Insomnia: causes, types and treatments

What is insomnia?

Insomnia is a very common sleep disorder where people find it difficult to fall asleep or stay asleep. It can also make you wake up too early and not be able to get back to sleep.

This results in people having poor sleep and/or insufficient amounts of sleep, which leaves you feeling tired and low on energy during the day.

It's not just your energy that's affected by insomnia, either. It can also have detrimental effects on your mood and mental wellbeing, your physical health, and your overall quality of life.

What are the symptoms of insomnia?

People with insomnia commonly experience symptoms including:

• Difficulty falling asleep at night
• Waking up in the night and/or lying awake at night
• Waking up too early in the morning
• Still feeling tired after sleep
• Feeling sleepy or tired during the day
• Difficulty concentrating
• Issues with memory
• Irritability and low mood
• Greater likelihood of making mistakes
• Anxiety about sleep

How common is insomnia?

Most adults will experience insomnia at some point in their lives. For many people, changing their sleep habits – also known as improving your sleep hygiene – is enough to fix the problem.

However, for some people the problem becomes chronic. If you have trouble sleeping (whether falling asleep or staying asleep) three or more nights a week for three months or more, it's classed as chronic insomnia.

This is a common medical condition, thought to affect up to 10% of people. As anyone with chronic insomnia will tell you, it can have a serious impact on your life.

Are there different types of insomnia?

Different people will be affected by insomnia in different ways. But, while there are probably countless different experiences of insomnia, there are still certain categories that can be useful to help diagnose and treat the problem.

Short-term vs chronic insomnia

As discussed above, many people will experience sleep problems for a short while. When it becomes frequent and last for a number of months, it's classed as chronic.

Sleep onset insomnia

This is when you struggle to fall asleep in the first place. You might find yourself tossing and turning without getting to sleep.

Sleep maintenance insomnia

This is when you can't stay asleep through the night. Often, this means you'll wake up at least once in the night and then struggle to get back to sleep.

Early morning awakening insomnia

This sees people waking up long before they want to in the morning (or even the middle of the night) and not being able to get back to sleep.

Mixed insomnia

You might hear people talking about 'mixed insomnia', though it's not a technical term. This is where you experience a mix of the above three types of sleep problems. For example, you might struggle to fall asleep then also wake up very early.

What are the main causes of insomnia symptoms?

Insomnia is caused by a variety of factors, ranging from lifestyle factors to medical conditions. Some of the most common causes include:

• Stress, anxiety, depression and other mental health issues
• Shift work (especially as it can prohibit a regular sleep-wake cycle)
• Irregular sleep patterns
• Poor sleep habits (also known as sleep hygiene)
• Jet lag
• Sleep apnoea and other sleep-related disorders
• Caffeine, nicotine and alcohol
• Poor diet
• Certain medications

Will insomnia go away on its own?

For most people, sleep problems will be a short-term issue that will go away either on their own or when you change your sleep habits.

For example, many people will have difficulty sleeping during times of emotional change (getting married, having a baby) or when they're under stress (during exams, when changing jobs). This will generally ease as the causes pass.

However, chronic insomnia is unlikely to go away on its own. You should speak to your doctor about getting treatment.

What treatments are available for insomnia?

Dr Olga Runcie, Consultant psychiatrist and sleep specialist  shares her advice on treatments for insomnia.

There are many different types of sleep aids for Insomnia, including over-the-counter (non-prescription) and prescription medications as well as herbal remedies.

If you have long-term or chronic insomnia, it may be best to look into a treatment that addresses the cause of the problem and not just the symptoms. Cognitive behavioural therapy is often the first recommendation in this case.

Prescription medications

The medications most commonly prescribed for Insomnia in the UK include benzodiazepine hypnotics (Diazepam, Temazepam) and non-benzodiazepine hypnotics (Zolpidem, Zopiclone).

Doctors also frequently prescribe sedative antidepressants, antihistamines and, sometimes, small doses of sedative antipsychotics to improve sleep.

Medications do have certain advantages. These include easy accessibility, a simple administration route, and that they generally take quick effect.

Not having to commit to behavioural changes may also be an appealing benefit for some people.

However, sleeping pills can have serious side effects, with addiction counted among them.

Over-the-counter medications and herbal remedies

Certain over-the-counter medications and herbal supplements are advertised as treatments for insomnia. Melatonin, for example, is commonly recommended for sleep difficulties.

The problem with non-prescription remedies is that they often only work if taken correctly, in the right does and at a specific time, all of which may need to be tailored individually to you.

Which of these remedies will work for you will all depend on the type and duration of your insomnia and your symptoms.

For this reason, you should always speak to a doctor before taking any sleep aid. They'll support and monitor you to track its effectiveness.

When it comes to any medication for insomnia, whether prescription or over-the-counter, it's important to remember that you're not addressing the causes of your sleep issues. Medication can be very effective for acute symptoms, but it won't relieve chronic insomnia in the long-term.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) has been shown to be a very effective non-pharmaceutical treatment for insomnia. Studies show it can lead to a long-term improvement in sleep quality.

It works by pinpointing the thoughts and behaviours that might be causing your sleep issues and aims to change these. For many people, it can result in significant and sustained changes in sleep behaviours and sleep attitudes.

As treatment for sleep problems is very individualised, the number of sessions you will need will vary between four and eight.