When sleep stops coming easily
Insomnia means trouble falling asleep, staying asleep or getting good-quality sleep, even when you have the time and a decent place to sleep.1 It is common. It affects women more often than men, and older adults more often than younger ones.6
Short spells usually follow stress or a change in routine and can last days or weeks.2 Insomnia is called chronic when it happens 3 or more nights a week for more than 3 months.3 By day it can bring sleepiness, low energy and irritability, and it can make you drowsy at the wheel.9
How insomnia can keep itself going
An illustration of a common pattern, based on the NHLBI description of causes and of stimulus control. It is not a diagnosis.
A trigger
Stress or a change in routine disturbs sleep for a few nights.2
Worry about sleep
Clock-watching and worrying about sleep make it worse.7
Bed becomes a place to be awake
Lying awake teaches you to link bed with being awake. Stimulus control reverses this.20
Daytime catch-up
Long naps, caffeine and screens late in the day push sleep further away.8
Why it hangs on
Insomnia often keeps itself going. Worrying about whether you will sleep, and watching the clock, can make it worse.7 Long daytime naps, little activity, caffeine, alcohol and screens late in the evening all add to the risk.8
Most chronic insomnia is secondary: a symptom or side effect of another problem, such as a medical condition, a medicine or another sleep disorder.5 Some cold and allergy products disrupt sleep, and so can some prescriptions for other conditions.29
The first treatment is a therapy
Cognitive behavioral therapy for insomnia, CBT-I, is a 6- to 8-week plan to help you fall asleep faster and stay asleep longer. NHLBI says it is usually recommended as the first treatment option for long-term insomnia and can be very effective.16 NCCIH calls it the most strongly recommended treatment.21
It can be done by a doctor, nurse or therapist, in person, by phone or online.17 The parts that feel strangest are often the ones that matter most: a set amount of time in bed, and getting up when you can't sleep.1920
What CBT-I involves
| Part | What it does | What it asks of you |
|---|---|---|
| Cognitive therapy | Helps you feel less nervous about not being able to sleep.18 | Noticing and questioning worried thoughts about sleep. |
| Relaxation training | Teaches you how to relax and fall asleep faster.18 | Practicing a relaxation method, often at bedtime. |
| Sleep education | Helps you learn good sleep habits.18 | A regular schedule, and caffeine and screens moved earlier.2325 |
| Sleep restriction | Sets a specific amount of time in bed; with time, sleep improves.19 | Keeping to the time in bed your therapist sets. |
| Stimulus control | Links being in bed with being asleep.20 | Bed only when sleepy; out of bed if you can't sleep.20 |
CBT-I usually takes 6 to 8 weeks and can be done in person, by phone or online.1617
Habits that help, and how much sleep is enough
Adults need 7 to 9 hours a day, and older adults need about the same.1012
Recommended hours of sleep a day, by age
General recommendations, not results measured in you, and not a description of a ProperHealth or Clarkson service.
- Same time, every day. Sleep and wake around the same time, weekends included,23 keeping any difference to about an hour.24
- Caffeine earlier. Its effects can last up to 8 hours.25
- Alcohol has a cost. It can help you fall asleep but makes sleep lighter.26
- Move during the day, at least 5 to 6 hours before bed.27
- A quiet last hour, away from bright screens.28
- Up after 20 minutes. If you can't fall asleep, get up and do something relaxing.22
The sleep-aid shelf
Over-the-counter sleep aids usually rely on antihistamines. They can make you sleepy, but they can be unsafe for some people, so talk to your doctor before using them for insomnia.30 Diphenhydramine generally should not be used in older adults.31
Research has not proven melatonin to be an effective treatment for insomnia.32 It may help with jet lag or shift work, but two clinical guidelines recommended against it for chronic insomnia.33 Kava has been linked to serious liver injury, and valerian's value for insomnia has not been demonstrated.36
What the evidence says about common sleep options
Recommended first
Use only with advice
Prescription sleep medicines may help in the short term, but they carry risks and should not be used long term.35
A historical perspective: Dr. Majid Ali
“Bedtime technology for me? No, thank you.”
— Dr. Majid Ali, 26 December 2014
Dr. Ali treated sleep as something to protect rather than medicate, and he was wary of technology in the bedroom. Today's advice is close: make the hour before bed quiet time, away from bright screens.28
Some of his sleep records also contain remedy protocols and oxidant-therapy material. The sources used here do not support those, and nothing here recommends a remedy for insomnia.
What to do this week
Set one wake-up time for every day
Weekends included, with no more than about an hour's difference.24 This is part of good sleep habits.
Get up after about 20 minutes awake
Do something relaxing, then go back to bed when sleepy.22
Move caffeine and screens earlier
Caffeine can last up to 8 hours.25 Make the hour before bed quiet time.28
Keep a sleep diary for 1 to 2 weeks
Bedtimes, wake times, naps, caffeine, alcohol and exercise.13 Take it to your appointment.
Ask about CBT-I by name
It is usually the first treatment recommended for long-term insomnia, and it can be done online.1617
When to get help now
Each warning sign cites the official guidance behind it. The wording still needs pharmacist sign-off.
- Thoughts of harming yourself, or feeling you would be better off gone — call or text 988 (Suicide & Crisis Lifeline, US) now. If you are in immediate danger, call 911.40
- Falling asleep while driving, at work or mid-conversation — do not drive while drowsy, and talk to your provider.4142
- Loud snoring with pauses in breathing, or waking up gasping or choking — ask for a sleep assessment.43
- Sleepwalking, eating or driving while asleep on a sleep medicine — do not take the next dose until you have spoken to your prescriber.4445
- Confusion or a fall in an older adult using a sleep aid — tell the doctor right away.4647
- Insomnia with low mood, loss of interest or hopelessness — book an appointment; this is treatable.4849
Every numbered marker links to the exact passage it rests on. Check the sources.