Insomnia: Why You Can’t Sleep and What Actually Helps
Almost everyone sleeps badly now and then. Insomnia is different. It means repeated difficulty falling asleep, staying asleep or waking too early, despite adequate opportunity to sleep, and it causes problems during the day such as fatigue, poor concentration, irritability or low mood. When this occurs at least three nights a week for three months or more, it is called chronic insomnia, and it affects roughly one in ten adults.
How much sleep do we need
Most adults need seven to nine hours, though needs vary. Older adults often sleep more lightly and wake more often. Quality matters as much as quantity: if you wake feeling rested and function well in the day, you are probably getting enough.
Why insomnia develops
Short-term insomnia usually has an obvious trigger such as stress, illness, travel, grief or a change of routine. In some people it persists long after the trigger has gone. Three factors combine:
- Predisposing: a tendency to overthink, anxiety, family history or a light sleeping nature
- Precipitating: the stressful event that started it
- Perpetuating: the habits and worries that keep it going, such as lying in bed awake, napping, drinking more coffee or worrying about sleep itself
The perpetuating factors are the key target of treatment.
Other contributors
- Anxiety and depression, which are both a cause and a consequence
- Pain, reflux, breathing problems, frequent urination and menopause hot flushes
- Restless legs syndrome and sleep apnoea
- Medicines such as steroids, some antidepressants, decongestants and stimulants
- Caffeine, nicotine and alcohol; alcohol helps you drop off but fragments sleep later in the night
- Irregular shift work or jet lag
- Screens and bright light late in the evening
Ruling out and treating these underlying conditions is an essential first step.
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The best treatment: CBT for insomnia
Cognitive behavioural therapy for insomnia (CBT-I) is recommended as the first-line treatment by major guidelines. It is as effective as sleeping tablets in the short term and clearly better in the long term, with no side effects. It typically includes:
- Sleep restriction: temporarily limiting time in bed to the amount you actually sleep, then expanding it as sleep becomes consolidated. This builds a strong sleep drive.
- Stimulus control: use the bed only for sleep and intimacy; if awake for around 20 minutes, get up, do something calm in dim light and return when sleepy.
- Cognitive work: challenging unhelpful beliefs such as “I must get eight hours or I will fall apart.”
- Relaxation techniques and a wind-down routine.
- Sleep hygiene as a supporting piece, not the whole treatment.
Many people access CBT-I through trained therapists, group programmes or validated online courses.
Sleep habits that help
- Keep a regular wake time every day, including weekends. This is the most powerful anchor for your body clock.
- Get bright light, ideally outdoors, within an hour of waking.
- Limit caffeine after midday and avoid heavy meals and alcohol in the evening.
- Exercise regularly, but not vigorously within a couple of hours of bedtime.
- Keep the bedroom cool, dark and quiet.
- Dim lights and put screens away an hour before bed.
- Do not watch the clock; turn it to face away.
- Avoid long daytime naps; if needed keep them under 30 minutes and before mid-afternoon.
What about sleeping pills
Medicines can play a role for short periods. Z-drugs and benzodiazepines can help during a crisis but cause tolerance, daytime drowsiness, memory problems, falls and dependence, so they are generally limited to a few weeks. Over-the-counter antihistamine sleep aids lose effect quickly and cause next-day grogginess. Melatonin is useful for jet lag, shift work and some older adults, while newer dual orexin receptor antagonists are options in selected cases. Discuss any medicine with a doctor, especially if you drive or are older.
When to see a doctor
Seek help if insomnia lasts more than a month, is affecting your daytime functioning, or comes with loud snoring and pauses in breathing, irresistible leg movements, low mood or anxiety. Sleep is not a luxury; it is the foundation of physical and mental health, and chronic insomnia is highly treatable.
This article is for general information and is not a substitute for professional medical advice. If you are worried about your health or have symptoms, speak to a doctor or other qualified health professional.