Insomnia is a common disorder that affects millions of people worldwide: it’s estimated that around a third of people in the UK will suffer insomnia at some point in their lives. Problems with sleeping can be caused by a number of issues, and for some people, insomnia is a chronic, long-term issue.

Read on to find out more about insomnia – and remember that you can connect to a network and community of carers and other people who are living with the condition by joining Carecircle.

What is insomnia?

Insomnia is defined as difficulty in falling or staying asleep. You might find yourself struggling to fall asleep in the evening, spending long periods awake in the middle of the night, or consistently waking up too early in the morning and struggling to fall asleep again.

Older people are more likely to suffer from insomnia, and it is also more common in women than in men.

Types of insomnia

Broadly, insomnia is classified into primary insomnia, where the insomnia itself is the main disorder, and secondary insomnia, which can be a side effect of medicines or the result of other health conditions. Beyond that, there are several different categories:

Acute insomnia

Also known as short-term insomnia, this is where the bout of sleeplessness lasts for less than three months.

Chronic insomnia

Also known as long-term insomnia, this is when insomnia carries on for more than three months, and is often the result of another health condition.

Sleep onset insomnia

This is where you find it difficult to get to sleep at night.

Sleep maintenance insomnia

This is when you find yourself waking up during the night, or too early in the morning.

Behavioural insomnia of childhood

This is the term for when children find it hard to get to sleep or refuse to go to bed, usually because of a negative association with sleep.

Stages of sleep deprivation

Most people with insomnia will experience partial sleep deprivation, where they sleep for less than the recommended 7–9 hours (for an adult) every night. The effects of this can build up over time, causing a ‘sleep debt’. You may find yourself becoming chronically fatigued and operating at a lower level of efficiency, and you may even involuntarily succumb to ‘microsleeps’, where you nod off for a few seconds at a time.

Total sleep deprivation is where you cannot sleep at all, and there are four stages to this:

Stage 1

No sleep for 24 hours. This results in lowered levels of alertness, similar to being over the drink-driving limit. You might experience problems with short-term memory, and become more easily irritated and stressed. Your reaction times and ability to concentrate are reduced.

Stage 2

No sleep for 48 hours. The symptoms of stage 1 intensify, and you are likely to start succumbing to microsleeps.

Stage 3

No sleep for 72 hours. The symptoms intensify further, and you may start to experience delusions and feelings of paranoia.

Stage 4

No sleep for 96 hours. In addition to intensifying symptoms, you may start to experience vivid hallucinations.

What are the symptoms of insomnia?

The typical symptoms of insomnia include:

• Struggling to fall asleep at night
• Waking up one or several times during the night
• Waking up early and being unable to fall back asleep
• Being unable to nap during the day even when tired
• Feeling tired after waking up
• Feeling irritable and tired throughout the day
• Finding it difficult to concentrate because of tiredness

What causes insomnia?

There can be a wide range of causes for insomnia, but some of the most common are:

• Stress, depression or anxiety
• Jet lag or switching to night shifts
• Temperature: where the bedroom is too hot or cold
• Too much noise
• Use of drugs or alcohol, as well as nicotine and caffeine
• An uncomfortable bed
• Health conditions such as chronic pain, chronic obstructive pulmonary disease or restless legs syndrome

How do you diagnose insomnia?

Usually insomnia is easy to self-diagnose if you find yourself regularly waking up in the night or finding it difficult to fall asleep. You can also do a self-assessment test to work out your ‘sleep score’.

If your insomnia is caused by underlying health problems such as depression or chronic pain, you should speak to your doctor. You should also speak to your doctor if the insomnia continues for a long period, even after you have made changes to improve your sleeping habits.

Insomnia treatment

A few simple lifestyle changes can usually help to treat insomnia, such as:

• Exercising regularly during the day
• Going to bed at the same time daily
• Making sure to relax for at least an hour before bed by, for example, having a bath or reading a book
• Improving your mattress or pillows to make your bed more comfortable
• Keeping your bedroom cool, dark and free of noise
• Avoiding stimulants like caffeine and alcohol in the hours leading up to bedtime

Remember that it’s important to seek support, especially if your insomnia results from mental health problems such as depression or anxiety; you can join Carecircle to meet other people who are going through similar experiences. Your doctor may also refer you to a therapist for cognitive behavioural therapy (CBT) if your insomnia is caused by persistent thoughts that prevent you from sleeping.

Natural sleeping remedies

If your insomnia doesn’t improve after trying the changes above, you might want to consider a natural sleeping remedy. These include lavender, chamomile, valerian and passionflower, and can be found in a number of products including teas and pillow sprays.

Over-the-counter sleeping pills

Sleeping pills should only ever be used as a last resort if other treatments haven’t worked, and even then, they should only be used for a short period. Some of them contain valerian root, while others use the hormone melatonin. Many of them contain a sedating antihistamine, such as diphenhydramine.

Living with insomnia

Insomnia can be debilitating, making it difficult to cope with everyday activities as you struggle with extreme tiredness. Often you can fall into a vicious circle, getting frustrated with yourself for not being able to sleep, which in turn raises your anxiety levels and makes it even harder to fall asleep. Meditation and other mindfulness activities can help to ease your anxieties, and it may be reassuring to know that millions of other people are experiencing the same issues. Seek support wherever you can.

Insomnia FAQs

Below are a few answers to some of the most commonly asked questions about insomnia.

Why can’t I sleep?

Often, difficulty in sleeping is transient and caused by things such as jet lag, caffeine or simply too much noise. But sometimes it can be the result of stress, anxiety or depression, and persistent thoughts that prevent sleep or that wake you up in the middle of the night.

What to do when you can’t sleep?

The first thing to do is to control your environment: make sure your bedroom is dark, not too hot or cold, and that you have a comfortable pillow and mattress. If you’re plagued by persistent thoughts, try meditating. You can also picture a comforting scene in your mind and control your breathing, taking regular, deep breaths to help you relax. The key thing is to be kind to yourself – getting annoyed will only make it harder to sleep.

Why do I keep waking up at night?

Stress is the most common reason why people wake up in the middle of the night. In addition, the body’s circadian rhythm tends to change as you grow older, so people in middle age tend to have a shortened sleep duration and wake more often in the night. Hormones can play a part, too, and women may experience wakefulness during pregnancy and menopause. In addition, insomnia could be a side effect of prescription medicines, or result from drugs such as nicotine or alcohol.

Insomnia resources

Below are a few links to websites that can provide information about insomnia:

• NHS: Insomnia
• The Sleep Charity
• The National Sleep Foundation

We hope that this guide has been useful if you or someone close to you is suffering insomnia; if you’re concerned about any of the issues raised in this article, make sure to speak with your doctor. And remember that there’s a whole community out there on Carecircle who can provide support.

Guide sources

• NHS: Insomnia
• Medical News Today: What is insomnia? Everything you need to know
• Roth T. Insomnia: definition, prevalence, etiology, and consequences. J. Clin. Sleep Med. 3(5 Suppl), S7–S10 (2007)
• Johns Hopkins Medicine: Insomnia
• Momin, R.R. & Ketvertis, K. Short Term Insomnia
• Office on Women’s Health: Insomnia
• Stanford Health Care: Types of insomnia
• American Sleep Association
• The Guardian: How I cope with insomnia