Insomnia

Insomnia is difficulty falling asleep, staying asleep, or waking too early — with daytime consequences (tiredness, mood, concentration). Short-term insomnia (days to weeks) usually has a trigger. Chronic insomnia (over 3 months, 3 nights a week) needs a more structured approach. Sleeping tablets alone are not the answer.

Common causes

• Stress, anxiety, depression.
• Caffeine, alcohol, nicotine.
• Screens, irregular schedule, shift work.
• Poor sleep environment (noise, heat, light).
• Pain, reflux, frequent urination, snoring (sleep apnoea).
• Medicines — some BP, antidepressants, decongestants, steroids.
• Medical conditions — thyroid, restless legs, menopausal hot flushes.

What works — CBT-I is the evidence leader

• Stimulus control — bed only for sleep and sex; get up after 20 minutes awake; return when sleepy.
• Sleep restriction — limit time in bed to actual sleep time, gradually expand.
• Wake at the same time every day, including weekends.
• No screens, caffeine, alcohol, heavy meals for 3 hours before bed.
• Cool, dark, quiet bedroom; relaxation wind-down.
• Daylight and exercise in the morning strengthens the body clock.
• Cognitive work on "I must sleep / I won't cope" thoughts.
• CBT-I (cognitive behavioural therapy for insomnia) — online programmes, apps, or trained therapists; more durable than sleeping pills.

Medicines — useful, in place

• Short courses (up to 2-4 weeks) for acute insomnia with a clear trigger.
• Avoid long-term benzodiazepines and Z-drugs — dependence, falls, cognitive effects in older adults.
• Antidepressants, melatonin-class hormones, or newer non-addictive options — selected cases.
• Never mix with alcohol.
• Treat the underlying cause — depression, anxiety, pain, sleep apnoea, restless legs.

When to see a Health Expert

• Insomnia more than 3 weeks.
• Insomnia with depression, anxiety, or suicidal thoughts — urgent (KIRAN 1800-599-0019).
• Loud snoring, witnessed pauses in breathing — assess for sleep apnoea.
• Restless legs, sleep-walking, violent dream acting-out.
• Daytime drowsiness affecting safety (driving).