Insomnia

Distinguish difficulty sleeping from too little opportunity

Difficulty falling asleep, repeated waking or waking too early deserves assessment when it causes distress or affects daytime functioning. Work or caring duties that leave too little time for sleep differ from being unable to sleep despite the opportunity. Pain, mood, medicines and other sleep problems may also contribute.

Understand what keeps the cycle going

Stress may start the problem; long periods awake in bed, clock checking and worry about the next day can then maintain it. This is not a failure of discipline. A record of sleep timing, daytime sleepiness and medicines may be more useful for discussion than concentrating on a wearable’s deep-sleep estimate.

Look beyond a bedtime checklist

Cognitive behavioural therapy for insomnia (CBT-I) addresses sleep-related behaviours and worries through several components and is an important treatment for chronic insomnia. Adjustments to time in bed need to account for safety and circumstances. Understanding the idea does not mean imposing sleep deprivation on yourself or expecting an earlier bedtime to solve every case.

Judge progress in everyday life

Progress includes daytime alertness, reduced distress and any treatment adverse effects, not just minutes asleep. Review prescribed and nonprescription sleep products together. Marked daytime sleepiness, gasping during sleep or mood changes call for reassessment of possible coexisting problems.

Questions for your clinician

• Do I have enough opportunity for sleep, and what else needs assessment?
• Where can I access suitable CBT-I?
• Which daytime and night-time changes will show whether treatment is helping?

Explore the underlying science

• 51 · Sleep stages and regulation
• 52 · Circadian rhythms and daily function
• 54 · Insomnia and the evidence for interventions
• 56 · Light, shift work, jet lag and sleep

Sources

• NHLBI: Insomnia diagnosis
• NHLBI: Insomnia causes
• NHLBI: Insomnia treatment