What is insomnia?

Insomnia is a sleep disorder. If you have insomnia, you may find it hard to fall asleep or stay asleep. Most Australians experience insomnia at some point in their lives. More than 1 in 10 people have at least mild insomnia at any given time. It is more common in females and older people.

Insomnia can include:

• difficulty falling asleep
• waking up during the night and having trouble going back to sleep
• waking up too early and not being able to go back to sleep

Sometimes people experience all 3 of these.

You might experience insomnia for a short time. This can happen if you’re worried or stressed. Sometimes insomnia can become long term (known as chronic insomnia disorder).

This is defined as having trouble falling asleep or staying asleep at least 3 nights per week, for at least 3 months, that affects how you function during the day.

What are the symptoms of insomnia?

Symptoms of insomnia include:

• difficulty falling asleep
• waking up often during the night
• waking up too early, and not being able to go back to sleep
• not feeling refreshed when you wake up

Insomnia can also lead to symptoms during the day, making it harder to function. These may include:

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

People experience insomnia differently, and you might only have some of these symptoms.

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What causes insomnia?

There are many different causes of insomnia. Sometimes there is no clear cause. In other cases insomnia is caused by an underlying health condition. There are many factors which can cause or worsen insomnia.

Causes of insomnia and factors that can make it worse include:

• medical issues — in particular conditions causing chronic pain, hormone changes (such as hot flushes and night sweats during menopause), and breathing, urinary or digestive problems
• sleep disorders — such as obstructive sleep apnoea, circadian rhythm disorders caused by irregular sleep patterns and restless legs syndrome
• substances — including caffeine, nicotine, alcohol, amphetamines and some medicines
• mental health conditions — such as anxiety, depression, PTSD (post-traumatic stress disorder) or other disorders, stress caused by work or financial problems, relationship issues or grief
• unhealthy sleep habits — known as poor sleep hygiene

Some people are more likely to experience insomnia, including:

• older people
• people with dementia
• shift workers
• people who often travel across time zones
• people who have a genetic basis for insomnia

When should I see my doctor?

It is a good idea to see your doctor if you are having trouble sleeping or if you are:

• having problems with your mood
• feeling restless in bed
• waking up not feeling refreshed

Keeping a sleep diary is a good way to track your symptoms. You can share this with your doctor or another health professional.

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

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How is insomnia diagnosed?

There is no specific test to diagnose insomnia. Your doctor may ask you to keep a sleep diary or answer a questionnaire to help them understand your sleep problems. Your doctor will ask you about your:

• sleep habits
• medicines
• caffeine and alcohol use
• other symptoms (such as pain)

Your doctor may examine you to rule out underlying conditions or other sleep disorders that may be causing your insomnia. In some situations, your doctor may refer you for tests at a specialist sleep clinic.

ASK YOUR DOCTOR — Preparing for an appointment? Use the Question Builder for general tips on what to ask your GP or specialist.

How is insomnia treated?

There are many treatments for insomnia. Your doctor will help you choose a treatment plan based on your situation. Treatments include one or more of the following:

Treating an underlying condition

If your insomnia is caused by an underlying condition such as:

• pain
• hormone changes
• digestive problems
• a mental health condition
• other sleep disorders, such as sleep apnoea

Your doctor may suggest treating those conditions or recommend tests to find other ways to improve your symptoms.

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

Sleep hygiene

Good sleep hygiene includes forming good habits that will help you sleep well.

If your insomnia is caused by poor sleep hygiene, the first step in treatment is to learn to adopt healthy sleep habits and change any lifestyle factors that may contribute to the insomnia. Sleep hygiene is often used alongside other approaches to treat insomnia.

Good sleep habits include the following:

• Keep regular sleep patterns. Try to go to bed and wake up at around the same time every day and avoid daytime naps. Don’t spend too long in bed — most people should aim for 8 ½ hours or less. Staying in bed for longer can lead to broken sleep.
• Make sure your bedroom is comfortable. It should be quiet and dark, not too hot or too cold. Consider removing clocks from your bedroom, so you don’t keep checking the time. Avoid having screens in your bedroom, and don’t use screens for one hour before going to bed.
• Cut out nicotine, reduce or cut out alcohol and limit caffeine to mornings only.
• Exercise regularly, but not in the evening.
• If you can’t sleep, go to another room and engage in a quiet activity (such as reading) until you feel tired, and then try again. Try to reduce the time you spend in bed if you cannot sleep.
• Do something you find relaxing before bed.
• Try to manage anything that is worrying you earlier in the day, rather than at bedtime.

Relaxation techniques

Learn how to relax your body and mind before bed. This can help you let go of worries and prepare your body for sleep. Useful techniques to try before sleep include:

• breathing exercises
• muscle relaxation
• meditation

Cognitive behaviour therapy (CBT)

Cognitive behaviour therapy (CBT) is usually the first type of treatment to try if sleep strategies and relaxation techniques have not helped you. CBT is a treatment that helps you change how you think about sleep and feel less anxious or worried about it. It is usually provided by a psychologist and can be done individually or in a group. CBT is effective for insomnia, anxiety and depression.

Medicines

Prescription medicines

In the case of chronic insomnia, where other treatments have not helped, your doctor may prescribe medicines. Sleeping pills are less effective than CBT and are not a cure for insomnia, as they do not target the underlying problem. They can be useful for a short period of time, but become less effective if you take them too often. Long-term medicine use can also lead to addiction and side effects.

Your doctor may prescribe a medicine for insomnia (for example temazepam, zopiclone or zolpidem). They will recommend you use medicines at the lowest possible dose and for a short time. These medicines may cause side effects, especially among older people, like an increased risk of falling.

Other medicines (for example suvorexant and lemborexant) may help people stay asleep or fall asleep, but they’re not suitable for everyone — your doctor will prescribe these if they are a good option for you.

Many other prescription and over-the-counter medicines are sometimes used for sleep, but they’re not recommended — especially for older adults. These include antidepressants, some antihistamines and antipsychotics. They can cause serious side effects and often don’t work well for insomnia.

Side effects of some medicines could include:

• night wandering
• agitation
• excessive drowsiness during the day
• impaired thinking
• balance problems and dizziness
• allergic reactions

Sometimes, sleeping tablets can make insomnia worse, especially if you take them regularly.

Ask your pharmacist for advice if you are worried about the side effects of your medicines.

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 help you feel calm)
• to make you feel sleepy
• to reset your internal body clock

Melatonin is taken as a pill — there are different options your doctor can prescribe, based on the reason for your insomnia. The best time to take melatonin is 1 to 2 hours before you go to bed. You should not take melatonin before you drive or operate machinery, as it can make you sleepy. Melatonin is generally recommended for people over the age of 55 years. It should only be used for a 3 week period, and then reviewed by your doctor.

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 and about the effects of taking them for a long time.

It is important to talk to your doctor before you take any sleeping aid, including any over-the-counter or herbal remedies, as they may interact with your other medicines. Always 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 medicines, including over-the-counter sleeping aids.

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Other treatments

• Light therapy: uses bright light exposure and darkness to reset your internal body clock and improve sleep.
• Sleep restriction: this method reduces your time spent in bed, causing sleep deprivation. Once your sleep improves, you can gradually go back to sleeping normal hours.

What are the complications of insomnia?

Insomnia causes a range of problems that can occur during the day. It can be difficult to function normally. They include:

• poor concentration and short attention span
• making mistakes or forgetting things
• anxiety or depression (these issues can also cause insomnia)
• tension headaches

Insomnia that remains untreated can increase your risk of developing mental health conditions. It also increases your risk of cardiovascular and metabolic problems.

Being overtired can increase your risk of making mistakes or having an accident. Severe sleep deprivation can affect your ability to drive as much as alcohol.

Some medicines for insomnia can also cause complications, for example, increasing your risk of falls.

Can insomnia be prevented?

Insomnia can often be prevented by maintaining healthy habits and good sleep hygiene. To get a good night’s sleep try these:

• Go to bed and wake up at the same time every day — even on weekends.
• Exercise regularly, ideally every day.
• Avoid heavy meals and spicy foods around bedtime.
• Make your bedroom dark, cool and comfortable — remove any distractions.
• Avoid looking at screens, bright or blue light before going to bed — blue light reduces melatonin release and may disrupt sleep.

Some people find that having a warm drink or taking a warm bath before bed is soothing and improves their sleep quality.

Resources and support

• MindSpot’s Sleep Course is a free, therapist-assisted online program designed to help you improve your sleep.
• The Sleep Health Foundation provides information about insomnia and links to online resources and programs to assist you.
• Visit the Australian Psychological Society for more information on treatment options for insomnia.
• Access THIS WAY UP’s free online program to learn practical strategies to help deal with ongoing insomnia, based on CBT.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available 24 hours a day, 7 days a week.

Languages other than English

• The Health Resource Directory provides sleep hygiene information, as well as advice on good sleep habits in many community languages.