Causes of sleep problems include: physical illness (e.g. pain from conditions such as arthritis; mental health issues; substance misuse, and drinking alcohol or smoking (especially in the evening).
In the UK, insomnia has featured as the most common sign of mental health problems for the last 15 years. Stress and anxiety are also common causes of insomnia and can develop after a bereavement, family or work problems or financial worries.
Your sleep-wake cycle may also be disrupted by shift work or jet lag, or you may suffer from nightmares, sleep walking or restless legs syndrome, a condition which causes an irresistible urge to move the legs.
Sleep apnoea, a condition which causes the airways to narrow during sleep interrupting breathing and causing loud snoring and laboured breathing, can also affect sleep quality.
Side-effects from prescription pills can also disrupt sleep patterns. Common culprits include antidepressants, anti-epileptics, blood pressure pills, corticosteroids and anti-inflammatory drugs.
Sometimes though, there is no underlying cause for insomnia and these cases account for one in five cases of long-term insomnia. The symptoms may start after a stressful event but persist for much longer.
It should take you less than 30 minutes to fall asleep at night. The classic symptoms of insomnia are difficulty falling asleep, lying awake at night for long periods and waking up too early. You feel tired, find it hard to concentrate, become irritable and are not able to function normally.
It’s helpful to track your sleep pattern in a sleep diary for two weeks before seeing your doctor. He or she will ask how poor sleep is affecting you and assess how long it's been a problem.
Who gets it?
We all need different amounts of sleep, and this changes with age. For example, an average 15-year-old gets eight hours sleep, while a 60-year-old only 6.3 hours. One in three of us complain of poor sleep, while 10 to 15 per cent of adults have long-term insomnia. In older people, 25 per cent are affected. Insomnia is up to twice as common in women than men.
Around half of all diagnosed cases of insomnia are related to a mental health issue.
If your doctor finds the cause of your insomnia, treating this may be enough to restore your normal sleep pattern.
Adopting good sleeping habits (called sleep hygiene) is the first way to treat insomnia and for many people that's enough. This includes: adopting a regular bedtime and rising time; creating a relaxing bedtime routine; avoiding caffeine, alcohol and nicotine in the evening; not eating big meals before bedtime; cutting out any napping during the day and avoiding strenuous exercise four hours before bed.
Cognitive behavioural therapy for insomnia (CBT-I) can help by changing unhelpful thought patterns that keep you awake and teaching you how to relax.
Sleeping tablets are a last resort because of side-effects and the potential for addiction, plus they fail to tackle the underlying causes. They should only be used for two to four weeks and are only prescribed for severe insomnia, to ease short-term insomnia and if sleep hygiene and CBT don’t help. Your GP can prescribe benzodiazepines (temazepam, loprazolam, lormetazepam) or ‘Z’ drugs (zopiclone, zolpidem, zaleplon), newer types of sleeping pills.
A natural medicine called melatonin (the pill version is called Circadin) is licensed for adults aged over 55 with long-term insomnia. Melatonin is your body’s sleep hormone and it helps regulate your sleep cycle.
Some people find herbal remedies helpful, especially valerian and passiflora. One study found a herbal remedy containing valerian and passiflora was as effective for short-term insomnia as the sleeping pill zolpidem. Lavender pillow sprays and pillows filled with hops are also popular for inducing sleep.