What is insomnia?

Insomnia is a sleep disorder in which people are unable to fall asleep or stay asleep. Most Australians experience insomnia at some point in their lives, and about 1 in 10 people have at least mild insomnia at any given time. It is more common in women and elderly people.

Insomnia can include:

• difficulty getting to sleep
• waking up during the night and having trouble going back to sleep
• waking up too early

Sometimes people experience all three.

Some people experience insomnia for a short time, for example when they are worried or stressed. But sometimes insomnia is chronic (called chronic insomnia disorder), meaning people have trouble falling or staying asleep for at least 3 months, along with being impaired during the day.

What are the symptoms of insomnia?

People experience insomnia differently. Some of the symptoms of insomnia are:

• having difficulty falling asleep
• waking a lot during the night
• waking up too early and being unable to go back to sleep
• not feeling refreshed when you wake up

Insomnia can lead to the following symptoms during the day:

• tension headaches
• feeling tired or being too sleepy to do normal activities
• poor memory and concentration
• worrying about sleeping
• feeling irritable or moody
• being hyperactive, aggressive or impulsive
• losing interest in doing things
• reduced energy and motivation
• feeling sleepy when sitting quietly

What causes insomnia?

Sometimes there is no underlying cause for insomnia. This is called primary insomnia.

Sometimes there is an underlying cause such as a general health condition, anxiety, depression or sleep disorder. This is called secondary insomnia.

Insomnia may be made worse by:

• poor sleep habits (sleep hygiene)
• substances including caffeine, nicotine, alcohol, amphetamines and some prescription medicines
• stress, caused by work or financial problems, relationship issues or grief
• medical issues, in particular conditions causing pain, hormone changes (e.g. hot flushes and night sweats during menopause), and breathing, urinary or digestive problems
• mental health problems — insomnia can be a symptom of anxiety, depression or other disorders
• sleep disorders, including obstructive sleep apnoea, circadian rhythm disorders caused by irregular sleep patterns, restless legs syndrome and periodic limb movement
• life stage — elderly people are more likely to have insomnia
• shift work — people who work different shifts often do not sleep as well as those who work set hours during the day

When should I see my doctor?

It is a good idea to see your doctor if you are having trouble sleeping or you are having problems with your mood, feeling restless in bed, snoring badly or waking up not feeling refreshed. Keeping a sleep diary is a good way to track symptoms, which you can share with your health professional.

If they think you have insomnia, your doctor may refer you to see a sleep specialist or psychologist.

How is insomnia diagnosed?

Your health professional will ask you about your sleep habits, medications, how much caffeine and alcohol you consume, and other symptoms you may have, such as pain. They may examine you to rule out underlying conditions that may be causing your insomnia.

How is insomnia treated?

The first step in managing insomnia is to learn healthy sleep habits and change any lifestyle factors that may be contributing to the problem. Having a regular sleep routine, pre-bedtime activities and bedroom surroundings can have a big influence on sleep.

Sleep hygiene

• Try to go to bed and wake up at the same time each day.
• Spend the right amount of time in bed. Most people should not stay in bed for more than 8 ½ hours. Staying in bed for longer can lead to fragmented sleep.
• Make sure the bedroom is comfortable. It should be quiet and dark, with good temperature control.
• Cut out caffeine, nicotine and alcohol — or at least reduce them, or limit coffee to mornings only.
• Talk to your doctor about whether your prescription medicines may be contributing to the insomnia.
• Get regular exercise, but not in the evening.
• Avoid daytime naps.
• Avoid screens in the bedroom or for an hour before bed.
• Consider removing clocks from the bedroom and try not to look at the time on electronic devices.
• If you cannot sleep, go to another room and do a quiet activity until you feel tired and then try again.
• Do something relaxing before bed.
• Try to deal with anything that is worrying you earlier in the day, rather than at bedtime.

Relaxation techniques

Learning to relax before bed can help you let go of worries and prepare your body for sleep. Breathing exercises, progressive muscle relaxation and meditation can be useful techniques before sleep.

Online programs can help you deal with insomnia. For example, Reach.Out.com’s Recharge program is a personalised 6-week program to help you establish good sleep/wake patterns.

Cognitive behaviour therapy (CBT)

Cognitive behaviour therapy (CBT) is usually the first line of treatment if sleep strategies and relaxation are not effective. CBT, a treatment based on the idea that how you think and act affects how you feel, is usually provided by a psychologist and can be done individually or in a group. CBT is effective for insomnia, anxiety and depression.

Medication

In the case of chronic insomnia where other methods have not helped, doctors may prescribe medication. This can be useful for a short period of time. However, long-term medication use can cause addiction and may have side effects. These could include night wandering, agitation, excessive drowsiness, impaired thinking, balance problems or allergic reactions.

Sleeping tablets are not a cure for insomnia, and are less effective than CBT. Sometimes they can make insomnia worse, especially if you take them regularly.

Another option your doctor may recommend is melatonin, a hormone that controls the body’s night and day cycles. It can be used as a sedative, to make you feel sleepy, or to reset the internal body clock. It is taken as pills. The best time to take it is 1 hour before you go to bed. Because it can make you sleepy, you should not take it before you drive or operate machinery.

Over the counter sleep aids

You can buy herbal remedies over the counter that are promoted to help people sleep. These include kava, valerian, passionflower, hops, sour date, mimosa, lavender, California poppy and chamomile.

There is little scientific evidence about whether these remedies work, or the consequences of taking them for a long time.

It is important to talk to your doctor before you take a sleeping aid, as it may interact with your other medications. Make sure you follow the instructions on the label carefully and do not take them for a long period of time. You should avoid alcohol when you are taking over the counter sleeping aids.

Underlying conditions

If your insomnia is caused by an underlying condition such as pain, hormone changes, digestive problems, mental health problems or another sleep disorder, then addressing that condition should improve your insomnia.

If a medicine is causing the insomnia, your doctor may be able to give you a different medicine or help you cut down.

Other treatments

• Light therapy: the use of bright lights can change the internal body clock and improve sleep.
• Sleep restriction: this method reduces your sleep hours, causing sleep deprivation; once sleep has improved the sleep hours can return to normal.

If there is an underlying cause for the insomnia, such as sleep apnoea, a doctor may recommend investigations and other treatment.

Complications of insomnia

Insomnia also causes a range of problems that can occur during the day, and can make it difficult to function normally. They include:

• poor concentration
• making errors or forgetting things
• anxiety or depression (these issues can also cause insomnia)
• tension headaches
• digestive symptoms

Being overtired can increase the risk of someone making mistakes or having an accident. Research has shown that severe sleep deprivation can affect driving ability as much as alcohol.

Resources and support

Sleep Health Foundation (more information and link to resources).