Sleep - disturbed

About insomnia

The occasional night with a lack of sleep can make you feel very tired the following day but it won’t affect your health – however, sleep deprivation can be dangerous if you're driving or operating machinery. Insomnia that goes on for a long period of time may cause health problems such as high blood pressure and diabetes, or make you more likely to become overweight.

There are two types of insomnia.

  • Primary insomnia has no obvious cause.
  • Secondary insomnia is caused by an underlying problem, such as a health condition or psychological problems such as grief or depression.

Insomnia can also be described as either short term or long term.

  • Short-term (acute) insomnia lasts for between one and four weeks.
  • Long-term (chronic) insomnia lasts for more than four weeks.

Up to one in three people in the UK are thought to have insomnia at some point in their lives. More women get insomnia than men. As you get older, you're more likely to have difficulty sleeping – half of people over 65 have insomnia at some time.

About sleep

The reasons why we need to sleep aren't fully understood. However, the effects of sleep deprivation suggest that you need sleep in order to rest and repair your body and mind. Sleep is made up of a number of different stages

  • Pre-sleep is when your muscles are relaxed and your heart rate and breathing slow down.
  • Light sleep is when you're lightly asleep, you can still be woken up easily and won't feel confused.
  • Slow wave sleep is when it’s hard to wake up and, if someone does wake you, you may feel disorientated and confused. Slow wave sleep is the time when you might sleepwalk or talk in your sleep.
  • Rapid eye movement (REM) sleep is when your eyes move from side-to-side and your brain is very active but your muscles are totally relaxed. You dream mostly during REM sleep.

The stages of sleep occur in cycles, usually lasting between one to two hours, moving from pre-sleep, light sleep, to slow wave sleep, then to REM sleep and back again during the course of a night. You may have up to five cycles of sleep during a typical night.

The amount of sleep you need varies from person to person. Most adults need seven to eight hours but some people can manage with much less. People of different ages need different amounts of sleep. A baby needs about 17 hours a day, whereas an older child needs about nine to 10 hours a day.

Symptoms of insomnia

The symptoms of insomnia may include:

  • difficulty getting to sleep
  • difficulty staying asleep (frequently waking up and finding it difficult to get back to sleep)
  • waking up early in the morning
  • feeling tired, irritable and unable to concentrate the next day

If you consistently can’t sleep, you can feel irritable, anxious and depressed.

If you have any of these symptoms, see your GP for advice.

Causes of insomnia

There is usually no single cause of insomnia, but there are a number of factors that can contribute to you getting it. Some of the main causes are listed below.

  • Psychological health problems such as stress, anxiety, depression, grief or alcoholism.
  • Physical health problems such as pain, asthma or heart disease.
  • Medicines such as slimming medicines, antidepressants or medicines to treat high blood pressure.
  • Jet lag, a temporary condition that can cause disturbed sleep patterns, digestion problems and a lack of energy (fatigue) following air travel across a number of time zones.
  • Environmental factors such as noise, an uncomfortable bed or being too hot or cold.
  • Lifestyle habits, for example not having a regular sleep routine, eating late at night, drinking excessive amounts of alcohol or using stimulants such as nicotine.

Diagnosis of insomnia

If your sleep problems are affecting your quality of life, see your GP.

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP may ask you to keep a sleep diary for at least two weeks. You may be asked to record things like the time you go to bed, how long you think it takes you to get to sleep and how often you wake. Your GP may also ask you to record what you're doing during the day and just before you go to bed, for example, when you have your meals or whether you have drinks with caffeine in them.

Most people don’t need to have special sleep tests. Your GP will often be able to diagnose the type and cause of your insomnia by the description of your sleep pattern. See our common questions for more information.

Treatment of insomnia

Self-help

There are a number of things that you can do to help overcome insomnia. These are known as sleep hygiene measures that promote a healthy sleep routine. Some examples are listed below.

  • Don't have drinks that contain caffeine or alcohol six hours before going to bed.
  • Don't smoke or take nicotine replacement medicines before going to bed.
  • Take regular exercise, but don't do strenuous activity immediately before going to bed as this may increase the amount of adrenaline your body produces, making it difficult to get to sleep. But you can have sex before going to sleep.
  • Don't take naps during the day.
  • Take a warm bath, have a milky drink, read or listen to soothing music to create a relaxed mood before going to bed. Consider relaxation therapy if you’re stressed.
  • Try to get into a daily routine to establish a sleep pattern. Go to bed at the same time each night and get up at the same time each morning.
  • Don't have heavy or rich meals, especially within a few hours before going to bed.
  • If you can't sleep, get up and read until you feel sleepy or do something you find relaxing. Don't watch television in the bedroom as this can stimulate your mind. Try not to lie in bed thinking about how much sleep you’re missing, otherwise your mind may start to associate your bedroom as a place of frustration and lack of sleep.
  • Mentally dealing with the day's unfinished business is also helpful. Write down any worries to deal with the next day, before you go to bed. This may help to clear them from your mind and prevent them resurfacing in the early hours.
  • Make sure your room isn't too hot or cold, or too noisy. Have a comfortable, supportive mattress on your bed. Wear ear plugs or an eye mask if necessary.
  • Use your bedroom for sleep and sex only – try not to use it to work or watch television.

Medicines

Medicines can treat insomnia, but they are often considered a last resort. This is because they may not work for very long and can sometimes make you feel drowsy the following day. Once you start taking medicines to help you sleep you will need to take more and more to get the same effect. These medicines can also be addictive. It’s important to discuss your options with your GP.

There are two main types of medicines for insomnia – hypnotics such as the medicines zaleplon, zolpidem, zopiclone and benzodiazepines, such as diazepam or lorazepam. Your GP can prescribe these for a short period of time (less than two weeks) to treat severe insomnia. Be careful not to drive if you still feel sleepy in the morning after taking these medicines.

If you’re over 55 your GP may prescribe you a long-acting melatonin, which is a type of hormone that your body produces. Melatonin is important in controlling your sleep pattern – it activates parts of your brain that encourage sleep.

Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

Complementary therapies

There is some research that shows that the herb valerian may be effective for insomnia, but more research is needed to confirm this. Currently there isn’t enough good quality medical evidence to show that valerian, or any other herbal remedy, can treat insomnia.

You may find herbal remedies helpful but there is limited evidence to show they work. Herbal remedies often contain active ingredients and may interact with other medicines or cause side-effects. Don’t start taking any herbal remedies without speaking to your GP or pharmacist first.

Other treatments

Other therapies that can help you to learn how to improve your sleep include the following.

  • Stimulus-control therapy can help you to connect your bed with going to sleep and to create a regular sleep routine. This therapy may involve getting out of bed and doing something relaxing if you’re unable to fall asleep within 15 to 20 minutes.
  • Relaxation therapy can help you to relax your muscles and to clear your mind of distracting thoughts.
  • Cognitive behavioural therapy (CBT) can help you deal with anxieties that may lead to sleep problems. It can also help to develop positive ideas about sleep, which aims to reduce concerns about not getting enough sleep. CBT teaches you to understand what healthy sleep is and how to deal with any negative thoughts about sleep.
  • Sleep-restriction therapy limits the amount of time you spend in bed to the time when you’re actually asleep. You may go to sleep later and wake up earlier to make you spend more time in bed asleep.

Can the menopause cause insomnia?

Answer

Yes, symptoms of the menopause, such as hot flushes and night sweats, can sometimes cause insomnia.

Explanation

The menopause occurs when your ovaries stop producing eggs. The average age of natural menopause for women in the UK is 51, although this varies from person to person. During menopause, the amount of oestrogen in your body falls, which can cause symptoms including hot flushes and night sweats. These symptoms usually last for between two and five years. Hot flushes and night sweats can wake you up in the night and cause you to have trouble sleeping.

Hot flushes can sometimes be triggered by eating hot spicy food or drinking coffee or alcohol, so try not to eat or drink these before you go to bed. Keep your bedroom cool and well ventilated with fresh air. If you're worried that you're not getting enough sleep, see your GP for advice. He or she may prescribe hormone replacement therapy (HRT) to control your symptoms, which may help you to sleep. HRT is available in a number of forms, for example as tablets, skin patches, or an implant. Speak to your GP about the risks and benefits of taking HRT.

The menopause can also make underlying problems such as anxiety and depression worse, which can in turn cause insomnia. If you need support and advice, see your GP.

Does acupuncture work as a treatment for insomnia?

Answer

There is no evidence as yet to suggest that acupuncture can help to improve insomnia.

Explanation

Acupuncture is a type of complementary medicine that involves inserting fine needles into your skin on certain areas of your body. It’s based on the idea that acupuncture needles stimulate nerve endings and alter the way your brain functions. It's claimed this can help to improve the symptoms of a variety of conditions.

There have been a few small research studies that have looked at whether acupuncture can help with insomnia. So far the results show that acupuncture is unlikely to help if you have insomnia. If you’re planning to have acupuncture, discuss this with your GP first. Also let the acupuncturist know if you’re taking any medicines. It’s important not to stop taking any medicines that you have been prescribed by your GP.

Will medicines that I can buy over the counter help with my insomnia?

Answer

Yes, over-the-counter remedies can be effective at helping you sleep, but only over a short period of time.

Explanation

There are several remedies that you can buy from your pharmacy without a prescription. These usually contain antihistamines. They can be effective, but often make you feel sleepy the next morning. For this reason, don't drive or operate machinery the day after you have taken them.

Don’t take these remedies for long periods of time because you can start to become tolerant to them. This means that they won't work as well as when you started using them, and you will need to start taking higher doses to produce the same effect.

Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

How do I know whether I’m getting a good night's sleep or not?

Answer

The amount of sleep you need is individual to you but, in general, most adults need seven to eight hours sleep a night.

Explanation

It should take you less than half an hour to fall asleep and you should generally sleep for between seven and eight hours a night, but this can vary. You may wake up for a couple of minutes every two hours or so but you shouldn’t be aware of these 'mini wakes'. You should feel refreshed once you have woken up.

If you’re having trouble getting to sleep and feel that it’s affecting your quality of life, see your GP for advice.

What do tests for insomnia involve?

Answer

Most people can be diagnosed with insomnia simply by describing their symptoms to their GP. However, your GP may refer you to a sleep specialist at a sleep centre to find out what is causing your insomnia. Here, you may have one or more tests.

Explanation

Your doctor may use tools such as the Pittsburgh sleep quality index or the Epworth sleepiness scale to first identify if you have insomnia, and to then assess how severe it is. You may be asked to fill out a questionnaire, which will provide your doctor with information about your sleep habits and the quality of your sleep.If you have already tried a treatment for insomnia and this hasn’t worked, there are a number of tests that can help your doctor to find out what may be the cause of the problem. These include the following.

  • A polysomnography test can record your brain activity, eye movements, sleep quality, heart rate, and blood pressure as well as assess your breathing. You will usually need to stay overnight at a sleep centre for this test. This test may be able to diagnose causes of insomnia such as obstructive sleep apnoea.
  • An actigraphy test can track your sleep habits over weeks or even months. You wear a small, wristwatch-sized device that monitors your movement while you’re asleep.

These tests will allow your doctor to track your sleep patterns and identify sleep-related problems that you don't know you have or can't describe.

Tests can be very helpful in identifying potential causes of insomnia. It’s also important to keep a personal sleep diary to record information such as the time you go to bed, how long you think it takes you to get to sleep and how often you wake, as well as what you're doing during the day and just before you go to bed. Information like this will help your doctor identify the cause of your insomnia and how best to treat it.

For more information about tests for insomnia, speak to your GP.