Understanding insomnia: symptoms, causes and solutions

Getting a good night’s sleep can be challenging for a variety of reasons, with stress, medical conditions and lifestyle factors all playing a role. The influx of digital technology in our lives has made it even harder, with many of us checking our phones or using our laptops just before or in bed, which makes it harder to relax and drift off. If you’re regularly having difficulty sleeping, you may have insomnia — one in 10 adults in the UK have insomnia. 

On average, an adult needs seven to nine hours of good quality sleep every night, although this varies depending on your age, lifestyle, health, diet and environment. If you wake in the morning feeling rested, then you likely have had a good night’s sleep. Although most people will struggle to fall asleep or stay asleep at some point in their lives, this doesn’t always develop into insomnia. Insomnia occurs when you are unable to get to sleep or remain asleep for more than three nights a week for a duration of three months or more.

Types of insomnia

There are two main types of insomnia that affect adults — onset insomnia and maintenance insomnia. Onset insomnia refers to difficulty falling asleep, while maintenance insomnia refers to difficulty staying asleep or regularly waking up too early. In both cases, worrying about your insomnia often makes it worse. It is also possible to have both onset insomnia and maintenance insomnia at the same time.

Signs of insomnia

Insomnia symptoms include lying awake for long periods at night before falling asleep, waking up several times during the night, and waking up early in the morning and not being able to get back to sleep.

You may also notice that you wake up feeling tired and are not refreshed by your sleep. You may struggle to concentrate and function properly during the day, and become irritable and moody.

What causes insomnia?

Some people are more likely to develop insomnia than others and consequently, insomnia may persist even after the initial cause is resolved. Alcohol or drug misuse, certain medications, anxiety, stress, depression, a traumatic event, jet lag and a change in sleeping habits (eg sleeping in a new house) can all trigger insomnia. Worrying about your insomnia or trying and failing to resolve it can make you more wakeful, resulting in a vicious circle that makes it harder to stop insomnia. 

In addition to psychological and lifestyle factors, insomnia is also associated with a range of medical conditions, including sleep disorders such as obstructive sleep apnoea (OSA), cardiovascular disease, cancer, diabetes, gastroesophageal reflux disease (GORD) and conditions that cause chronic (long-term) pain eg arthritis, fibromyalgia and back problems. 

Diagnosing and treating insomnia

If you’re concerned that you have insomnia, see your GP. Sometimes simply talking to a medical professional about your concerns can improve your symptoms. It can also be helpful to keep a daily sleep diary. Use it to track when you fall asleep, how long it takes you to fall asleep, how many times you wake up in the night, what time you wake up in the morning and also to rate your quality of sleep.

Your GP will ask you about your symptoms and medical history. If you have insomnia, this will help them determine the underlying cause. If your insomnia is associated with a specific medical condition, treatment of the underlying condition may help. If it’s caused by certain medications, your GP may change your dosage or prescribe an alternative medication.

Your GP may also recommend cognitive behavioural therapy (CBT) techniques to improve your insomnia in both the short and long term. As it is often our thoughts, behaviours and emotional distress that stop us from sleeping, CBT can help by targeting these issues and providing tools to prevent the vicious circle triggered by worrying about your insomnia.

Home remedies for insomnia

Psychological and lifestyle factors can both cause insomnia and worsen insomnia caused by an underlying medical condition. There are several steps you can take to improve your sleep by tackling these factors.

Try to relax before going to bed eg by having a warm bath or having a non-alcoholic, non-caffeinated milky drink. It also helps to stick to a routine, with fixed times for going to bed and waking up. To help yourself drift off to sleep, make sure your room is as dark as possible and avoid stimulating activities in the hour before bedtime eg using mobile phones, laptops or tablets, or watching TV.

If you do wake during the night, try to avoid checking the time as clock-watching can increase your anxiety and make it harder to fall back asleep.

Aside from your nightly routine, you should also avoid napping during the day, even if you are tired, as this can disrupt your ability to fall asleep at bedtime. Regular exercise can help you fall asleep at night but avoid exercise in the three hours before bedtime as this can make you feel more awake.

If these home remedies aren’t enough to resolve your insomnia, see your GP and try not to worry — there are other approaches your doctor can support you with.

Author biography 

Miss Annie Beresford is a Consultant Clinical Psychologist at Spire Harpenden Hospital and Spire Norwich Hospital, specialising in Acceptance and Commitment Therapy (ACT), Cognitive Behavioural Therapy (CBT), Enhanced Cognitive Therapy for Eating Disorders (CBT-E), personal construct psychotherapy and integrative psychotherapy, and clinical hypnosis. She has over 30 years of experience as a Chartered Clinical Psychologist and is interested in the influence of nutrition, exercise and sleep quality on mental as well as physical wellbeing. Miss Beresford favours a holistic approach when designing therapy programmes in order to best meet the needs and aspirations of patients.