to start winding down for bed
- Using relaxation techniques before bedtime, such is listening to calming music, reading a light fiction book, taking a bath, or practising meditation or mindfulness
- Avoiding using your phone, laptop or watching TV during the hour or two before you go to sleep. Screens like this emit blue light which keeps your mind awake and can stop you from sleeping, or disrupt the quality of the sleep you get. If you have to use your phone or laptop at night, set the screen to night mode or use an app or extension which makes the screen slightly more yellow to balance out the blue light. If this isn't possible, you can buy tinted glasses to counteract the blue light. However, prevention is always best for a good night's sleep
- Investing in making your bedroom the best supervisor could be. Buy bug blackout curtains, earplugs and an eye mask to help manage environmental factors which may be causing sleep disturbances. There are also apps you can get on your phone with music and talking designed to help you sleep better
- Avoiding factors which may stimulate your brain before going to sleep. Caffeine, alcohol and nicotine are all known to keep your brain awake, and although exercise during the day can help you sleep better at night, make sure it is more than four hours before you go to bed. Heavy meals directly before sleeping may also impair the rest you get, although a light snack before bed can help you to doze off
- Avoiding napping during the day
- Keeping a pen and paper by your bed. If you're feeling stressed before going to sleep, or have things on your mind that you’re worried you’ll forget, writing them down can help to take mental pressure off your brain before you go to bed. This can also be helpful if you wake during the night worried about something
- Taking light exercise during the day, but not too close to bedtime
- Avoiding using your bedroom for anything other than sleep or sex
- Avoiding watching the clock if you cannot sleep, as it will only make you more worried about how long you've been awake
- Turning off your phone before bed so you know you can not be disturbed in the night. Some people choose to put their phone in another room whilst they sleep
You may wish to keep a sleep diary to see if there any factors not listed above which help you sleep better.
Should I go to my GP about insomnia?
If your sleep problems affect your day to day life, or if they've been going on for more than four weeks and your insomnia becomes chronic, you should speak to your GP. Your doctor will first rule out any underlying health problems such as long-term sleep disorder, or mental-health disorder that will require treating in its own right.
If your insomnia is caused by an underlying condition such as depression or anxiety, your doctor may recommend CBT (cognitive behavioural therapy) to ease the problem. If you associate sleeping with fear, stress or panic, a professional sleep therapist can help to break this chain of thought allowing you to sleep better.
What medication is available to treat insomnia?
Doctors are often reluctant to prescribe medication to treat insomnia and won't use it as a first line of defence. This is because not only is changing your sleeping habits easier and safer, but overuse of sleeping tablets can lead to tolerance and dependency which can cause long-term, more serious problems. It is always better to treat the cause of the problem than to mask it. Sleeping tablets can also leave you tired the next morning, which can make driving or using heavy machinery dangerous.
However, should your GP decide sleeping tablets are the best way for you to receive treatment, you may be prescribed one of two types. You may be prescribed a slow release tablet, such as Circadin, which is taken several hours before sleep to help you drift off easily. It’s possible a faster acting alternative such as Zolpidem may be prescribed instead by your doctor. Better known by its brand name Ambien, Zolpidem increases the sedative effect of certain chemicals in the brain.