Information for People with Insomnia
While the CSRU conducts clinical research, it is not a clinical facility and does not treat patients. We cannot, therefore, discuss individual sleep problems. Below we provide answers to the questions we are most frequently asked about getting help for insomnia. Please keep in mind that these answers have been prepared for people living in the UK. Further advice and information on insomnia is also available from the NHS Choices website. If you live in the US or Australia, information on insomnia (and clinicians who treat insomnia) is available from the American Academy of Sleep Medicine website and from the Australasian Sleep Association website.
Insomnia is a sleep disorder characterised by problems getting to sleep, or problems staying asleep, or feelings that your sleep is inadequate or ‘unrefreshing’ - despite adequate opportunities to obtain sleep. These symptoms then ‘spill over’ into the day causing problems with social interactions, work or family performance, and general daytime functioning. Typically, people with insomnia feel fatigued (listless, lethargic, lacking energy, under motivated) and inadequately rested for the day ahead. However, many people with insomnia do not feel ‘sleepy’ (that is, they do not feel that they would fall asleep if given the opportunity during the day). Brief periods of disturbed sleep are not uncommon in modern life. However, for insomnia to be diagnosed, the symptoms must persist continuously for a month or more.
From time to time we advertise for volunteers to help in our research programmes. If you are responding to such an announcement, please follow the instructions which accompanied the advertisement. However, participating in research studies is not a substitute for seeking, or taking, appropriate professional advice. If you have a sleep problem, you may find some of the advice below helpful.
If you feel that your complaint matches the description of insomnia (above), then consider seeing you general practitioner (GP) to discuss your sleep. Make it easier for your doctor to help you by being specific about your symptoms and your problem. Explain whether you have problems getting to sleep or staying asleep, describe the daytime impact of this problem (do you experience fatigue during the day?). Try to pin-point what you really want from both your sleep (for example, greater predictability, resources to deal with episodes of sleeplessness, etc.) and your doctor (sleeping tablets? Reassurance? an explanation?). You may have a health problem that is causing or aggravating your sleep difficulties; your doctor is the best person to assess this. If sleeping tablets are offered, ask your doctor how long these can be prescribed for, and what you do if your sleep problem persists beyond this period. We would also suggest that you obtain information about sleep and insomnia from the many books on this subject available in high-street or online book shops. And finally, you should look at your sleeping habits and consider opportunities to improve your ‘sleep hygiene’.
Sleep hygiene simply means living your life in a way that safeguards your sleep. In practice, this means doing those things which promote sleep (like keeping regular bedtimes and maintaining a regular night time routine), and avoiding those things which antagonise sleep (like caffeine consumed too close to bedtime, or exercise taken too late in the evening). A complete list of recommended “dos” and “don’ts” can be found in some of the better self-help books. Improvements in sleep hygiene provide a very useful ‘first step’ when dealing with insomnia and can be particularly helpful when combined with psychological (see below) or pharmacological treatments. A summary of sleep hygiene instructions, together with a useful 'Daily Sleep Diary' for monitoring your own sleep, are available here.
Most types of insomnia benefit from cognitive behavioural therapy (or 'CBT'). There is, however, a shortage of trained CBT 'insomnia therapists' in the UK, though CBT (as a generic therapeutic skill) is widely available in the NHS. Our advice is that you consult your GP again, explain your reluctance to consume sleeping tablets, and ask for a referral to a clinical psychologist. Most NHS clinical psychologists will be able to use CBT strategies for sleep and insomnia management (though they don't always know that CBT can be used in this way). Alternatively, you can use the British Psychological Society website www.BPS.org.uk to find a fully qualified local private practitioner skilled in the use of CBT. (On the BPS homepage there's a 'find a psychologist' button; enter your postcode for psychologists offering services in your area). We advise you to ring the psychologist first and satisfy yourself that they can offer/have experience with cognitive behaviour therapy for insomnia.
Sleeping tablets prescribed by your doctor are intended only for short-term use (say 3-4 weeks). They are not intended for the long-term treatment of chronic insomnia. After several weeks of continuous use many patients develop some degree of ‘tolerance’ to their sleep medication, which means that the drugs become progressively less effective. Unfortunately, if we abruptly discontinue drugs to which we have developed a tolerance, we may experience ‘withdrawal effects’ – unpleasant symptoms while the body adjusts. Ironically, the abrupt discontinuation of sleeping tablets can result in a special type of insomnia called ‘rebound insomnia’, typically one or more nights of very disturbed sleep. If you have been taking sleeping tablets for months or years, consult your doctor before attempting to discontinue use. If you have been taking sleeping tablets for more than 4 weeks and your sleep is still unsatisfactory, cognitive behavioural therapy (CBT – see question above) can help you to both sleep better and discontinue your tablets.
Probably not. The amount of sleep a person needs is influenced by several factors, including age. As adults get older, their sleep tends to become shorter, lighter and more fragmented. As with most aspects of adult ageing, these changes are slow, but universal. So the amount of sleep we get will depend, among other things, on how old we are. That said, people of similar ages can also show remarkable differences in the amount of sleep they appear to need. Simply put, some people need more sleep than others. Given this, it would be unreasonable to suggest that all adults need the same (or even a similar) amounts of sleep each night. In population surveys where thousands of people report their ‘typical’ sleep durations, the average duration of sleep for adults is, in fact, around 7 hours. But remember, this is is an average not a rule.
If the sleep you obtain allows you to awake feeling reasonably refreshed, to function efficiently the next day, and to conduct your affairs without experiencing intrusive episodes of fatigue, then you are probably getting enough sleep.
Yes. We would recommend two books written for the general reader which are educational, clinically helpful and modestly priced. Both of these books have been written by clinical and scientific experts in sleep.
- Overcoming insomnia and sleep problems (a self-help guide using Cognitive Behavioral Techniques). Colin A Espie. Robinson, 2006.
- Relief from Insomnia: Getting the Sleep of Your Dreams. Charles M Morin. Main Street Books, 1996.