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Insomnia

Published by Bupa's health information team, March 2010.

This factsheet is for people who are having trouble sleeping, who have insomnia or who would like information about it.

Insomnia is not being able to get enough sleep. It's usually related to finding it hard to get to sleep or stay asleep. People who have insomnia often wake up without having had enough sleep and don't feel refreshed after sleep.

• About insomnia
• Symptoms of insomnia
• Causes of insomnia
• Diagnosis of insomnia
• Treatment of insomnia
• Questions and answers
• Related topics
• Further information
• Sources

About insomnia

Insomnia is the inability to fall asleep, or to stay asleep long enough to get a proper night's sleep. The occasional night with too little sleep can make you feel very tired the following day. This can be dangerous if you're driving or operating machinery. Insomnia which goes on for a long period of time can cause health problems such as high blood pressure and diabetes, or make you more likely to become overweight.

There are two types of insomnia, called primary and secondary insomnia. Primary insomnia has no obvious cause. Secondary insomnia is caused by an underlying problem, such as a medical condition or psychological problem such as grief and depression.

Insomnia can be described as either short term or long term. Short-term insomnia lasts for between one and four weeks. Long-term (chronic) insomnia lasts for more than four weeks.

One in four people in the UK are thought to suffer from insomnia at some point in their lives. More women experience insomnia than men. As you get older, you're more likely to have difficulty sleeping. One in every two people over the age of 65 has insomnia at some time.

About sleep

The reasons why we need to sleep aren't fully understood. However, the effects of a lack of sleep suggest that you need sleep in order to rest and repair your body. Sleep happens daily and is a period when you're unconscious and unaware of your surroundings. Your sleep is made up of five different stages which are listed below.

• Pre-sleep - when your muscles are relaxed and your heart rate and breathing slow down.
• Light sleep - when you're lightly asleep, can still be woken up easily and won't feel confused.
• Slow wave sleep - the time when you might sleepwalk or talk in your sleep.
• Deep slow wave sleep - when you're hard to wake up and, if someone does wake you, you may feel disorientated and confused.
• Rapid eye movement (REM) sleep - 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, moving from REM sleep to deep sleep and back again during the course of a night. You may have five cycles of sleep during a typical night.

The amount of sleep you need is very individual. Some adults need eight hours sleep whereas others 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. Most adults need seven to eight hours sleep

Symptoms of insomnia

The symptoms of insomnia typically 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 don't get enough sleep, you can feel irritable, anxious and depressed.

Causes of insomnia

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

• Psychological health problems such as stress, depression, grief or alcoholism.
• Physical health problems such as asthma, pain or menopause symptoms.
• Medicines such as those taken for asthma.
• Jet lag - this is 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 alcohol or using stimulants such as nicotine.

Diagnosis of insomnia

To diagnose the type and cause of your insomnia your GP will ask you 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 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.

Special sleep tests aren't usually needed to diagnose insomnia.

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. Some examples are listed below.

• Don't have drinks with caffeine, alcohol or nicotine within six hours of going to bed.
• Take regular exercise, but don't do strenuous activity immediately before going to bed. It's alright to have sex before going to sleep.
• 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 you go to bed.
• Try to get into a daily routine to establish a sleep pattern. 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 your mind. 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 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 - don't use it to work, read or watch television.

Medicines

Medicines can be used to treat insomnia. However, 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.

There are two main types of medicines for insomnia. Hypnotics such as the medicines zaleplon, zolpidem and zopiclone and benzodiazepines, such as diazepam or lorazepam. These can be prescribed by your GP for a short period (less than two weeks) to treat severe insomnia.

Complementary therapies

There is some evidence that the herb valerian is effective for insomnia. Passionflower, hops, lavender, lemon balm and Jamaica dogwood are also traditionally used to help you sleep, but their benefits have not been proven in medical trials. If you are taking any other medication, check with your GP or pharmacist before taking any herbal remedies.

Other treatments

There are other therapies that can help you to learn a number of ways of improving your sleep. Some of the main ones are listed below.

• Stimulus-control therapy. This helps you to connect your bed with going to sleep and to create a regular sleep routine.
• Relaxation. This helps you to relax your muscles and to clear your mind of distracting thoughts.
• Cognitive Behavioural Therapy. This can help you to deal with anxieties that may be stopping sleep and helps develop positive ideas about sleep.
• Sleep restriction. This limits the amount of time you spend in bed to the time when you are actually asleep. This makes you tired.

Related topics

• Benzodiazepines and Z-drugs
• Cognitive behavioural therapy
• Giving up smoking
• Jet lag
• Physical activity

Further information

• British Association for Behavioural and Cognitive Psychotherapies (BABCP)
  0161 797 4484
  www.babcp.com
• British Association for Counselling and Psychotherapy (BACP)
  01455 883316
  www.bacp.co.uk

Sources

• Insomnia. Mental Health Foundation. www.mentalhealth.org.uk, accessed 5 September 2009
• Sleeping well. The Royal College of Psychiatrists. www.rcpsych.ac.uk, accessed 5 September 2009
• Insomnia. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 5 September 2009
• Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2007:242
• Joint National Formulary Committee. British National Formulary. 57 ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2009.
• Barnes J. Herbal therapeutics: insomnia. The Pharmaceutical Journal 2002; 269:219-21

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 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: March 2010