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Published by Bupa's health information team, December 2007.
This factsheet is for people who are having trouble sleeping, or who would like information about insomnia.
Most people have the occasional night of disturbed sleep. Insomnia is a feeling of not being able to get enough sleep. It's usually related to finding it hard to get to sleep, waking up without having had enough sleep or not feeling refreshed after sleep. One in four people are thought to suffer from insomnia at some point in their lives.
What is insomnia?
Insomnia is the inability to fall asleep, or to stay asleep long enough to get a proper night's sleep. This can make you feel permanently tired.
The exact function of sleep is not fully understood. However, the effects of a lack of sleep suggest that its main function is to rest and repair the body.
Sleep occurs daily and is a period when we are unconscious and unaware of our surroundings. Your sleep is made up of five different stages: drowsiness, light sleep, two stages of deep sleep and finally rapid eye movement sleep (REM). In REM sleep, your breathing, heart rate and eye movements become more rapid and your limb muscles are temporarily paralysed. This is the time when most dreams occur.
The stages of sleep occur in cycles. The first cycle, which ends after the completion of the first REM stage, usually lasts for 90 minutes. Each cycle after the first lasts longer because the REM stage lasts longer in each cycle. A person may have five cycles of sleep during a typical night.
How much sleep do I need?
Different people may need less or more sleep than others, and 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. Most adults need seven to eight hours sleep.
People tend to sleep lightly and for shorter periods as they get older. In older people it takes longer to fall asleep, the amount and length of waking points during the night increase, and the time spent in deep sleep decreases.
The symptoms of insomnia typically include:
- difficulty getting to sleep
difficulty staying asleep (frequently waking up and difficulty getting back to sleep)
waking up early in the morning
feeling tired in the morning
If you don't get enough sleep, you can feel irritable, anxious and depressed.
There is usually no single cause of insomnia, but there are a number of factors known to contribute, including:
psychological health problems such as stress or anxiety
physical health problems such as asthma or pain
medicines like those taken for asthma, vertigo and depression
jet lag (for more information see Related topics)
environmental factors such as noise, an uncomfortable bed or being too hot or cold
lifestyle habits, eg eating late at night, drinking alcohol or using stimulants such as nicotine
A lack of sleep may also increase the risk of certain health conditions including high blood pressure, obesity and diabetes.
There are two types of insomnia.
This is insomnia that has an obvious underlying cause. It affects three out of 10 people with insomnia. Sleep patterns, behaviour before sleep and sleeping environment (eg being too hot or cold) are often the cause.
This is insomnia that is caused by a medical condition. Psychological problems such as grief, depression and dementia cause secondary insomnia in five out of 10 people. One in 10 people are affected by secondary insomnia because of physical problems such as arthritis, diabetes and pain.
Secondary insomnia can also be caused by medicines taken for health-related conditions. It can also be caused by other factors, such as substance or alcohol misuse. Medicines, alcohol or illegal drugs cause insomnia in about one to two of every 10 people with insomnia.
Insomnia can be described as either transient, short-term or long-term. Transient insomnia lasts for only a few nights. Short-term insomnia lasts for more than two to three nights but less than three weeks. Long-term (chronic) insomnia occurs on most nights of the week and lasts three or more weeks.
If your work or leisure activities are disturbed by daytime sleepiness, or if you wake up not feeling refreshed and feeling irritable, you should visit your GP. He or she may recommend that you take certain self-help measures to help you sleep (please see Self-help). He or she will also look out for any underlying causes that need treatment.
Be aware that insomnia can make you feel sleepy during the day, which may affect your co-ordination when operating machinery or driving a car.
There are a number of things that you can do to help overcome insomnia. These are known as sleep hygiene measures and include the following.
Reduce your caffeine intake, especially late in the day.
Drink alcohol in moderation. It may make you sleepy, but it will cause you to wake up early.
If you smoke, try to stop. Night-time breathing problems are more likely in smokers. For more information see Related topics.
Take regular exercise, but don't do strenuous activity immediately before going to bed. For more information see Related topics.
Don't take naps during the day.
Try taking a warm bath, having a milky drink or listening to soothing music to create a relaxed mood before going to bed.
Meditation and exercise such as yoga can have a relaxing affect, helping prepare your body for sleep.
Try to get into a daily routine to establish a sleep rhythm. Go to bed the same time each night and get up the same time each morning.
Don't have heavy or rich meals, especially in the few hours before you go 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 as this can stimulate the mind, and try not to lie in bed thinking about how much sleep you are missing.
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 re-surfacing in the early hours.
Make sure your room isn't too hot or too cold, and that your bed is comfortable.
Psychologists can teach you simple relaxation techniques to help combat insomnia. They can also provide "talking treatments" (psychotherapy) which can help people come to terms with various life events such as bereavement or marital problems that may be triggers of insomnia.
You can also learn psychological tricks - such as telling yourself you must stay awake, which often has the opposite effect.
Specific sleep therapy includes cognitive behaviour therapy (CBT), which can deal with anxieties that may be stopping sleep and helps develop positive ideas about sleep. For more information see Related topics.
Hypnotics such as the medicines zaleplon, zolpidem and zopiclone or benzodiazepines (eg diazepam or lorazepam) can be prescribed by your doctor for a short period (less than two weeks) to treat severe insomnia. These medicines can cause drowsiness the next day and can be addictive.
Sedative antihistamines such as diphenhydramine (Nytol) and promethazine (Phenergan) can help treat insomnia. These are effective but stay in the body for a long time and can cause a hangover effect in the morning. Ask your GP for more advice about these medicines.
There is some scientific evidence that the herb valerian is effective for insomnia. Passiflora and wild lettuce extract are also traditionally used, but their benefits have not been proven in medical trials. Lavender and chamomile may also be helpful. If you are taking any other medication, check with your GP or pharmacist before taking any herbal remedies.
- British Association for Behavioural and Cognitive Psychotherapies (BABCP)
0161 797 4484
- British Association for Counselling and Psychotherapy (BACP)
0870 443 5252
See our answers to common questions about insomnia, including:
- Barnes J, Anderson LA and Phillipson JD. Herbal Medicines: A guide for healthcare professionals. London: Pharmaceutical Press. 2002 482-483
- British National Formulary (BNF) September 2006. London: BMJ Publishing Group 2006. 52
- Guidance on the use of zaleplon, zolpidem and zopliclone for the short-term management of insomnia. April 2002. National Institute of Health and Clinical Evidence (NICE)
accessed 6 December 2006
- Hobbs C Herbal Remedies for Dummies. New York: IDG Books Worldwide, 1998.
- Insomnia. NHS Library for Health. Clinical Knowledge Summaries.
accessed 27 November 2006
- Insomnia. The Mental Health Foundation
accessed 1 November 2006
- Insomnia. The Sleep Foundation
accessed 7 December 2006
- Psychotherapy. The Royal College of Psychiatrists
accessed 7 December 2006
- Simon C, Everitt H, Birtwistle J, Stevenson B. Oxford Handbook of General Practice. Oxford: Oxford University Press. 2002: 886-887
- Sleep disorders. The Mental Health Foundation
accessed 1 December 2006
- Sleeping Well. The Royal College of Psychiatrists.
accessed 30 November 2006
- Tiredness. The Royal College of Psychiatrists
accessed 27 November 2006
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Susan Mills, Senior Sleep Researcher, University of Surrey; Dr James Quekett, Bsc.MB Ch.B MRCGP DRCOG DFFP, partner/principal general practitioner at Rowcroft Medical Centre; and other Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: December 2007