🕷️ Crawler Inspector

URL Lookup

Direct Parameter Lookup

Raw Queries and Responses

1. Shard Calculation

Query:

Response:

Calculated Shard: 142 (from laksa097)

2. Crawled Status Check

Query:

curl -X POST \
  'http://laksa142.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://patient.info/mental-health/insomnia-poor-sleep\')), getAhrefsUnparsedNoserviceFromURL(\'https://patient.info/mental-health/insomnia-poor-sleep\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/patient.info\/mental-health\/insomnia-poor-sleep","crawl_time":1776455762,"first_indexed_time":1552307668,"http_code":200,"src_unparsed":"info,patient!\/mental-health\/insomnia-poor-sleep s443","src_root_hash":"3361025486351115142","history_drop_reason":null,"meta_title":"Insomnia (Poor Sleep): Causes, Types, and Treatment","meta_descriptions":["As many as one in three people can have insomnia or some difficulty with sleeping. However, there are many things you can do to help yourself. Written by a GP."],"attrs_boilerpipe_text":"What is insomnia?\nInsomnia means poor sleep. About one third of adults do not get as much sleep as they would like. Poor sleep can mean:\nNot being able to get off to sleep.\nWaking up too early.\nWaking for long periods in the night.\nNot feeling refreshed after a night's sleep.\nIf you have poor sleep, particularly over a long period of time, it can severely affect your life, as it can cause:\nTiredness (fatigue)\nand loss of energy in the daytime.\nPoor concentration.\nLoss of interest in usual activities.\nIrritability.\nDepression\nand\nanxiety\n.\nInability to do things as well or as much as usual - for example, work, social activities, exercise. Errors might occur at work or whilst driving, which could have serious consequences.\nA worse quality of life.\nDifferent people need different amounts of sleep. Children need more sleep than adults. For adults, the minimum we need is about 6 hours per night. On average, most adults need between 6 and 9 hours of sleep to feel refreshed.\nMost people establish a pattern that is normal for them in their early adult life. However, as you become older, it is normal to sleep less. For most people it takes less than thirty minutes to fall asleep.\nSo, everyone is different. What is important is that the amount of sleep that you get should be sufficient for you, and that you usually feel refreshed and not sleepy during the daytime. Therefore, the strict medical definition of insomnia is: 'Difficulty in getting to sleep, difficulty staying asleep, early wakening, or non-restorative sleep despite adequate time and opportunity to sleep, resulting in impaired daytime functioning, such as poor concentration, mood disturbance, and daytime tiredness.'\nFurther ways to promote sleep in more difficult cases include relaxation techniques, regular exercise and certain psychological therapies.\nSleeping tablets are not the best way to help with sleep problems because they don't fix the cause of insomnia, you can get addicted to them, and they often stop working if you take them regularly.\nA normal night's sleep has three main parts:\nQuiet sleep.\nThis is divided into stages 1-4. Each stage becomes more deep. Quiet sleep is sometimes called deep sleep.\nRapid eye movement (REM) sleep.\nREM sleep occurs when the brain is very active but the body is limp, apart from the eyes which move rapidly. Most dreaming occurs during REM sleep.\nShort periods of waking for 1-2 minutes.\nEach night, about 4-5 periods of quiet sleep alternate with 4-5 periods of REM sleep. In addition, several short periods of waking for 1-2 minutes occur about every two hours or so, but occur more frequently towards the end of the night's sleep. The graph below shows a typical normal pattern of sleep in a young adult.\nHypnogram\nNormally, you do not remember the times that you wake if they last less than two minutes. If you are distracted during the wakeful times (for example, a partner snoring, traffic noise, etc) then the wakeful times tend to last longer and you are more likely to remember them.\nPoor sleep may develop for no apparent reason. However, there are a number of possible causes which include the following:\nConcern about wakefulness\nYou may remember the normal times of being awake in the night. You may feel that to wake in the night is not normal, and worry about getting back off to sleep. You may clock-watch and check the time each time you wake up.\nThis may make you irritated or anxious, and you are more likely to remember the times of wakefulness. You may then have an impression of having a bad night's sleep, even when the total amount of time asleep was normal.\nTemporary problems\nPoor sleep is often temporary. This may be because of stress, a work or family problem, jet lag, a change of routine, a new baby, a strange bed, etc. Poor sleep in these situations usually improves in time.\nStress, anxiety or depression\nYou may find it difficult to switch off your\nanxieties\nabout work, home or personal problems. Also, poor sleep is sometimes due to\ndepression\n. Other symptoms of depression include a low mood, lethargy, poor concentration, tearfulness and persistent negative thoughts. Depression is common. Treatment of depression or anxiety often cures the poor sleep too.\nSleep apnoea\nThis sometimes occurs in people who snore, most commonly in obese people. In this condition the large airways narrow or collapse as you fall asleep. This not only causes snoring but also reduces the amount of oxygen that gets to the lungs.\nThis causes you to wake up to breathe properly. You may wake up many times each night which may result in daytime tiredness.\nSee the separate leaflet called Sleep apnoea\n.\nNote\n: most people who snore do not have sleep apnoea and they do sleep well.\nOther illnesses\nVarious illnesses keep some people awake. For example, illness causing pain,\nleg cramps\n, breathlessness,\nindigestion\n,\ncough\n, itch, hot flushes, mental health problems, etc.\nStimulants\nThese can interfere with sleep. There are three common culprits.\nAlcohol\n- many people take an alcoholic drink to help sleep. Alcohol does help you get to sleep quicker, but then causes broken, poor-quality sleep and early morning wakefulness.\nCaffeine\n- which is in tea, coffee, some soft drinks such as cola, and even chocolate. It is also in some painkiller tablets and other medicines (check the ingredients on the medicine packet). Caffeine is a stimulant and may cause poor sleep.\nNicotine\n(from\nsmoking\n) is a stimulant, so it would help not to smoke.\nOther recreational drugs\nOther recreational drugs\n(for example, ecstasy, cocaine, cannabis and amphetamines) can affect sleep.\nPrescribed medicines\nSome medicines sometimes interfere with sleep. For example, 'water tablets' (diuretics), some antidepressants,\nsteroids\n,\nbeta-blockers\n, painkillers containing caffeine, and some cold remedies containing pseudoephedrine. Also, if you suddenly stop taking regular sleeping tablets or other sedative medicines, this can cause rebound poor sleep.\nScreen time\nThere is some evidence that the time we spend looking at electronic screens can affect our sleep. It may be that certain types of light from e-readers and electronic tablets can disrupt control of our natural day-and-night cycle.\nThere are studies which suggest we may sleep better after reading a printed book or a particular kind of screen before bedtime. There are also some studies which show that in children and adolescents, more time using electronic devices in the daytime is linked to less good sleep at night. It's best to avoid using screens within an hour or two of bed. Try to keep devices like phones and laptops out of reach of the bed, or, ideally, outside the bedroom entirely.\nUnrealistic expectations\nSome people just need less sleep than others. If your sleep pattern has not changed, and you do not feel sleepy during the day, you are probably getting enough sleep. Older people and people who do little exercise tend to need less sleep. Some people think they should be able to nap during the day - and sleep eight hours at night!\nA vicious cycle\nWhatever the initial cause, worry about poor sleep and worry about feeling tired the next day are common reasons for the problem to become worse.\nSleep paralysis\nSome people may also experience waking from sleep but then being unable to move or speak for a period of time. Some people experience the same problems when they are falling asleep.\nSee the separate leaflet called Sleep paralysis\n.\nThere are different definitions and classifications of poor sleep (insomnia) around, which can make things confusing. Doctors may classify insomnia into one of the following categories:\nBy type\nPrimary insomnia is insomnia that occurs when no illness or other secondary cause (comorbidity) is identified. Primary insomnia accounts for about one in five cases of long-term insomnia.\nSecondary (or comorbid) insomnia occurs when insomnia is a symptom of, or is associated with, other conditions. These can be medical or mental health conditions, or drug or substance misuse (as discussed above).\nBy duration\nShort-term if insomnia lasts days to weeks, and up to three months.\nLong-term (or persistent) if insomnia lasts for three months or longer.\nBy a combination of factors\nSome authorities use the term 'chronic insomnia disorder'. To have this diagnosis, you would:\nHave problems sleeping for at least three nights a week for at least three months.\nBe distressed or have problems functioning due to your sleeping problem.\nNot have another condition which could affect sleep, ie mental or physical illnesses or another sleep disorder.\nAvoid caffeine, smoking and alcohol, especially in the hours before bedtime.\nAvoid heavy meals or strenuous exercise shortly before going to bed.\nGo to bed and get up at the same time each day.\nRegular daytime exercise helps you feel more relaxed and tired at bedtime.\nThis section will discuss five topics which can help to promote better sleep:\nUnderstanding some facts.\nSleep hygiene.\nRelaxation techniques.\nDaytime exercise.\nPsychological treatments called cognitive and behavioural therapies.\nIn effect, these can be used in a step-wise fashion. You need only go on to the next step if the previous step is not very helpful, but each step requires a greater degree of effort.\nUnderstanding some facts\nIt is often helpful to understand that short periods of waking each night are normal. Some people are reassured about this and so do not become anxious when they find themselves awake in the night.\nAlso, remember that worry about poor sleep can itself make things worse. Also, it is common to have a few bad nights if you have a period of stress, anxiety or worry. This is often just for a short time and a normal sleep pattern often resumes after a few days.\nGeneral tips for sleeping better (often called sleep hygiene)\nThe following are commonly advised to help promote sleep in people with sleep difficulties, and may be all that is necessary:\nReduce caffeine\n- do not have any food, medicines, or drinks that contain caffeine or other stimulants for six hours before bedtime (see above). Some people have found that cutting out caffeine completely through the day has helped.\nDo not smoke\nwithin six hours before bedtime.\nDo not drink alcohol\nwithin six hours before bedtime.\nDo not have a heavy meal\njust before bedtime (although a light snack may be helpful).\nDo not do any strenuous exercise within four hours of bedtime\n(but exercising earlier in the day is helpful).\nBody rhythms\n- try to get into a routine of wakefulness during the day and sleepiness at night. The body becomes used to rhythms or routines. If you keep to a pattern, you are more likely to sleep well. Therefore:\nNo matter how tired you are, do not sleep or nap during the day.\nIt is best to go to bed only when sleepy-tired in the late evening.\nSwitch the light out as soon as you get into bed.\nAlways get up at the same time each day, seven days a week, however short the time asleep. Use an alarm to help with this. Resist the temptation to lie in - even after a poor night's sleep. Do not use weekends to catch up on sleep, as this may upset the natural body rhythm that you have got used to in the week.\nThe bedroom\nshould be a quiet, relaxing place to sleep:\nIt should not be too hot, cold, or noisy.\nEarplugs and eye shades may be useful if you are sleeping with a snoring or wakeful partner.\nMake sure the bedroom is dark with good curtains to stop early morning sunlight.\nDon't use the bedroom for activities such as work, eating or television.\nConsider changing your bed if it is old, or not comfortable.\nHide your alarm clock under your bed. Many people will clock-watch and this does not help you to get off to sleep.\nMood and atmosphere\n- try to relax and wind down with a routine before going to bed. For example:\nA stroll followed by a bath, some reading, and a warm drink (without caffeine) may be relaxing in the late evening.\nDo not do anything mentally demanding within 90 minutes of going to bed - such as studying.\nGo to bed when sleepy-tired.\nSome people find playing soft music is helpful at bedtime. Try a player with a time switch that turns the music off after about 30 minutes.\nIf you cannot get off to sleep after 20-30 minutes\n- then get up. It's best not to just lie in bed, worrying about getting to sleep. Get up and do something you find relaxing until you feel sleepy, and then go back to bed.\nRelaxation techniques\nThese aim to reduce your mental and physical arousal before going to bed. Relaxation techniques may help even if you are not anxious but find it hard to get off to sleep. There are a number of techniques.\nFor example, progressive muscular relaxation has been shown to help promote sleep. This technique consists of tensing and relaxing various muscle groups in sequence. For more information, see the leaflet called\nRelaxation exercises.\nYou can find a podcast or app that takes you through deep-breathing exercises, and other methods to help you relax. See Further Reading below.\nDaytime exercise\nRegular daytime exercise can help you to feel more relaxed and tired at bedtime. This may help you to sleep better. (However, you should not do exercise near to bedtime if you have insomnia.) If possible, do some exercise on most days.\nEven a walk in the afternoon or early evening is better than nothing. However, ideally, you should aim for at least 30 minutes of moderate exercise on five or more days a week.\nModerate exercise means that you get warm and slightly out of breath. You do not need to go to a gym! Brisk walking, jogging, cycling, climbing stairs, heavy DIY, heavy gardening, dancing and heavy housework are all moderate-intensity physical exercises.\nSee the separate leaflet called Exercise and physical activity\n.\nBehavioural and cognitive therapies\nIf you have severe persistent poor sleep, your doctor may refer you to a psychologist or other health professional for psychological treatments. These are various therapies which help re-train your brain and the way you feel, think or behave.\nResearch studies have found that there is a good chance that behavioural and cognitive therapies will improve sleep in adults with insomnia. Increasingly, research has also shown that some of these therapies can be delivered digitally (ie through an app, online, etc).\nThere are various types of therapy and they include the following:\nStimulus-control therapy\n. This helps you to re-associate the bed and bedroom with sleep and to re-establish a consistent sleep\/wake pattern.\nSleep restriction therapy\n. Very briefly, the principle of this treatment is that you limit the time that you spend in bed at night. As things improve, the time in bed is then lengthened. An example of the way that this may be done in practice is as follows:\nFirst, you may be asked to find out how much you are actually sleeping each night. You can do this by keeping a\nsleep diary\n.\nYou may then be advised to restrict the amount of time that you spend in bed to the time that you actually sleep each night. For example, if you spend eight hours in bed each night but you sleep for only six hours then your allowed time in bed would be six hours. So, in this example, say you normally go to bed at 11 pm, get to sleep at 1 am and get up at 7 am. To restrict your time in bed to six hours, you may be advised to go to bed at 1 am but still get up at 7 am.\nYou then make weekly adjustments to the allowed time in bed, depending on the time spent asleep. (You need to keep on with the sleep diary.)\nWhen 90% of the time spent in bed is spent asleep then the allowed time spent in bed is increased by 15 minutes, by going to bed 15 minutes earlier. In the above example, you would then go to bed at 12.45 am.\nAdjustments are made each week until you are sleeping for a longer length most nights.\nRelaxation training\n. This teaches you ways of reducing tension. For example, this may include the progressive muscle relaxation technique as described earlier, plus various other techniques described earlier.\nParadoxical intention\n. This involves staying passively awake, avoiding any intention to fall asleep. It is used for people who have trouble getting to sleep (but not maintaining sleep).\nBiofeedback\n. With this technique, you are connected to electrical sensors which give you feedback by sounds and lights to show you what your body is doing. This is to help you control certain body functions (such as muscle tension).\nCognitive therapy\n. Cognitive therapy is often used in combination with a behavioural intervention (such as stimulus control, sleep restriction, or relaxation training); this is then called\ncognitive behavioural therapy (CBT)\n.\nSee the separate article CBT for insomnia: how does it work?\nfor more details.\nAccessing sleep-focused therapy\nThere are various different ways to access sleep-focused therapy. What's available on the NHS varies a little depending on where you are.\nYour GP may be able to refer you for sessions led by a psychotherapist or psychologist. These can be individual or group sessions, and may be in-person, over the phone, or via video call.\nThere are also online courses and apps. Sleepio is one example of an app that uses cognitive behavioural therapy for insomnia (CBT-I). Sleepio was recommended for use by the UK's National Institute for Health and Care Excellence (NICE) in 2022. In some areas of the UK it's available free on the NHS; in other places you may need to pay a subscription.\nOther resources include:\nSleepstation (also available free on the NHS in some areas).\nCalm, a meditation app (free trial, then paid).\nHeadspace, a guided meditation app (free trial, then paid).\nPzizz, an app that aims to help you relax and fall asleep quicker (free download, with in-app purchases and subscription).\nSee the separate article How to improve your sleep behaviour\nfor more details.\nSleeping tablets are not usually advised for insomnia\nThe main types of\nsleeping tablets\nare in a class of medicines called benzodiazepines and a class called Z drugs.\nTo read more about why these medicines may be prescribed, see the separate leaflet called Benzodiazepines and Z drugs\n.\nIn the past, sleeping tablets were commonly prescribed. However, they have been shown to have problems and are now not commonly prescribed.\nIf a sleeping tablet is prescribed, it is usually just a short course (a week or so) to get over a particularly bad patch.\nPossible problems with sleeping tablets include:\nDrowsiness the next day. You may not be safe to drive or to operate machinery.\nClumsiness and confusion in the night if you have to get up. For example, if you have had a sleeping tablet, you may fall over if you get up in the night to go to the toilet. (Older people who take sleeping tablets have an increased risk of falling and breaking their hip.)\nTolerance to sleeping tablets may develop if you take them regularly. This means that, in time, the usual dose has no effect. You then need a higher dose to help with sleep. In time, the higher dose then has no effect, and so on.\nSome people become addicted to (dependent on) sleeping tablets and have withdrawal symptoms if the tablets are stopped suddenly.\nOther medicines that may be used to help sleep include\nmelatonin\nand some\nantihistamines\n.\nHerbal remedies are used by some people to help with sleep. For example, valerian.\nHowever, research studies have shown that there is very little evidence to show that these work. Therefore, they are not recommended.\nLong-term use of sleeping tablets has been linked with serious health problems, such as an increased risk of dementia, and an increased risk of earlier death.\nIf you've been taking sleeping tablets for a long time, your doctor should regularly review them with you, including discussing the benefits and harms. If you want to stop, they are no longer helping, or they are becoming harmful, your doctor may suggest stopping them - usually in a gradual way and with support.\nSee a doctor if you feel that illness or medication is causing poor sleep\n. Treating any underlying condition that is causing the problem, if possible, can help to promote sleep. In particular, depression and anxiety are common causes of poor sleep and can often be treated.","attrs_markdown":"![](https:\/\/stats.patient.info\/matomo.php?idsite=1&rec=1)\n\n[Skip to main content](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep#content)\n\nSign in\n\nSearch\n\n- [Home](https:\/\/patient.info\/)\n- [Health advice](https:\/\/patient.info\/health)\n- [Medicines and treatment](https:\/\/patient.info\/medicine)\n- [Tools and resources](https:\/\/patient.info\/medical-calculators)\n- [Community](https:\/\/patient.info\/community)\n- [Medical professionals](https:\/\/patient.info\/doctor)\n\n- [Health topics Trusted patient information leaflets with clear, clinically reviewed advice on conditions, symptoms and treatments.](https:\/\/patient.info\/)\n  \n  - ###### Health topics\n    [All health topics](https:\/\/patient.info\/health)\n    [Allergies, blood and immune system](https:\/\/patient.info\/allergies-blood-immune)\n    \n    [Bones, joints and muscles](https:\/\/patient.info\/bones-joints-muscles)\n    \n    [Brain and nerves](https:\/\/patient.info\/brain-nerves)\n    \n    [Cancer](https:\/\/patient.info\/cancer)\n    \n    [Chest and lungs](https:\/\/patient.info\/chest-lungs)\n    \n    [Children's health](https:\/\/patient.info\/childrens-health)\n    \n    [Diabetes](https:\/\/patient.info\/diabetes)\n    \n    [Digestive health](https:\/\/patient.info\/digestive-health)\n    \n    [Ear, nose and throat](https:\/\/patient.info\/ear-nose-throat)\n    \n    [Eye health](https:\/\/patient.info\/eye-care)\n    \n    [Foot care](https:\/\/patient.info\/foot-care)\n    \n    [General health](https:\/\/patient.info\/general-health-and-lifestyle)\n    \n    [Healthy living](https:\/\/patient.info\/healthy-living)\n    \n    [Heart health and blood vessels](https:\/\/patient.info\/heart-health)\n    \n    [Hormones](https:\/\/patient.info\/hormones)\n    \n    [Infections](https:\/\/patient.info\/infections)\n    \n    [Kidney and urinary tract](https:\/\/patient.info\/kidney-urinary-tract)\n    \n    [Men's health](https:\/\/patient.info\/mens-health)\n    \n    [Mental health](https:\/\/patient.info\/mental-health)\n    \n    [Oral and dental care](https:\/\/patient.info\/oral-dental-care)\n    \n    [Pregnancy](https:\/\/patient.info\/pregnancy)\n    \n    [Senior health](https:\/\/patient.info\/senior-health)\n    \n    [Sexual health](https:\/\/patient.info\/sexual-health)\n    \n    [Signs and symptoms](https:\/\/patient.info\/signs-symptoms)\n    \n    [Skin, nail and hair health](https:\/\/patient.info\/skin-conditions)\n    \n    [Surgery and procedures](https:\/\/patient.info\/surgery-procedures)\n    \n    [Tests and investigations](https:\/\/patient.info\/about-tests-and-investigations)\n    \n    [Travel and vaccinations](https:\/\/patient.info\/travel-and-vaccinations)\n    \n    [Treatment and medication](https:\/\/patient.info\/treatment-medication)\n    \n    [Women's health](https:\/\/patient.info\/womens-health)\n  \n  [Healthy living Expert features, lifestyle guidance and real-life stories designed to support your everyday health and wellbeing.](https:\/\/patient.info\/)\n  \n  - ###### Healthy living\n    [Latest features](https:\/\/patient.info\/news-and-features)\n    \n    [Health news](https:\/\/patient.info\/health-news)\n    \n    [Browse all topics](https:\/\/patient.info\/features)\n    [Cold and flu season](https:\/\/patient.info\/cold-and-flu-season)\n    \n    [Health research](https:\/\/patient.info\/health-research)\n    \n    [Weight loss management](https:\/\/patient.info\/weight-loss-management)\n    \n    [Student health](https:\/\/patient.info\/student-health-and-wellbeing)\n    [Allergies, blood and immune system](https:\/\/patient.info\/features\/allergies-blood-immune)\n    \n    [Bones, joints and muscles](https:\/\/patient.info\/features\/bones-joints-muscles)\n    \n    [Brain and nerves](https:\/\/patient.info\/features\/brain-nerves)\n    \n    [Cancer](https:\/\/patient.info\/features\/cancer)\n    \n    [Chest and lungs](https:\/\/patient.info\/features\/chest-lungs)\n    \n    [Children's health](https:\/\/patient.info\/features\/childrens-health)\n    \n    [COVID-19](https:\/\/patient.info\/features\/covid)\n    \n    [Diabetes](https:\/\/patient.info\/features\/diabetes)\n    \n    [Diet and nutrition](https:\/\/patient.info\/features\/diet-and-nutrition)\n    \n    [Digestive health](https:\/\/patient.info\/features\/digestive-health)\n    \n    [Ear, nose and throat](https:\/\/patient.info\/features\/ear-nose-throat)\n    \n    [Eye health](https:\/\/patient.info\/features\/eye-care)\n    \n    [Foot care](https:\/\/patient.info\/features\/foot-care)\n    \n    [General health](https:\/\/patient.info\/features\/general-health-and-lifestyle)\n    \n    [Healthy living](https:\/\/patient.info\/features\/healthy-living)\n    \n    [Heart health and blood vessels](https:\/\/patient.info\/features\/heart-health)\n    \n    [Hormones](https:\/\/patient.info\/features\/hormones)\n    \n    [Infections](https:\/\/patient.info\/features\/infections)\n    \n    [Kidney and urinary tract](https:\/\/patient.info\/features\/kidney-urinary-tract)\n    \n    [Men's health](https:\/\/patient.info\/features\/mens-health)\n    \n    [Mental health](https:\/\/patient.info\/features\/mental-health)\n    \n    [Oral and dental care](https:\/\/patient.info\/features\/oral-dental-care)\n    \n    [Pregnancy](https:\/\/patient.info\/features\/pregnancy)\n    \n    [Senior health](https:\/\/patient.info\/features\/senior-health)\n    \n    [Sexual health](https:\/\/patient.info\/features\/sexual-health)\n    \n    [Signs and symptoms](https:\/\/patient.info\/features\/signs-symptoms)\n    \n    [Skin, nail and hair health](https:\/\/patient.info\/features\/skin-conditions)\n    \n    [Tests and investigations](https:\/\/patient.info\/features\/about-tests-and-investigations)\n    \n    [Travel and vaccinations](https:\/\/patient.info\/features\/travel-and-vaccinations)\n    \n    [Treatment and medication](https:\/\/patient.info\/features\/treatment-medication)\n    \n    [Women's health](https:\/\/patient.info\/features\/womens-health)\n  \n  [Travel advice Find country-specific travel health advice.](https:\/\/patient.info\/)\n  \n  - ###### Featured countries\n    [Australia](https:\/\/patient.info\/travel-and-vaccinations\/australia)\n    \n    [Brazil](https:\/\/patient.info\/travel-and-vaccinations\/brazil)\n    \n    [Canada](https:\/\/patient.info\/travel-and-vaccinations\/canada)\n    \n    [Egypt](https:\/\/patient.info\/travel-and-vaccinations\/Egypt)\n    \n    [India](https:\/\/patient.info\/travel-and-vaccinations\/india)\n    \n    [Japan](https:\/\/patient.info\/travel-and-vaccinations\/japan)\n    \n    [Spain](https:\/\/patient.info\/travel-and-vaccinations\/spain)\n    [Countries A-Z](https:\/\/patient.info\/travel-country)\n  \n  [Tests and investigations Information and guidance about tests and an easy, fast and accurate symptom checker.](https:\/\/patient.info\/)\n  \n  - ###### Tests and investigations\n    [Symptom checker](https:\/\/patient.info\/symptom-checker)\n    \n    [AskPatient Ai](https:\/\/patient.info\/ask\/patient)\n    [About tests and investigations](https:\/\/patient.info\/about-tests-and-investigations)\n    \n    [Biopsy](https:\/\/patient.info\/about-tests-and-investigations#biopsy)\n    \n    [Blood tests](https:\/\/patient.info\/about-tests-and-investigations#bloodtests)\n    \n    [Endoscopy](https:\/\/patient.info\/about-tests-and-investigations#endoscopy)\n    \n    [Heart tests](https:\/\/patient.info\/about-tests-and-investigations#hearttests)\n    \n    [Imaging](https:\/\/patient.info\/about-tests-and-investigations#imaging)\n    \n    [Screening tests](https:\/\/patient.info\/about-tests-and-investigations#screeningtests)\n    \n    [Urine and bladder tests](https:\/\/patient.info\/about-tests-and-investigations#urineandbladdertests)\n    \n    [Other tests and investigations](https:\/\/patient.info\/about-tests-and-investigations#othertestsandinvestigations)\n- [Medicine information Information and fact sheets for patients and professionals. Find out side effects, medicine names, dosages and uses.](https:\/\/patient.info\/)\n  \n  - ###### Medicine information\n    [All medicines A-Z](https:\/\/patient.info\/medicine)\n    \n    [Drug interaction checker](https:\/\/patient.info\/treatment-medication\/interaction-checker)\n    [Allergy medicines](https:\/\/patient.info\/allergy-medicines)\n    \n    [Analgesics and pain medication](https:\/\/patient.info\/analgesics-and-pain-medication)\n    \n    [Anti-inflammatory medicines](https:\/\/patient.info\/anti-inflammatory-medicines)\n    \n    [Breathing treatment and respiratory care](https:\/\/patient.info\/breathing-treatment-and-respiratory-care)\n    \n    [Cancer treatment and drugs](https:\/\/patient.info\/cancer-treatment-and-drugs)\n    \n    [Contraceptive medicines](https:\/\/patient.info\/contraceptive-medicines)\n    \n    [Diabetes medicines](https:\/\/patient.info\/diabetes-medicines)\n    \n    [Medicine interactions](https:\/\/patient.info\/medication-interactions)\n    \n    [ENT and mouth care](https:\/\/patient.info\/ent-and-mouth-care)\n    \n    [Eye care medicine](https:\/\/patient.info\/eye-care-medicine)\n    \n    [Gastrointestinal treatment](https:\/\/patient.info\/gastrointestinal-treatment)\n    \n    [Genitourinary medicine](https:\/\/patient.info\/genito-urinary-medicine)\n    \n    [Heart disease treatment and prevention](https:\/\/patient.info\/heart-disease-treatment-and-prevention)\n    \n    [Hormonal imbalance treatment](https:\/\/patient.info\/hormonal-imbalance-treatment)\n    \n    [Hormone deficiency treatment](https:\/\/patient.info\/hormone-deficiency-treatment)\n    \n    [Immunosuppressive drugs](https:\/\/patient.info\/immunosuppressive-drugs)\n    \n    [Infection treatment medicine](https:\/\/patient.info\/infection-treatment-medicine)\n    \n    [Kidney conditions treatments](https:\/\/patient.info\/treatment-for-kidneys)\n    \n    [Muscle, bone and joint pain treatment](https:\/\/patient.info\/muscle-bone-and-joint-pain-treatment)\n    \n    [Nausea medicine and vomiting treatment](https:\/\/patient.info\/nausea-medicine-and-vomiting-treatment)\n    \n    [Nervous system drugs](https:\/\/patient.info\/nervous-system-drugs)\n    \n    [Reproductive health](https:\/\/patient.info\/reproductive-health)\n    \n    [Skin conditions treatments](https:\/\/patient.info\/treatments-for-skin-conditions)\n    \n    [Substance abuse treatment](https:\/\/patient.info\/substance-abuse-treatment)\n    \n    [Vaccines and immunisation](https:\/\/patient.info\/vaccines-and-immunisation)\n    \n    [Vitamin and mineral supplements](https:\/\/patient.info\/vitamin-and-mineral-supplements)\n  \n  [Find a healthcare provider Search trusted NHS and private clinics registered with the Care Quality Commission (CQC).](https:\/\/patient.info\/)\n  \n  - ###### Patient.info directory\n    [Find a healthcare provider](https:\/\/patient.info\/directory)\n    [Doctors\/GPs](https:\/\/patient.info\/directory\/single-category\/doctors-gps\/)\n    \n    [Dentists](https:\/\/patient.info\/directory\/single-category\/dentist\/)\n    \n    [Urgent care centres](https:\/\/patient.info\/directory\/single-category\/urgent-care-centres\/)\n    \n    [Hospitals](https:\/\/patient.info\/directory\/single-category\/hospital\/)\n    \n    [Nursing homes](https:\/\/patient.info\/directory\/single-category\/nursing-homes\/)\n    \n    [Homecare agencies](https:\/\/patient.info\/directory\/single-category\/homecare-agencies\/)\n    \n    [Hospices](https:\/\/patient.info\/directory\/single-category\/hospice\/)\n    \n    [Diagnostics](https:\/\/patient.info\/directory\/single-category\/diagnosis-screening\/)\n    \n    [Browse all service categories](https:\/\/patient.info\/directory\/all-categories\/)\n  \n  [GP practice services Easily manage your healthcare with digital tools for booking GP appointments, ordering repeat prescriptions, and more.](https:\/\/patient.info\/)\n  \n  - ###### GP practice services\n    [NHS App](https:\/\/patient.info\/gp-practice-services)\n    \n    [Pharmacy First](https:\/\/patient.info\/pharmacy-first)\n    \n    [Patient Record Access](https:\/\/patient.info\/health\/patient-records-access)\n  \n  [Pharmacy services Help with common conditions under the NHS Pharmacy First scheme, with prescription medication, delivered for free.](https:\/\/patient.info\/)\n  \n  - ###### Pharmacy First\n    [What is NHS pharmacy first](https:\/\/patient.info\/pharmacy-first)\n    [Shingles](https:\/\/patient.info\/skin-conditions\/shingles-herpes-zoster-leaflet)\n    \n    [Impetigo](https:\/\/patient.info\/childrens-health\/impetigo-leaflet)\n    \n    [Sinusitis](https:\/\/patient.info\/ears-nose-throat-mouth\/acute-sinusitis)\n    \n    [Infected insect bite](https:\/\/patient.info\/skin-conditions\/insect-bites-and-stings-leaflet)\n    \n    [Sore throat](https:\/\/patient.info\/ears-nose-throat-mouth\/sore-throat-2)\n    \n    [UTI](https:\/\/patient.info\/kidney-urinary-tract\/urinary-tract-infections)\n    \n    [Contraception](https:\/\/patient.info\/news-and-features\/easy-ways-to-get-the-pill-options-beyond-the-gp-surgery)\n    \n    [Weight loss treatments](https:\/\/patient.info\/weight-loss-management)\n- [Medical tools and resources Take charge of your health with easy-to-use tools and trusted resources.](https:\/\/patient.info\/)\n  \n  - ###### Patient tools and resources\n    [All medical calculators, tools and resources](https:\/\/patient.info\/medical-calculators)\n    [Symptom checker](https:\/\/patient.info\/symptom-checker)\n    \n    [AskPatient Ai](https:\/\/patient.info\/ask\/patient)\n    \n    [Personalised digital habit coaching](https:\/\/patient.info\/features\/healthy-living\/building-healthier-habits)\n    \n    [BMI calculator](https:\/\/patient.info\/healthy-living\/calculate-bmi)\n    \n    [Generalised anxiety disorder assessment](https:\/\/patient.info\/doctor\/mental-health\/gad-7)\n    \n    [Patient health questionnaire](https:\/\/patient.info\/doctor\/mental-health\/phq-9)\n    \n    [Pregnancy due date calculator](https:\/\/patient.info\/doctor\/pregnancy-due-date-calculator)\n    \n    [Ovulation calculator](https:\/\/patient.info\/pregnancy\/ovulation-calculator)\n    \n    [Sleep debt calculator](https:\/\/patient.info\/healthy-living\/sleep-debt-calculator)\n    \n    [Calorie calculator](https:\/\/patient.info\/healthy-living\/calorie-calculator)\n    \n    [BMR (Basal Metabolic Rate) calculator](https:\/\/patient.info\/healthy-living\/basal-metabolic-rate-calculator)\n    \n    [Glucose Ketone Index (GKI) calculator](https:\/\/patient.info\/healthy-living\/glucose-ketone-index-gki-calculator)\n    \n    [Epworth sleepiness scale](https:\/\/patient.info\/signs-symptoms\/tiredness-fatigue\/epworth-sleepiness-scale)\n    \n    [Asthma control test (ACT)](https:\/\/patient.info\/chest-lungs\/asthma-control-test)\n    \n    [Benefits checker](https:\/\/patient.info\/general-health\/benefits-calculator)\n    \n    [PIP helper](https:\/\/patient.info\/general-health\/check-your-personal-independence-payment-pip-eligibility)\n    \n    [Patient.info app](https:\/\/patient.info\/app)\n    \n    [Pollen map](https:\/\/patient.info\/features\/allergies-blood-immune\/pollen-map)\n  \n  [Healthy eating Healthy recipe inspiration for nourishing meals and everyday wellbeing.](https:\/\/patient.info\/)\n  \n  - ###### Healthy eating\n    [Browse all recipes](https:\/\/patient.info\/recipes)\n    [Balanced nutrition](https:\/\/patient.info\/recipes\/balanced-nutrition-recipes)\n    \n    [Diabetes friendly](https:\/\/patient.info\/recipes\/diabetes-friendly-recipes)\n    \n    [Heart healthy](https:\/\/patient.info\/recipes\/heart-healthy-recipes)\n    \n    [High protein](https:\/\/patient.info\/recipes\/high-protein-recipes)\n    \n    [Low fat](https:\/\/patient.info\/recipes\/low-fat-recipes)\n    \n    [Low sugar](https:\/\/patient.info\/recipes\/low-sugar-recipes)\n    \n    [Vegan](https:\/\/patient.info\/recipes\/vegan-recipes)\n    \n    [Vegetarian](https:\/\/patient.info\/recipes\/vegetarian-recipes)\n  \n  [Health and wellness video library Discover our library of trusted health videos.](https:\/\/patient.info\/)\n  \n  - ###### Health and wellness video library\n    [All health and wellness videos](https:\/\/patient.info\/video-library)\n    \n    [Visit our YouTube channel](https:\/\/www.youtube.com\/patient)\n    [Bones, joints and muscles](https:\/\/patient.info\/video-library#bones,jointsandmuscles)\n    \n    [Cancer](https:\/\/patient.info\/video-library#cancer)\n    \n    [Diabetes](https:\/\/patient.info\/video-library#diabetes)\n    \n    [General health and lifestyle](https:\/\/patient.info\/video-library#generalhealthandlifestyle)\n    \n    [Infections](https:\/\/patient.info\/video-library#infections)\n    \n    [Mental health](https:\/\/patient.info\/video-library#mentalhealth)\n    \n    [Other conditions](https:\/\/patient.info\/video-library#otherconditions)\n    \n    [Pregnancy and miscarriage](https:\/\/patient.info\/video-library#pregnancyandmiscarriage)\n    \n    [Sexual health and contraception](https:\/\/patient.info\/video-library#sexualhealthandcontraception)\n    \n    [Women's health](https:\/\/patient.info\/video-library#women'shealth)\n    \n    [Explore more videos on YouTube](https:\/\/www.youtube.com\/patient)\n  \n  [Self-assessment quizzes Our self-assessment quizzes can help you recognise signs of common health conditions.](https:\/\/patient.info\/)\n  \n  - ###### Self-assessment quizzes\n    [All self-assessment quizzes](https:\/\/patient.info\/self-assessment)\n    [Depression](https:\/\/patient.info\/self-assessment#depression)\n    \n    [Diabetes](https:\/\/patient.info\/self-assessment#diabetes)\n    \n    [OCD](https:\/\/patient.info\/self-assessment#ocd)\n    \n    [Periods](https:\/\/patient.info\/self-assessment#periods)\n    \n    [Pregnancy](https:\/\/patient.info\/self-assessment#pregnancy)\n  \n  [Brain teasers Explore daily brain teasers that challenge how you think, reason and solve problems.](https:\/\/patient.info\/)\n  \n  - ###### Brain teasers\n    [Leaderboard](https:\/\/patient.info\/brain-teasers\/leaderboard)\n    \n    [Your progress and scores](https:\/\/patient.info\/brain-teasers\/profile)\n    [All brain teasers](https:\/\/patient.info\/brain-teasers)\n    \n    [Complete the daily challenge](https:\/\/patient.info\/brain-teasers\/daily-challenge)\n    \n    [The Daily Decode](https:\/\/patient.info\/brain-teasers\/cryptogram)\n    \n    [Myth or Fact](https:\/\/patient.info\/brain-teasers\/myth-or-fact)\n    \n    [Symptoms Sort](https:\/\/patient.info\/brain-teasers\/symptoms-sort)\n    \n    [Word Ladder](https:\/\/patient.info\/brain-teasers\/word-ladder)\n- [Patient communities Browse discussions, ask questions, and share experiences across hundreds of health topics – all in a safe, supportive space.](https:\/\/patient.info\/)\n  \n  - ###### Patient communities\n    [Log in](https:\/\/community.patient.info\/login)\n    \n    [Sign up](https:\/\/community.patient.info\/signup)\n    [Browse all patient communities](https:\/\/community.patient.info\/)\n    [Allergies, blood and immune system](https:\/\/community.patient.info\/c\/allergies-blood-and-immune-system\/4)\n    \n    [Bones, joints and muscles](https:\/\/community.patient.info\/c\/bones-joints-and-muscles\/2)\n    \n    [Brain and nerves](https:\/\/community.patient.info\/c\/brain-and-nerves\/6)\n    \n    [Cancer](https:\/\/community.patient.info\/c\/cancer\/7)\n    \n    [Chest and lungs](https:\/\/community.patient.info\/c\/chest-and-lungs\/8)\n    \n    [Children's health](https:\/\/community.patient.info\/c\/childrens-health\/9)\n    \n    [Cosmetic surgery](https:\/\/community.patient.info\/c\/cosmetic-surgery\/40)\n    \n    [Diabetes](https:\/\/community.patient.info\/c\/diabetes\/11)\n    \n    [Digestive health](https:\/\/community.patient.info\/c\/digestive-health\/16)\n    \n    [Ears, nose and throat](https:\/\/community.patient.info\/c\/ears-nose-and-throat\/12)\n    \n    [Eye care](https:\/\/community.patient.info\/c\/eye-care\/13)\n    \n    [Foot care](https:\/\/community.patient.info\/c\/foot-care\/41)\n    \n    [General health and lifestyle](https:\/\/community.patient.info\/c\/general-health-and-lifestyle\/43)\n    \n    [Heart health and blood vessels](https:\/\/community.patient.info\/c\/heart-health-and-blood-vessels\/18)\n    \n    [Hormones](https:\/\/community.patient.info\/c\/hormones\/45)\n    \n    [Infections](https:\/\/community.patient.info\/c\/infections\/20)\n    \n    [Kidney and urinary tract](https:\/\/community.patient.info\/c\/kidney-and-urinary-tract\/15)\n    \n    [Men's health](https:\/\/community.patient.info\/c\/mens-health\/24)\n    \n    [Mental health](https:\/\/community.patient.info\/c\/mental-health\/25)\n    \n    [Oral and dental care](https:\/\/community.patient.info\/c\/oral-and-dental-care\/44)\n    \n    [Pregnancy](https:\/\/community.patient.info\/c\/pregnancy\/27)\n    \n    [Senior health](https:\/\/community.patient.info\/c\/senior-health\/28)\n    \n    [Sexual health](https:\/\/community.patient.info\/c\/sexual-health\/10)\n    \n    [Signs and symptoms](https:\/\/community.patient.info\/c\/signs-and-symptoms\/30)\n    \n    [Skin, nail and hair health](https:\/\/community.patient.info\/c\/skin-nail-and-hair-health\/29)\n    \n    [Tests and investigations](https:\/\/community.patient.info\/c\/tests-and-investigations\/32)\n    \n    [Travel and vaccinations](https:\/\/community.patient.info\/c\/travel-and-vaccinations\/39)\n    \n    [Treatment and medication](https:\/\/community.patient.info\/c\/treatment-and-medication\/19)\n    \n    [Women's health](https:\/\/community.patient.info\/c\/womens-health\/33)\n    \n    [Other conditions](https:\/\/community.patient.info\/c\/other-conditions\/34)\n  \n  [Patient voices Hear directly from people living with health conditions - everyday experiences, tough decisions, unexpected triumphs, and everything in between.](https:\/\/patient.info\/)\n  \n  - ###### Patient voices\n    [Browse all stories](https:\/\/patient.info\/patient-voices)\n    [Children's health](https:\/\/patient.info\/patient-voices#children'shealth)\n    \n    [Hearing](https:\/\/patient.info\/patient-voices#hearing)\n    \n    [Mental health](https:\/\/patient.info\/patient-voices#mentalhealth)\n    \n    [Senior health](https:\/\/patient.info\/patient-voices#seniorhealth)\n    \n    [Women's health](https:\/\/patient.info\/patient-voices#women'shealth)\n  \n  [Podcasts Candid conversations on health from celebrities, experts and real people.](https:\/\/patient.info\/)\n  \n  - ###### Patient podcasts\n    [Browse all podcasts](https:\/\/patient.info\/features\/podcast)\n    [Yorkshire Talks](https:\/\/patient.info\/features\/podcast#yorkshiretalks)\n    \n    [Sex and Relationships](https:\/\/patient.info\/features\/podcast#thesexandrelationshipspodcast)\n- [Medical professional hub Information and tools written by clinicians for medical professionals, and training resources.](https:\/\/patient.info\/)\n  \n  - ###### Medical professional hub\n    [Medical professional content hub](https:\/\/patient.info\/doctor)\n    \n    [Clinical topics](https:\/\/patient.info\/doctor\/articles)\n    \n    [Professional articles A-Z](https:\/\/patient.info\/doctor\/articles#a-z-a)\n    \n    [Medicines information](https:\/\/patient.info\/medicine)\n    \n    [Medical tools and resources for professionals](https:\/\/patient.info\/doctor\/professional-tools-and-resources)\n  \n  [Professional articles Evidence-based professional reference pages authored by our clinical team for the use of medical professionals.](https:\/\/patient.info\/)\n  \n  - ###### Professional articles\n    [View all professional articles A-Z](https:\/\/patient.info\/doctor\/articles#a-z-a)\n    \n    [Browse by clinical topic](https:\/\/patient.info\/doctor\/articles)\n    [Anaesthetics and pain control](https:\/\/patient.info\/doctor\/anaesthetics)\n    \n    [Cardiovascular disease](https:\/\/patient.info\/doctor\/cardiovascular-disease)\n    \n    [Congenital and inherited disorders](https:\/\/patient.info\/doctor\/congenital-disorders)\n    \n    [Dermatology](https:\/\/patient.info\/doctor\/dermatology)\n    \n    [Drug therapy](https:\/\/patient.info\/doctor\/drug-therapy)\n    \n    [Ear, nose and throat](https:\/\/patient.info\/doctor\/ear-nose-throat)\n    \n    [Emergency medicine and trauma](https:\/\/patient.info\/doctor\/emergency-medicine)\n    \n    [Endocrine disorders](https:\/\/patient.info\/doctor\/endocrine-disorders)\n    \n    [Fertility and reproduction](https:\/\/patient.info\/doctor\/fertility)\n    \n    [Gastroenterology](https:\/\/patient.info\/doctor\/gastroenterology)\n    \n    [General surgery](https:\/\/patient.info\/doctor\/general-surgery)\n    \n    [Gynaecology](https:\/\/patient.info\/doctor\/gynaecology)\n    \n    [Haematology](https:\/\/patient.info\/doctor\/haematology)\n    \n    [History and examination](https:\/\/patient.info\/doctor\/history-examination)\n    \n    [Infectious disease](https:\/\/patient.info\/doctor\/infectious-disease)\n    \n    [Information governance and security](https:\/\/patient.info\/doctor\/information-governance-and-security)\n    \n    [Investigations](https:\/\/patient.info\/doctor\/investigations)\n    \n    [Mental health](https:\/\/patient.info\/doctor\/mental-health)\n    \n    [Mouth and dental disorders](https:\/\/patient.info\/doctor\/mouth-dental-disorders)\n    \n    [Multisystem disease](https:\/\/patient.info\/doctor\/multisystem-diseases)\n    \n    [Neurology](https:\/\/patient.info\/doctor\/neurology)\n    \n    [Nutrition](https:\/\/patient.info\/doctor\/nutrition)\n    \n    [Obstetrics](https:\/\/patient.info\/doctor\/obstetrics)\n    \n    [Occupational illness](https:\/\/patient.info\/doctor\/occupational-illness)\n    \n    [Oncology](https:\/\/patient.info\/doctor\/oncology)\n    \n    [Ophthalmology](https:\/\/patient.info\/doctor\/ophthalmology)\n    \n    [Orthopaedics and sports medicine](https:\/\/patient.info\/doctor\/orthopaedics)\n    \n    [Paediatrics](https:\/\/patient.info\/doctor\/paediatrics)\n    \n    [Palliative and terminal care](https:\/\/patient.info\/doctor\/palliative-terminal-care)\n    \n    [Pathological processes](https:\/\/patient.info\/doctor\/pathological-processes)\n    \n    [Primary care](https:\/\/patient.info\/doctor\/primary-care)\n    \n    [Public health medicine](https:\/\/patient.info\/doctor\/public-health-medicine)\n    \n    [Renal disorders](https:\/\/patient.info\/doctor\/renal-disorders)\n    \n    [Respiratory medicine](https:\/\/patient.info\/doctor\/respiratory-medicine)\n    \n    [Rheumatology](https:\/\/patient.info\/doctor\/rheumatology)\n    \n    [Screening and prevention](https:\/\/patient.info\/doctor\/screening-prevention)\n    \n    [Social care](https:\/\/patient.info\/doctor\/social-care)\n    \n    [Therapies](https:\/\/patient.info\/doctor\/therapies)\n    \n    [Thinking about medicine](https:\/\/patient.info\/doctor\/thinking-about-medicine)\n    \n    [Toxicology and iatrogenic disorders](https:\/\/patient.info\/doctor\/toxicology)\n    \n    [Travel related disease](https:\/\/patient.info\/doctor\/travel-related-disease)\n    \n    [Urology](https:\/\/patient.info\/doctor\/urology)\n  \n  [Medical tools and resources Clinical tools for medical professional use.](https:\/\/patient.info\/)\n  \n  - ###### Medical tools and resources\n    [All medical tools and resources](https:\/\/patient.info\/medical-calculators)\n    \n    [All clinical calculators](https:\/\/patient.info\/doctor\/professional-tools-and-resources)\n    [BMI calculator](https:\/\/patient.info\/healthy-living\/calculate-bmi)\n    \n    [Generalised anxiety disorder assessment](https:\/\/patient.info\/doctor\/mental-health\/gad-7)\n    \n    [Patient health questionnaire](https:\/\/patient.info\/doctor\/mental-health\/phq-9)\n    \n    [Pregnancy due date calculator](https:\/\/patient.info\/doctor\/pregnancy-due-date-calculator)\n    \n    [Digital Paediatric Growth Charts](https:\/\/patient.info\/doctor\/professional-tools-and-resources\/growth-charts)\n    \n    [Social media toolkit](https:\/\/patient.info\/social-media-toolkit)\n\n- [Health topics](https:\/\/patient.info\/health)\n- [Healthy living](https:\/\/patient.info\/healthy-living)\n- [Sleep and insomnia](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep)\n- Insomnia\n\n# Insomnia\n## Poor sleep\nPeer reviewed by [Dr Colin Tidy, MRCGP](https:\/\/patient.info\/authors\/dr-colin-tidy)Last updated by [Dr Doug McKechnie, MRCGP](https:\/\/patient.info\/authors\/dr-doug-mckechnie)Last updated 23 Jun 2024\n\nMeets Patient’s [editorial guidelines](https:\/\/patient.info\/editorial-policy)Est. **16 min** reading time\n\n- Download\n  [Download](https:\/\/pdf.patient.info\/?url=https%3A%2F%2Fpatient.info%2Fmental-health%2Finsomnia-poor-sleep)\n  Article PDF has been downloaded\n- Share\n  #### Share\n  - [Share via email](mailto:?subject=Patient%20-%20Insomnia&body=https%3A%2F%2Fpatient.info%2Fmental-health%2Finsomnia-poor-sleep)\n  - [Share via Facebook](https:\/\/www.facebook.com\/sharer\/sharer.php?u=https%3A%2F%2Fpatient.info%2Fmental-health%2Finsomnia-poor-sleep)\n  - [Share via LinkedIn](https:\/\/www.linkedin.com\/sharing\/share-offsite\/?url=https%3A%2F%2Fpatient.info%2Fmental-health%2Finsomnia-poor-sleep)\n  - [Share via X](https:\/\/x.com\/intent\/post?text=Patient%20-%20Insomnia&url=https%3A%2F%2Fpatient.info%2Fmental-health%2Finsomnia-poor-sleep)\n  - [Share via WhatsApp](https:\/\/api.whatsapp.com\/send?text=Patient%20-%20Insomnia%20https%3A%2F%2Fpatient.info%2Fmental-health%2Finsomnia-poor-sleep)\n  - [Copy link](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep#copy)\n  Article link copied to clipboard\n- Language\n  #### Language\n  - [English](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep)\n  - [Deutsch](https:\/\/de.patient.info\/mental-health\/insomnia-poor-sleep)\n  - [Español](https:\/\/es.patient.info\/mental-health\/insomnia-poor-sleep)\n  - [Français](https:\/\/fr.patient.info\/mental-health\/insomnia-poor-sleep)\n  - [Italiano](https:\/\/it.patient.info\/mental-health\/insomnia-poor-sleep)\n  - [Português](https:\/\/pt.patient.info\/mental-health\/insomnia-poor-sleep)\n- Discussion\n- Audio Version\n\nIn this series:[Snoring](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep\/snoring)[Sleepwalking](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep\/sleepwalking)[Sleep paralysis](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep\/sleep-paralysis)[Sleeping tablets](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep\/sleeping-tablets)[Benzodiazepines and Z drugs](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep\/benzodiazepines-and-z-drugs)\n\nAs many as one in three people can have some difficulty with sleeping. However, there are many things you can do to help yourself. This leaflet aims to show you some of them. For example, simple things like winding down before bedtime, avoiding certain foods and drinks, and a bedtime routine can help.  \n  \nEDITORS NOTES\n\n[Dr Krishna Vakharia](https:\/\/patient.info\/authors\/dr-krishna-vakharia), 24th November 2023\n\nThere is a new oral medication that NICE has recommended called daridorexant. This can only be used under certain conditions. Your doctor will discuss if it is suitable for you. For further information take a look at the further reading section.\n\nDo you need support with anxiety, depression or stress?\n\nGet Onebright CBT private therapy appointments sooner than NHS services.  \n£99 per session – delivered virtually. CBT will help you get better by making you more aware of the connection between your thoughts, feelings and behaviours so you can feel healthy and happy.\n\n[Find out more](https:\/\/onebright.com\/patient-info\/)\n\n![OneBright logo](https:\/\/images.ctfassets.net\/xxv4b9mbhlgd\/4xLeUTH6nAJVUufRHOQPu7\/19f5b88126201fa0ace776206316013e\/Onebright_on_Dark_RGB.png)\n\n### In this article:\n- [What is insomnia?](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep#what-is-insomnia)\n- [What is a normal amount of sleep?](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep#what-is-a-normal-amount-of-sleep)\n- [Understanding normal sleep](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep#understanding-normal-sleep)\n- [What causes insomnia?](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep#what-causes-insomnia)\n- [Insomnia classifications](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep#insomnia-classifications)\n- [How can I sleep better?](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep#how-can-i-sleep-better)\n- [What about sleeping tablets?](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep#what-about-sleeping-tablets)\n- [A final note](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep#a-final-note)\n- [Further reading and references](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep#furtherreading)\n\n## What is insomnia?\n[Dr Roger Henderson, MBBS](https:\/\/patient.info\/authors\/dr-roger-henderson)\n## What is insomnia?\nInsomnia means poor sleep. About one third of adults do not get as much sleep as they would like. Poor sleep can mean:\n\n- Not being able to get off to sleep.\n- Waking up too early.\n- Waking for long periods in the night.\n- Not feeling refreshed after a night's sleep.\n\nIf you have poor sleep, particularly over a long period of time, it can severely affect your life, as it can cause:\n\n- [Tiredness (fatigue)](https:\/\/patient.info\/signs-symptoms\/tiredness-fatigue) and loss of energy in the daytime.\n- Poor concentration.\n- Loss of interest in usual activities.\n- Irritability.\n- [Depression](https:\/\/patient.info\/mental-health\/depression-leaflet) and [anxiety](https:\/\/patient.info\/mental-health\/anxiety).\n- Inability to do things as well or as much as usual - for example, work, social activities, exercise. Errors might occur at work or whilst driving, which could have serious consequences.\n- A worse quality of life.\n\n## What is a normal amount of sleep?\n[Back to contents](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep#toc)\n\nDifferent people need different amounts of sleep. Children need more sleep than adults. For adults, the minimum we need is about 6 hours per night. On average, most adults need between 6 and 9 hours of sleep to feel refreshed.\n\nMost people establish a pattern that is normal for them in their early adult life. However, as you become older, it is normal to sleep less. For most people it takes less than thirty minutes to fall asleep.\n\nSo, everyone is different. What is important is that the amount of sleep that you get should be sufficient for you, and that you usually feel refreshed and not sleepy during the daytime. Therefore, the strict medical definition of insomnia is: 'Difficulty in getting to sleep, difficulty staying asleep, early wakening, or non-restorative sleep despite adequate time and opportunity to sleep, resulting in impaired daytime functioning, such as poor concentration, mood disturbance, and daytime tiredness.'\n\nFurther ways to promote sleep in more difficult cases include relaxation techniques, regular exercise and certain psychological therapies.\n\nSleeping tablets are not the best way to help with sleep problems because they don't fix the cause of insomnia, you can get addicted to them, and they often stop working if you take them regularly.\n\n## Understanding normal sleep\n[Back to contents](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep#toc)\n\nA normal night's sleep has three main parts:\n\n- **Quiet sleep.** This is divided into stages 1-4. Each stage becomes more deep. Quiet sleep is sometimes called deep sleep.\n- **Rapid eye movement (REM) sleep.** REM sleep occurs when the brain is very active but the body is limp, apart from the eyes which move rapidly. Most dreaming occurs during REM sleep.\n- **Short periods of waking for 1-2 minutes.**\n\nEach night, about 4-5 periods of quiet sleep alternate with 4-5 periods of REM sleep. In addition, several short periods of waking for 1-2 minutes occur about every two hours or so, but occur more frequently towards the end of the night's sleep. The graph below shows a typical normal pattern of sleep in a young adult.\n\n## Hypnogram\n![Hypnogram - a chart of a normal night's sleep](https:\/\/patient.info\/images\/default_image.png)\n\nNormally, you do not remember the times that you wake if they last less than two minutes. If you are distracted during the wakeful times (for example, a partner snoring, traffic noise, etc) then the wakeful times tend to last longer and you are more likely to remember them.\n\n## What causes insomnia?\n[Back to contents](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep#toc)\n\nPoor sleep may develop for no apparent reason. However, there are a number of possible causes which include the following:\n\n### Concern about wakefulness\nYou may remember the normal times of being awake in the night. You may feel that to wake in the night is not normal, and worry about getting back off to sleep. You may clock-watch and check the time each time you wake up.\n\nThis may make you irritated or anxious, and you are more likely to remember the times of wakefulness. You may then have an impression of having a bad night's sleep, even when the total amount of time asleep was normal.\n\n### Temporary problems\nPoor sleep is often temporary. This may be because of stress, a work or family problem, jet lag, a change of routine, a new baby, a strange bed, etc. Poor sleep in these situations usually improves in time.\n\n### Stress, anxiety or depression\nYou may find it difficult to switch off your [anxieties](https:\/\/patient.info\/mental-health\/anxiety) about work, home or personal problems. Also, poor sleep is sometimes due to [depression](https:\/\/patient.info\/mental-health\/depression-leaflet). Other symptoms of depression include a low mood, lethargy, poor concentration, tearfulness and persistent negative thoughts. Depression is common. Treatment of depression or anxiety often cures the poor sleep too.\n\n### Sleep apnoea\nThis sometimes occurs in people who snore, most commonly in obese people. In this condition the large airways narrow or collapse as you fall asleep. This not only causes snoring but also reduces the amount of oxygen that gets to the lungs.\n\nThis causes you to wake up to breathe properly. You may wake up many times each night which may result in daytime tiredness. [See the separate leaflet called Sleep apnoea](https:\/\/patient.info\/signs-symptoms\/tiredness-fatigue\/obstructive-sleep-apnoea-syndrome). **Note**: most people who snore do not have sleep apnoea and they do sleep well.\n\n### Other illnesses\nVarious illnesses keep some people awake. For example, illness causing pain, [leg cramps](https:\/\/patient.info\/bones-joints-muscles\/cramps-in-the-leg), breathlessness, [indigestion](https:\/\/patient.info\/digestive-health\/dyspepsia-indigestion), [cough](https:\/\/patient.info\/chest-lungs\/cough-leaflet), itch, hot flushes, mental health problems, etc.\n\n### Stimulants\nThese can interfere with sleep. There are three common culprits.\n\n- [**Alcohol**](https:\/\/patient.info\/healthy-living\/alcohol-and-liver-disease\/alcohol-and-sensible-drinking) - many people take an alcoholic drink to help sleep. Alcohol does help you get to sleep quicker, but then causes broken, poor-quality sleep and early morning wakefulness.\n- **Caffeine** - which is in tea, coffee, some soft drinks such as cola, and even chocolate. It is also in some painkiller tablets and other medicines (check the ingredients on the medicine packet). Caffeine is a stimulant and may cause poor sleep.\n- **Nicotine** (from [smoking](https:\/\/patient.info\/healthy-living\/quit-smoking-cessation)) is a stimulant, so it would help not to smoke.\n### Other recreational drugs\n[Other recreational drugs](https:\/\/patient.info\/healthy-living\/recreational-drugs) (for example, ecstasy, cocaine, cannabis and amphetamines) can affect sleep.\n\n### Prescribed medicines\nSome medicines sometimes interfere with sleep. For example, 'water tablets' (diuretics), some antidepressants, [steroids](https:\/\/patient.info\/treatment-medication\/steroids), [beta-blockers](https:\/\/patient.info\/heart-health\/beta-blockers), painkillers containing caffeine, and some cold remedies containing pseudoephedrine. Also, if you suddenly stop taking regular sleeping tablets or other sedative medicines, this can cause rebound poor sleep.\n\n### Screen time\nThere is some evidence that the time we spend looking at electronic screens can affect our sleep. It may be that certain types of light from e-readers and electronic tablets can disrupt control of our natural day-and-night cycle.\n\nThere are studies which suggest we may sleep better after reading a printed book or a particular kind of screen before bedtime. There are also some studies which show that in children and adolescents, more time using electronic devices in the daytime is linked to less good sleep at night. It's best to avoid using screens within an hour or two of bed. Try to keep devices like phones and laptops out of reach of the bed, or, ideally, outside the bedroom entirely.\n\n### Unrealistic expectations\nSome people just need less sleep than others. If your sleep pattern has not changed, and you do not feel sleepy during the day, you are probably getting enough sleep. Older people and people who do little exercise tend to need less sleep. Some people think they should be able to nap during the day - and sleep eight hours at night\\!\n\n### A vicious cycle\nWhatever the initial cause, worry about poor sleep and worry about feeling tired the next day are common reasons for the problem to become worse.\n\n### Sleep paralysis\nSome people may also experience waking from sleep but then being unable to move or speak for a period of time. Some people experience the same problems when they are falling asleep. [See the separate leaflet called Sleep paralysis](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep\/sleep-paralysis).\n\n## Insomnia classifications\n[Back to contents](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep#toc)\n\nThere are different definitions and classifications of poor sleep (insomnia) around, which can make things confusing. Doctors may classify insomnia into one of the following categories:\n\n### By type\n- Primary insomnia is insomnia that occurs when no illness or other secondary cause (comorbidity) is identified. Primary insomnia accounts for about one in five cases of long-term insomnia.\n- Secondary (or comorbid) insomnia occurs when insomnia is a symptom of, or is associated with, other conditions. These can be medical or mental health conditions, or drug or substance misuse (as discussed above).\n### By duration\n- Short-term if insomnia lasts days to weeks, and up to three months.\n- Long-term (or persistent) if insomnia lasts for three months or longer.\n### By a combination of factors\nSome authorities use the term 'chronic insomnia disorder'. To have this diagnosis, you would:\n\n- Have problems sleeping for at least three nights a week for at least three months.\n- Be distressed or have problems functioning due to your sleeping problem.\n- Not have another condition which could affect sleep, ie mental or physical illnesses or another sleep disorder.\n\n## How can I sleep better?\n[Back to contents](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep#toc)\n\n- Avoid caffeine, smoking and alcohol, especially in the hours before bedtime.\n- Avoid heavy meals or strenuous exercise shortly before going to bed.\n- Go to bed and get up at the same time each day.\n- Regular daytime exercise helps you feel more relaxed and tired at bedtime.\n\nThis section will discuss five topics which can help to promote better sleep:\n\n- Understanding some facts.\n- Sleep hygiene.\n- Relaxation techniques.\n- Daytime exercise.\n- Psychological treatments called cognitive and behavioural therapies.\n\nIn effect, these can be used in a step-wise fashion. You need only go on to the next step if the previous step is not very helpful, but each step requires a greater degree of effort.\n\n### Understanding some facts\nIt is often helpful to understand that short periods of waking each night are normal. Some people are reassured about this and so do not become anxious when they find themselves awake in the night.\n\nAlso, remember that worry about poor sleep can itself make things worse. Also, it is common to have a few bad nights if you have a period of stress, anxiety or worry. This is often just for a short time and a normal sleep pattern often resumes after a few days.\n\n### General tips for sleeping better (often called sleep hygiene)\nThe following are commonly advised to help promote sleep in people with sleep difficulties, and may be all that is necessary:\n\n- **Reduce caffeine** - do not have any food, medicines, or drinks that contain caffeine or other stimulants for six hours before bedtime (see above). Some people have found that cutting out caffeine completely through the day has helped.\n- **Do not smoke** within six hours before bedtime.\n- **Do not drink alcohol** within six hours before bedtime.\n- **Do not have a heavy meal** just before bedtime (although a light snack may be helpful).\n- **Do not do any strenuous exercise within four hours of bedtime** (but exercising earlier in the day is helpful).\n- **Body rhythms** - try to get into a routine of wakefulness during the day and sleepiness at night. The body becomes used to rhythms or routines. If you keep to a pattern, you are more likely to sleep well. Therefore:\n  - No matter how tired you are, do not sleep or nap during the day.\n  - It is best to go to bed only when sleepy-tired in the late evening.\n  - Switch the light out as soon as you get into bed.\n  - Always get up at the same time each day, seven days a week, however short the time asleep. Use an alarm to help with this. Resist the temptation to lie in - even after a poor night's sleep. Do not use weekends to catch up on sleep, as this may upset the natural body rhythm that you have got used to in the week.\n- **The bedroom** should be a quiet, relaxing place to sleep:\n  - It should not be too hot, cold, or noisy.\n  - Earplugs and eye shades may be useful if you are sleeping with a snoring or wakeful partner.\n  - Make sure the bedroom is dark with good curtains to stop early morning sunlight.\n  - Don't use the bedroom for activities such as work, eating or television.\n  - Consider changing your bed if it is old, or not comfortable.\n  - Hide your alarm clock under your bed. Many people will clock-watch and this does not help you to get off to sleep.\n- **Mood and atmosphere** - try to relax and wind down with a routine before going to bed. For example:\n  - A stroll followed by a bath, some reading, and a warm drink (without caffeine) may be relaxing in the late evening.\n  - Do not do anything mentally demanding within 90 minutes of going to bed - such as studying.\n  - Go to bed when sleepy-tired.\n  - Some people find playing soft music is helpful at bedtime. Try a player with a time switch that turns the music off after about 30 minutes.\n- **If you cannot get off to sleep after 20-30 minutes** - then get up. It's best not to just lie in bed, worrying about getting to sleep. Get up and do something you find relaxing until you feel sleepy, and then go back to bed.\n### Relaxation techniques\nThese aim to reduce your mental and physical arousal before going to bed. Relaxation techniques may help even if you are not anxious but find it hard to get off to sleep. There are a number of techniques.\n\nFor example, progressive muscular relaxation has been shown to help promote sleep. This technique consists of tensing and relaxing various muscle groups in sequence. For more information, see the leaflet called [Relaxation exercises.](https:\/\/patient.info\/features\/mental-health\/relaxation-exercises)\n\nYou can find a podcast or app that takes you through deep-breathing exercises, and other methods to help you relax. See Further Reading below.\n\n### Daytime exercise\nRegular daytime exercise can help you to feel more relaxed and tired at bedtime. This may help you to sleep better. (However, you should not do exercise near to bedtime if you have insomnia.) If possible, do some exercise on most days.\n\nEven a walk in the afternoon or early evening is better than nothing. However, ideally, you should aim for at least 30 minutes of moderate exercise on five or more days a week.\n\nModerate exercise means that you get warm and slightly out of breath. You do not need to go to a gym! Brisk walking, jogging, cycling, climbing stairs, heavy DIY, heavy gardening, dancing and heavy housework are all moderate-intensity physical exercises. [See the separate leaflet called Exercise and physical activity](https:\/\/patient.info\/healthy-living\/physical-activity-for-health).\n\n### Behavioural and cognitive therapies\nIf you have severe persistent poor sleep, your doctor may refer you to a psychologist or other health professional for psychological treatments. These are various therapies which help re-train your brain and the way you feel, think or behave.\n\nResearch studies have found that there is a good chance that behavioural and cognitive therapies will improve sleep in adults with insomnia. Increasingly, research has also shown that some of these therapies can be delivered digitally (ie through an app, online, etc).\n\nThere are various types of therapy and they include the following:\n\n**Stimulus-control therapy**. This helps you to re-associate the bed and bedroom with sleep and to re-establish a consistent sleep\/wake pattern.\n\n**Sleep restriction therapy**. Very briefly, the principle of this treatment is that you limit the time that you spend in bed at night. As things improve, the time in bed is then lengthened. An example of the way that this may be done in practice is as follows:\n\n- First, you may be asked to find out how much you are actually sleeping each night. You can do this by keeping a [sleep diary](https:\/\/patient.info\/features\/healthy-living\/sleep-diary).\n- You may then be advised to restrict the amount of time that you spend in bed to the time that you actually sleep each night. For example, if you spend eight hours in bed each night but you sleep for only six hours then your allowed time in bed would be six hours. So, in this example, say you normally go to bed at 11 pm, get to sleep at 1 am and get up at 7 am. To restrict your time in bed to six hours, you may be advised to go to bed at 1 am but still get up at 7 am.\n- You then make weekly adjustments to the allowed time in bed, depending on the time spent asleep. (You need to keep on with the sleep diary.)\n- When 90% of the time spent in bed is spent asleep then the allowed time spent in bed is increased by 15 minutes, by going to bed 15 minutes earlier. In the above example, you would then go to bed at 12.45 am.\n- Adjustments are made each week until you are sleeping for a longer length most nights.\n\n**Relaxation training**. This teaches you ways of reducing tension. For example, this may include the progressive muscle relaxation technique as described earlier, plus various other techniques described earlier.\n\n**Paradoxical intention**. This involves staying passively awake, avoiding any intention to fall asleep. It is used for people who have trouble getting to sleep (but not maintaining sleep).\n\n**Biofeedback**. With this technique, you are connected to electrical sensors which give you feedback by sounds and lights to show you what your body is doing. This is to help you control certain body functions (such as muscle tension).\n\n**Cognitive therapy**. Cognitive therapy is often used in combination with a behavioural intervention (such as stimulus control, sleep restriction, or relaxation training); this is then called [cognitive behavioural therapy (CBT)](https:\/\/patient.info\/mental-health\/cognitive-behavioural-therapy-cbt-leaflet).\n\n[See the separate article CBT for insomnia: how does it work?](https:\/\/patient.info\/features\/healthy-living\/cbt-for-insomnia-how-does-it-work) for more details.\n\n### Accessing sleep-focused therapy\nThere are various different ways to access sleep-focused therapy. What's available on the NHS varies a little depending on where you are.\n\nYour GP may be able to refer you for sessions led by a psychotherapist or psychologist. These can be individual or group sessions, and may be in-person, over the phone, or via video call.\n\nThere are also online courses and apps. Sleepio is one example of an app that uses cognitive behavioural therapy for insomnia (CBT-I). Sleepio was recommended for use by the UK's National Institute for Health and Care Excellence (NICE) in 2022. In some areas of the UK it's available free on the NHS; in other places you may need to pay a subscription.\n\nOther resources include:\n\n- Sleepstation (also available free on the NHS in some areas).\n- Calm, a meditation app (free trial, then paid).\n- Headspace, a guided meditation app (free trial, then paid).\n- Pzizz, an app that aims to help you relax and fall asleep quicker (free download, with in-app purchases and subscription).\n\n[See the separate article How to improve your sleep behaviour](https:\/\/patient.info\/features\/healthy-living\/how-to-improve-your-sleep-behaviour) for more details.\n\n## What about sleeping tablets?\n[Back to contents](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep#toc)\n### Sleeping tablets are not usually advised for insomnia\nThe main types of [sleeping tablets](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep\/sleeping-tablets) are in a class of medicines called benzodiazepines and a class called Z drugs. [To read more about why these medicines may be prescribed, see the separate leaflet called Benzodiazepines and Z drugs](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep\/benzodiazepines-and-z-drugs).\n\nIn the past, sleeping tablets were commonly prescribed. However, they have been shown to have problems and are now not commonly prescribed.\n\nIf a sleeping tablet is prescribed, it is usually just a short course (a week or so) to get over a particularly bad patch.\n\nPossible problems with sleeping tablets include:\n\n- Drowsiness the next day. You may not be safe to drive or to operate machinery.\n- Clumsiness and confusion in the night if you have to get up. For example, if you have had a sleeping tablet, you may fall over if you get up in the night to go to the toilet. (Older people who take sleeping tablets have an increased risk of falling and breaking their hip.)\n- Tolerance to sleeping tablets may develop if you take them regularly. This means that, in time, the usual dose has no effect. You then need a higher dose to help with sleep. In time, the higher dose then has no effect, and so on.\n- Some people become addicted to (dependent on) sleeping tablets and have withdrawal symptoms if the tablets are stopped suddenly.\n\nOther medicines that may be used to help sleep include [melatonin](https:\/\/patient.info\/medicine\/melatonin-tablets-for-insomnia-adaflex-circadin) and some [antihistamines](https:\/\/patient.info\/allergies-blood-immune\/allergies\/antihistamines).\n\nHerbal remedies are used by some people to help with sleep. For example, valerian.\n\nHowever, research studies have shown that there is very little evidence to show that these work. Therefore, they are not recommended.\n\nLong-term use of sleeping tablets has been linked with serious health problems, such as an increased risk of dementia, and an increased risk of earlier death.\n\nIf you've been taking sleeping tablets for a long time, your doctor should regularly review them with you, including discussing the benefits and harms. If you want to stop, they are no longer helping, or they are becoming harmful, your doctor may suggest stopping them - usually in a gradual way and with support.\n\n## A final note\n[Back to contents](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep#toc)\n\n**See a doctor if you feel that illness or medication is causing poor sleep**. Treating any underlying condition that is causing the problem, if possible, can help to promote sleep. In particular, depression and anxiety are common causes of poor sleep and can often be treated.\n\n#### Patient picks for [Sleep and insomnia](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep)\n[![Sleep debt calculator](https:\/\/patient.info\/images\/default_image.png)Healthy living Sleep debt calculator Open the sleep debt calculator. by Patient infomatics team](https:\/\/patient.info\/healthy-living\/sleep-debt-calculator)\n\n[![Sleeping tablets](https:\/\/patient.info\/images\/default_image.png)Healthy living Sleeping tablets Doctors avoid prescribing sleeping tablets if possible due to the problems they can cause and the concern that you could become dependent on them. by Dr Colin Tidy, MRCGP](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep\/sleeping-tablets)\n\n### Further reading and references\n- [Buysse DJ, Germain A, Moul DE, et al](http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=21263078)\n  ; Efficacy of brief behavioral treatment for chronic insomnia in older adults. Arch Intern Med. 2011 May 23;171(10):887-95. Epub 2011 Jan 24.\n- [Buysse DJ](http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=23423416)\n  ; Insomnia. JAMA. 2013 Feb 20;309(7):706-16. doi: 10.1001\/jama.2013.193.\n- [Luik AI, Kyle SD, Espie CA](http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=28553574)\n  ; Digital Cognitive Behavioral Therapy (dCBT) for Insomnia: a State-of-the-Science Review. Curr Sleep Med Rep. 2017;3(2):48-56. doi: 10.1007\/s40675-017-0065-4. Epub 2017 May 8.\n- [Qaseem A, Kansagara D, Forciea MA, et al](https:\/\/www.acpjournals.org\/doi\/10.7326\/m15-2175)\n  ; Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2016 Jul 19;165(2):125-33. doi: 10.7326\/M15-2175. Epub 2016 May 3.\n- [Wilson S, Anderson K, Baldwin D, et al](http:\/\/www.ncbi.nlm.nih.gov\/entrez\/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=31271339)\n  ; British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update. J Psychopharmacol. 2019 Aug;33(8):923-947. doi: 10.1177\/0269881119855343. Epub 2019 Jul 4.\n- [Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults](https:\/\/www.nice.org.uk\/guidance\/ng215)\n  ; NICE guidance (April 2022)\n- [Sleepio to treat insomnia and insomnia symptoms](https:\/\/www.nice.org.uk\/guidance\/mtg70)\n  ; NICE medical technologies guidance, May 2022\n- [Insomnia](https:\/\/cks.nice.org.uk\/topics\/insomnia\/)\n  ; NICE CKS, April 2024 (UK access only)\n- [Sleep Diary](https:\/\/thesleepcharity.org.uk\/wp-content\/uploads\/The-Sleep-Charity-Sleep-Diary.pdf)\n  ; The Sleep Charity.\n- Sleepio app\n- Sleepstation app\n- Calm app\n- Headspace app\n- Pzizz app\n\n## Article history\nThe information on this page is written and peer reviewed by qualified clinicians.\n\n- ###### Next review due: 22 Jun 2027\n- ###### 23 Jun 2024 \\| Latest version\n  Last updated by\n  \n  [Dr Doug McKechnie, MRCGP](https:\/\/patient.info\/authors\/dr-doug-mckechnie)\n  \n  Peer reviewed by\n  \n  [Dr Colin Tidy, MRCGP](https:\/\/patient.info\/authors\/dr-colin-tidy)\n\n## Join the conversation\nShare your thoughts or experiences with others in our [patient communities.](https:\/\/community.patient.info\/)\n\n**Disclaimer:** The views expressed in the community do not represent medical advice. For any health concerns, consult your GP or healthcare provider.\n\n![flu eligibility checker](https:\/\/images.ctfassets.net\/xxv4b9mbhlgd\/67ZL1sw5SwXVH5pETgnbmd\/00adebe6fc9061807a7a9a14f77bcd68\/Untitled_design-24.png)\n\n#### Ask, share, connect.\nBrowse discussions, ask questions, and share experiences across hundreds of health topics.\n\nBrowse forums\n\n![symptom checker](https:\/\/images.ctfassets.net\/xxv4b9mbhlgd\/4YO2oGN3nTyecJaazD5OMM\/a915fdc3dae8d6afe9c93dcfa4c2cfcf\/Desktop.png)\n\n#### Feeling unwell?\nAssess your symptoms online with our free symptom checker\n\nCheck symptoms\n\n#### Sign up to the Patient newsletter\nYour weekly dose of clear, trustworthy health advice - written to help you feel informed, confident and in control.\n\nBy subscribing you accept our [Privacy Policy](https:\/\/patient.info\/privacy-policy). You can unsubscribe at any time. We never sell your data.\n\nOur clinical information meets the standards set by the NHS in their Standard for Creating Health Content guidance.  \n[Read our editorial policy.](https:\/\/patient.info\/editorial-policy)\n\n## Download the Patient app\nFollow us\n\nPatient\n\n[Subscribe to health updates](https:\/\/patient.info\/newsletter)[About us](https:\/\/patient.info\/about-us)[Advertise with us](https:\/\/patient.info\/commercial-opportunities)[Partnerships and collaboration](https:\/\/patient.info\/partnerships)[Authors](https:\/\/patient.info\/authors)[RSS feeds](https:\/\/patient.info\/rss-feeds)[International sites](https:\/\/patient.info\/language)[Contact us](https:\/\/patient.info\/contact-us)\n\nLegal\n\n[Accessibility statement](https:\/\/patient.info\/accessibility-statement)[Cookie policy](https:\/\/patient.info\/cookies)[Privacy policy](https:\/\/patient.info\/privacy-policy)[Terms of use](https:\/\/patient.info\/terms-and-conditions)[Editorial policy](https:\/\/patient.info\/editorial-policy)[Affiliate policy](https:\/\/patient.info\/affiliate-links)\n\nFollow us\n\n**Disclosure:** Some of the links in this article are affiliate links. If you click on a link and make a purchase, Patient.info may earn a small commission at no additional cost to you. This does not influence our editorial content or medical recommendations. [Read more about how we fund our work.](https:\/\/patient.info\/affiliate-links)\n\nPatient is a part of [![Navigate Health](https:\/\/patient.info\/logo-navigate-health.svg)](https:\/\/www.navigatehealth.co.uk\/)\n\n© 2026 Navigate Health Ltd. All rights reserved.  \n Registered number: 16229589  \n Registered office: 128 City Road, London, United Kingdom, EC1V 2NX.\n\nPatient is a UK registered trade mark.\n\nPatient does not provide medical advice, diagnosis or treatment.","attrs_readable_markdown":"What is insomnia?\n\nInsomnia means poor sleep. About one third of adults do not get as much sleep as they would like. Poor sleep can mean:\n\n- Not being able to get off to sleep.\n- Waking up too early.\n- Waking for long periods in the night.\n- Not feeling refreshed after a night's sleep.\n\nIf you have poor sleep, particularly over a long period of time, it can severely affect your life, as it can cause:\n\n- [Tiredness (fatigue)](https:\/\/patient.info\/signs-symptoms\/tiredness-fatigue) and loss of energy in the daytime.\n- Poor concentration.\n- Loss of interest in usual activities.\n- Irritability.\n- [Depression](https:\/\/patient.info\/mental-health\/depression-leaflet) and [anxiety](https:\/\/patient.info\/mental-health\/anxiety).\n- Inability to do things as well or as much as usual - for example, work, social activities, exercise. Errors might occur at work or whilst driving, which could have serious consequences.\n- A worse quality of life.\n\nDifferent people need different amounts of sleep. Children need more sleep than adults. For adults, the minimum we need is about 6 hours per night. On average, most adults need between 6 and 9 hours of sleep to feel refreshed.\n\nMost people establish a pattern that is normal for them in their early adult life. However, as you become older, it is normal to sleep less. For most people it takes less than thirty minutes to fall asleep.\n\nSo, everyone is different. What is important is that the amount of sleep that you get should be sufficient for you, and that you usually feel refreshed and not sleepy during the daytime. Therefore, the strict medical definition of insomnia is: 'Difficulty in getting to sleep, difficulty staying asleep, early wakening, or non-restorative sleep despite adequate time and opportunity to sleep, resulting in impaired daytime functioning, such as poor concentration, mood disturbance, and daytime tiredness.'\n\nFurther ways to promote sleep in more difficult cases include relaxation techniques, regular exercise and certain psychological therapies.\n\nSleeping tablets are not the best way to help with sleep problems because they don't fix the cause of insomnia, you can get addicted to them, and they often stop working if you take them regularly.\n\nA normal night's sleep has three main parts:\n\n- **Quiet sleep.** This is divided into stages 1-4. Each stage becomes more deep. Quiet sleep is sometimes called deep sleep.\n- **Rapid eye movement (REM) sleep.** REM sleep occurs when the brain is very active but the body is limp, apart from the eyes which move rapidly. Most dreaming occurs during REM sleep.\n- **Short periods of waking for 1-2 minutes.**\n\nEach night, about 4-5 periods of quiet sleep alternate with 4-5 periods of REM sleep. In addition, several short periods of waking for 1-2 minutes occur about every two hours or so, but occur more frequently towards the end of the night's sleep. The graph below shows a typical normal pattern of sleep in a young adult.\n\nHypnogram\n\n![Hypnogram - a chart of a normal night's sleep](https:\/\/patient.info\/images\/default_image.png)\n\nNormally, you do not remember the times that you wake if they last less than two minutes. If you are distracted during the wakeful times (for example, a partner snoring, traffic noise, etc) then the wakeful times tend to last longer and you are more likely to remember them.\n\nPoor sleep may develop for no apparent reason. However, there are a number of possible causes which include the following:\n\n### Concern about wakefulness\nYou may remember the normal times of being awake in the night. You may feel that to wake in the night is not normal, and worry about getting back off to sleep. You may clock-watch and check the time each time you wake up.\n\nThis may make you irritated or anxious, and you are more likely to remember the times of wakefulness. You may then have an impression of having a bad night's sleep, even when the total amount of time asleep was normal.\n\n### Temporary problems\nPoor sleep is often temporary. This may be because of stress, a work or family problem, jet lag, a change of routine, a new baby, a strange bed, etc. Poor sleep in these situations usually improves in time.\n\n### Stress, anxiety or depression\nYou may find it difficult to switch off your [anxieties](https:\/\/patient.info\/mental-health\/anxiety) about work, home or personal problems. Also, poor sleep is sometimes due to [depression](https:\/\/patient.info\/mental-health\/depression-leaflet). Other symptoms of depression include a low mood, lethargy, poor concentration, tearfulness and persistent negative thoughts. Depression is common. Treatment of depression or anxiety often cures the poor sleep too.\n\n### Sleep apnoea\nThis sometimes occurs in people who snore, most commonly in obese people. In this condition the large airways narrow or collapse as you fall asleep. This not only causes snoring but also reduces the amount of oxygen that gets to the lungs.\n\nThis causes you to wake up to breathe properly. You may wake up many times each night which may result in daytime tiredness. [See the separate leaflet called Sleep apnoea](https:\/\/patient.info\/signs-symptoms\/tiredness-fatigue\/obstructive-sleep-apnoea-syndrome). **Note**: most people who snore do not have sleep apnoea and they do sleep well.\n\n### Other illnesses\nVarious illnesses keep some people awake. For example, illness causing pain, [leg cramps](https:\/\/patient.info\/bones-joints-muscles\/cramps-in-the-leg), breathlessness, [indigestion](https:\/\/patient.info\/digestive-health\/dyspepsia-indigestion), [cough](https:\/\/patient.info\/chest-lungs\/cough-leaflet), itch, hot flushes, mental health problems, etc.\n\n### Stimulants\nThese can interfere with sleep. There are three common culprits.\n\n- [**Alcohol**](https:\/\/patient.info\/healthy-living\/alcohol-and-liver-disease\/alcohol-and-sensible-drinking) - many people take an alcoholic drink to help sleep. Alcohol does help you get to sleep quicker, but then causes broken, poor-quality sleep and early morning wakefulness.\n- **Caffeine** - which is in tea, coffee, some soft drinks such as cola, and even chocolate. It is also in some painkiller tablets and other medicines (check the ingredients on the medicine packet). Caffeine is a stimulant and may cause poor sleep.\n- **Nicotine** (from [smoking](https:\/\/patient.info\/healthy-living\/quit-smoking-cessation)) is a stimulant, so it would help not to smoke.\n### Other recreational drugs\n[Other recreational drugs](https:\/\/patient.info\/healthy-living\/recreational-drugs) (for example, ecstasy, cocaine, cannabis and amphetamines) can affect sleep.\n\n### Prescribed medicines\nSome medicines sometimes interfere with sleep. For example, 'water tablets' (diuretics), some antidepressants, [steroids](https:\/\/patient.info\/treatment-medication\/steroids), [beta-blockers](https:\/\/patient.info\/heart-health\/beta-blockers), painkillers containing caffeine, and some cold remedies containing pseudoephedrine. Also, if you suddenly stop taking regular sleeping tablets or other sedative medicines, this can cause rebound poor sleep.\n\n### Screen time\nThere is some evidence that the time we spend looking at electronic screens can affect our sleep. It may be that certain types of light from e-readers and electronic tablets can disrupt control of our natural day-and-night cycle.\n\nThere are studies which suggest we may sleep better after reading a printed book or a particular kind of screen before bedtime. There are also some studies which show that in children and adolescents, more time using electronic devices in the daytime is linked to less good sleep at night. It's best to avoid using screens within an hour or two of bed. Try to keep devices like phones and laptops out of reach of the bed, or, ideally, outside the bedroom entirely.\n\n### Unrealistic expectations\nSome people just need less sleep than others. If your sleep pattern has not changed, and you do not feel sleepy during the day, you are probably getting enough sleep. Older people and people who do little exercise tend to need less sleep. Some people think they should be able to nap during the day - and sleep eight hours at night\\!\n\n### A vicious cycle\nWhatever the initial cause, worry about poor sleep and worry about feeling tired the next day are common reasons for the problem to become worse.\n\n### Sleep paralysis\nSome people may also experience waking from sleep but then being unable to move or speak for a period of time. Some people experience the same problems when they are falling asleep. [See the separate leaflet called Sleep paralysis](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep\/sleep-paralysis).\n\nThere are different definitions and classifications of poor sleep (insomnia) around, which can make things confusing. Doctors may classify insomnia into one of the following categories:\n\n### By type\n- Primary insomnia is insomnia that occurs when no illness or other secondary cause (comorbidity) is identified. Primary insomnia accounts for about one in five cases of long-term insomnia.\n- Secondary (or comorbid) insomnia occurs when insomnia is a symptom of, or is associated with, other conditions. These can be medical or mental health conditions, or drug or substance misuse (as discussed above).\n### By duration\n- Short-term if insomnia lasts days to weeks, and up to three months.\n- Long-term (or persistent) if insomnia lasts for three months or longer.\n### By a combination of factors\nSome authorities use the term 'chronic insomnia disorder'. To have this diagnosis, you would:\n\n- Have problems sleeping for at least three nights a week for at least three months.\n- Be distressed or have problems functioning due to your sleeping problem.\n- Not have another condition which could affect sleep, ie mental or physical illnesses or another sleep disorder.\n\n- Avoid caffeine, smoking and alcohol, especially in the hours before bedtime.\n- Avoid heavy meals or strenuous exercise shortly before going to bed.\n- Go to bed and get up at the same time each day.\n- Regular daytime exercise helps you feel more relaxed and tired at bedtime.\n\nThis section will discuss five topics which can help to promote better sleep:\n\n- Understanding some facts.\n- Sleep hygiene.\n- Relaxation techniques.\n- Daytime exercise.\n- Psychological treatments called cognitive and behavioural therapies.\n\nIn effect, these can be used in a step-wise fashion. You need only go on to the next step if the previous step is not very helpful, but each step requires a greater degree of effort.\n\n### Understanding some facts\nIt is often helpful to understand that short periods of waking each night are normal. Some people are reassured about this and so do not become anxious when they find themselves awake in the night.\n\nAlso, remember that worry about poor sleep can itself make things worse. Also, it is common to have a few bad nights if you have a period of stress, anxiety or worry. This is often just for a short time and a normal sleep pattern often resumes after a few days.\n\n### General tips for sleeping better (often called sleep hygiene)\nThe following are commonly advised to help promote sleep in people with sleep difficulties, and may be all that is necessary:\n\n- **Reduce caffeine** - do not have any food, medicines, or drinks that contain caffeine or other stimulants for six hours before bedtime (see above). Some people have found that cutting out caffeine completely through the day has helped.\n- **Do not smoke** within six hours before bedtime.\n- **Do not drink alcohol** within six hours before bedtime.\n- **Do not have a heavy meal** just before bedtime (although a light snack may be helpful).\n- **Do not do any strenuous exercise within four hours of bedtime** (but exercising earlier in the day is helpful).\n- **Body rhythms** - try to get into a routine of wakefulness during the day and sleepiness at night. The body becomes used to rhythms or routines. If you keep to a pattern, you are more likely to sleep well. Therefore:\n  - No matter how tired you are, do not sleep or nap during the day.\n  - It is best to go to bed only when sleepy-tired in the late evening.\n  - Switch the light out as soon as you get into bed.\n  - Always get up at the same time each day, seven days a week, however short the time asleep. Use an alarm to help with this. Resist the temptation to lie in - even after a poor night's sleep. Do not use weekends to catch up on sleep, as this may upset the natural body rhythm that you have got used to in the week.\n- **The bedroom** should be a quiet, relaxing place to sleep:\n  - It should not be too hot, cold, or noisy.\n  - Earplugs and eye shades may be useful if you are sleeping with a snoring or wakeful partner.\n  - Make sure the bedroom is dark with good curtains to stop early morning sunlight.\n  - Don't use the bedroom for activities such as work, eating or television.\n  - Consider changing your bed if it is old, or not comfortable.\n  - Hide your alarm clock under your bed. Many people will clock-watch and this does not help you to get off to sleep.\n- **Mood and atmosphere** - try to relax and wind down with a routine before going to bed. For example:\n  - A stroll followed by a bath, some reading, and a warm drink (without caffeine) may be relaxing in the late evening.\n  - Do not do anything mentally demanding within 90 minutes of going to bed - such as studying.\n  - Go to bed when sleepy-tired.\n  - Some people find playing soft music is helpful at bedtime. Try a player with a time switch that turns the music off after about 30 minutes.\n- **If you cannot get off to sleep after 20-30 minutes** - then get up. It's best not to just lie in bed, worrying about getting to sleep. Get up and do something you find relaxing until you feel sleepy, and then go back to bed.\n### Relaxation techniques\nThese aim to reduce your mental and physical arousal before going to bed. Relaxation techniques may help even if you are not anxious but find it hard to get off to sleep. There are a number of techniques.\n\nFor example, progressive muscular relaxation has been shown to help promote sleep. This technique consists of tensing and relaxing various muscle groups in sequence. For more information, see the leaflet called [Relaxation exercises.](https:\/\/patient.info\/features\/mental-health\/relaxation-exercises)\n\nYou can find a podcast or app that takes you through deep-breathing exercises, and other methods to help you relax. See Further Reading below.\n\n### Daytime exercise\nRegular daytime exercise can help you to feel more relaxed and tired at bedtime. This may help you to sleep better. (However, you should not do exercise near to bedtime if you have insomnia.) If possible, do some exercise on most days.\n\nEven a walk in the afternoon or early evening is better than nothing. However, ideally, you should aim for at least 30 minutes of moderate exercise on five or more days a week.\n\nModerate exercise means that you get warm and slightly out of breath. You do not need to go to a gym! Brisk walking, jogging, cycling, climbing stairs, heavy DIY, heavy gardening, dancing and heavy housework are all moderate-intensity physical exercises. [See the separate leaflet called Exercise and physical activity](https:\/\/patient.info\/healthy-living\/physical-activity-for-health).\n\n### Behavioural and cognitive therapies\nIf you have severe persistent poor sleep, your doctor may refer you to a psychologist or other health professional for psychological treatments. These are various therapies which help re-train your brain and the way you feel, think or behave.\n\nResearch studies have found that there is a good chance that behavioural and cognitive therapies will improve sleep in adults with insomnia. Increasingly, research has also shown that some of these therapies can be delivered digitally (ie through an app, online, etc).\n\nThere are various types of therapy and they include the following:\n\n**Stimulus-control therapy**. This helps you to re-associate the bed and bedroom with sleep and to re-establish a consistent sleep\/wake pattern.\n\n**Sleep restriction therapy**. Very briefly, the principle of this treatment is that you limit the time that you spend in bed at night. As things improve, the time in bed is then lengthened. An example of the way that this may be done in practice is as follows:\n\n- First, you may be asked to find out how much you are actually sleeping each night. You can do this by keeping a [sleep diary](https:\/\/patient.info\/features\/healthy-living\/sleep-diary).\n- You may then be advised to restrict the amount of time that you spend in bed to the time that you actually sleep each night. For example, if you spend eight hours in bed each night but you sleep for only six hours then your allowed time in bed would be six hours. So, in this example, say you normally go to bed at 11 pm, get to sleep at 1 am and get up at 7 am. To restrict your time in bed to six hours, you may be advised to go to bed at 1 am but still get up at 7 am.\n- You then make weekly adjustments to the allowed time in bed, depending on the time spent asleep. (You need to keep on with the sleep diary.)\n- When 90% of the time spent in bed is spent asleep then the allowed time spent in bed is increased by 15 minutes, by going to bed 15 minutes earlier. In the above example, you would then go to bed at 12.45 am.\n- Adjustments are made each week until you are sleeping for a longer length most nights.\n\n**Relaxation training**. This teaches you ways of reducing tension. For example, this may include the progressive muscle relaxation technique as described earlier, plus various other techniques described earlier.\n\n**Paradoxical intention**. This involves staying passively awake, avoiding any intention to fall asleep. It is used for people who have trouble getting to sleep (but not maintaining sleep).\n\n**Biofeedback**. With this technique, you are connected to electrical sensors which give you feedback by sounds and lights to show you what your body is doing. This is to help you control certain body functions (such as muscle tension).\n\n**Cognitive therapy**. Cognitive therapy is often used in combination with a behavioural intervention (such as stimulus control, sleep restriction, or relaxation training); this is then called [cognitive behavioural therapy (CBT)](https:\/\/patient.info\/mental-health\/cognitive-behavioural-therapy-cbt-leaflet).\n\n[See the separate article CBT for insomnia: how does it work?](https:\/\/patient.info\/features\/healthy-living\/cbt-for-insomnia-how-does-it-work) for more details.\n\n### Accessing sleep-focused therapy\nThere are various different ways to access sleep-focused therapy. What's available on the NHS varies a little depending on where you are.\n\nYour GP may be able to refer you for sessions led by a psychotherapist or psychologist. These can be individual or group sessions, and may be in-person, over the phone, or via video call.\n\nThere are also online courses and apps. Sleepio is one example of an app that uses cognitive behavioural therapy for insomnia (CBT-I). Sleepio was recommended for use by the UK's National Institute for Health and Care Excellence (NICE) in 2022. In some areas of the UK it's available free on the NHS; in other places you may need to pay a subscription.\n\nOther resources include:\n\n- Sleepstation (also available free on the NHS in some areas).\n- Calm, a meditation app (free trial, then paid).\n- Headspace, a guided meditation app (free trial, then paid).\n- Pzizz, an app that aims to help you relax and fall asleep quicker (free download, with in-app purchases and subscription).\n\n[See the separate article How to improve your sleep behaviour](https:\/\/patient.info\/features\/healthy-living\/how-to-improve-your-sleep-behaviour) for more details.\n\n### Sleeping tablets are not usually advised for insomnia\nThe main types of [sleeping tablets](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep\/sleeping-tablets) are in a class of medicines called benzodiazepines and a class called Z drugs. [To read more about why these medicines may be prescribed, see the separate leaflet called Benzodiazepines and Z drugs](https:\/\/patient.info\/mental-health\/insomnia-poor-sleep\/benzodiazepines-and-z-drugs).\n\nIn the past, sleeping tablets were commonly prescribed. However, they have been shown to have problems and are now not commonly prescribed.\n\nIf a sleeping tablet is prescribed, it is usually just a short course (a week or so) to get over a particularly bad patch.\n\nPossible problems with sleeping tablets include:\n\n- Drowsiness the next day. You may not be safe to drive or to operate machinery.\n- Clumsiness and confusion in the night if you have to get up. For example, if you have had a sleeping tablet, you may fall over if you get up in the night to go to the toilet. (Older people who take sleeping tablets have an increased risk of falling and breaking their hip.)\n- Tolerance to sleeping tablets may develop if you take them regularly. This means that, in time, the usual dose has no effect. You then need a higher dose to help with sleep. In time, the higher dose then has no effect, and so on.\n- Some people become addicted to (dependent on) sleeping tablets and have withdrawal symptoms if the tablets are stopped suddenly.\n\nOther medicines that may be used to help sleep include [melatonin](https:\/\/patient.info\/medicine\/melatonin-tablets-for-insomnia-adaflex-circadin) and some [antihistamines](https:\/\/patient.info\/allergies-blood-immune\/allergies\/antihistamines).\n\nHerbal remedies are used by some people to help with sleep. For example, valerian.\n\nHowever, research studies have shown that there is very little evidence to show that these work. Therefore, they are not recommended.\n\nLong-term use of sleeping tablets has been linked with serious health problems, such as an increased risk of dementia, and an increased risk of earlier death.\n\nIf you've been taking sleeping tablets for a long time, your doctor should regularly review them with you, including discussing the benefits and harms. If you want to stop, they are no longer helping, or they are becoming harmful, your doctor may suggest stopping them - usually in a gradual way and with support.\n\n**See a doctor if you feel that illness or medication is causing poor sleep**. Treating any underlying condition that is causing the problem, if possible, can help to promote sleep. In particular, depression and anxiety are common causes of poor sleep and can often be treated.","meta_canonical":null}

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URL	https://patient.info/mental-health/insomnia-poor-sleep
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First Indexed	2019-03-11 12:34:28 (7 years ago)
HTTP Status Code	200
Meta Title	Insomnia (Poor Sleep): Causes, Types, and Treatment
Meta Description	As many as one in three people can have insomnia or some difficulty with sleeping. However, there are many things you can do to help yourself. Written by a GP.
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Boilerpipe Text	What is insomnia? Insomnia means poor sleep. About one third of adults do not get as much sleep as they would like. Poor sleep can mean: Not being able to get off to sleep. Waking up too early. Waking for long periods in the night. Not feeling refreshed after a night's sleep. If you have poor sleep, particularly over a long period of time, it can severely affect your life, as it can cause: Tiredness (fatigue) and loss of energy in the daytime. Poor concentration. Loss of interest in usual activities. Irritability. Depression and anxiety . Inability to do things as well or as much as usual - for example, work, social activities, exercise. Errors might occur at work or whilst driving, which could have serious consequences. A worse quality of life. Different people need different amounts of sleep. Children need more sleep than adults. For adults, the minimum we need is about 6 hours per night. On average, most adults need between 6 and 9 hours of sleep to feel refreshed. Most people establish a pattern that is normal for them in their early adult life. However, as you become older, it is normal to sleep less. For most people it takes less than thirty minutes to fall asleep. So, everyone is different. What is important is that the amount of sleep that you get should be sufficient for you, and that you usually feel refreshed and not sleepy during the daytime. Therefore, the strict medical definition of insomnia is: 'Difficulty in getting to sleep, difficulty staying asleep, early wakening, or non-restorative sleep despite adequate time and opportunity to sleep, resulting in impaired daytime functioning, such as poor concentration, mood disturbance, and daytime tiredness.' Further ways to promote sleep in more difficult cases include relaxation techniques, regular exercise and certain psychological therapies. Sleeping tablets are not the best way to help with sleep problems because they don't fix the cause of insomnia, you can get addicted to them, and they often stop working if you take them regularly. A normal night's sleep has three main parts: Quiet sleep. This is divided into stages 1-4. Each stage becomes more deep. Quiet sleep is sometimes called deep sleep. Rapid eye movement (REM) sleep. REM sleep occurs when the brain is very active but the body is limp, apart from the eyes which move rapidly. Most dreaming occurs during REM sleep. Short periods of waking for 1-2 minutes. Each night, about 4-5 periods of quiet sleep alternate with 4-5 periods of REM sleep. In addition, several short periods of waking for 1-2 minutes occur about every two hours or so, but occur more frequently towards the end of the night's sleep. The graph below shows a typical normal pattern of sleep in a young adult. Hypnogram Normally, you do not remember the times that you wake if they last less than two minutes. If you are distracted during the wakeful times (for example, a partner snoring, traffic noise, etc) then the wakeful times tend to last longer and you are more likely to remember them. Poor sleep may develop for no apparent reason. However, there are a number of possible causes which include the following: Concern about wakefulness You may remember the normal times of being awake in the night. You may feel that to wake in the night is not normal, and worry about getting back off to sleep. You may clock-watch and check the time each time you wake up. This may make you irritated or anxious, and you are more likely to remember the times of wakefulness. You may then have an impression of having a bad night's sleep, even when the total amount of time asleep was normal. Temporary problems Poor sleep is often temporary. This may be because of stress, a work or family problem, jet lag, a change of routine, a new baby, a strange bed, etc. Poor sleep in these situations usually improves in time. Stress, anxiety or depression You may find it difficult to switch off your anxieties about work, home or personal problems. Also, poor sleep is sometimes due to depression . Other symptoms of depression include a low mood, lethargy, poor concentration, tearfulness and persistent negative thoughts. Depression is common. Treatment of depression or anxiety often cures the poor sleep too. Sleep apnoea This sometimes occurs in people who snore, most commonly in obese people. In this condition the large airways narrow or collapse as you fall asleep. This not only causes snoring but also reduces the amount of oxygen that gets to the lungs. This causes you to wake up to breathe properly. You may wake up many times each night which may result in daytime tiredness. See the separate leaflet called Sleep apnoea . Note : most people who snore do not have sleep apnoea and they do sleep well. Other illnesses Various illnesses keep some people awake. For example, illness causing pain, leg cramps , breathlessness, indigestion , cough , itch, hot flushes, mental health problems, etc. Stimulants These can interfere with sleep. There are three common culprits. Alcohol - many people take an alcoholic drink to help sleep. Alcohol does help you get to sleep quicker, but then causes broken, poor-quality sleep and early morning wakefulness. Caffeine - which is in tea, coffee, some soft drinks such as cola, and even chocolate. It is also in some painkiller tablets and other medicines (check the ingredients on the medicine packet). Caffeine is a stimulant and may cause poor sleep. Nicotine (from smoking ) is a stimulant, so it would help not to smoke. Other recreational drugs Other recreational drugs (for example, ecstasy, cocaine, cannabis and amphetamines) can affect sleep. Prescribed medicines Some medicines sometimes interfere with sleep. For example, 'water tablets' (diuretics), some antidepressants, steroids , beta-blockers , painkillers containing caffeine, and some cold remedies containing pseudoephedrine. Also, if you suddenly stop taking regular sleeping tablets or other sedative medicines, this can cause rebound poor sleep. Screen time There is some evidence that the time we spend looking at electronic screens can affect our sleep. It may be that certain types of light from e-readers and electronic tablets can disrupt control of our natural day-and-night cycle. There are studies which suggest we may sleep better after reading a printed book or a particular kind of screen before bedtime. There are also some studies which show that in children and adolescents, more time using electronic devices in the daytime is linked to less good sleep at night. It's best to avoid using screens within an hour or two of bed. Try to keep devices like phones and laptops out of reach of the bed, or, ideally, outside the bedroom entirely. Unrealistic expectations Some people just need less sleep than others. If your sleep pattern has not changed, and you do not feel sleepy during the day, you are probably getting enough sleep. Older people and people who do little exercise tend to need less sleep. Some people think they should be able to nap during the day - and sleep eight hours at night! A vicious cycle Whatever the initial cause, worry about poor sleep and worry about feeling tired the next day are common reasons for the problem to become worse. Sleep paralysis Some people may also experience waking from sleep but then being unable to move or speak for a period of time. Some people experience the same problems when they are falling asleep. See the separate leaflet called Sleep paralysis . There are different definitions and classifications of poor sleep (insomnia) around, which can make things confusing. Doctors may classify insomnia into one of the following categories: By type Primary insomnia is insomnia that occurs when no illness or other secondary cause (comorbidity) is identified. Primary insomnia accounts for about one in five cases of long-term insomnia. Secondary (or comorbid) insomnia occurs when insomnia is a symptom of, or is associated with, other conditions. These can be medical or mental health conditions, or drug or substance misuse (as discussed above). By duration Short-term if insomnia lasts days to weeks, and up to three months. Long-term (or persistent) if insomnia lasts for three months or longer. By a combination of factors Some authorities use the term 'chronic insomnia disorder'. To have this diagnosis, you would: Have problems sleeping for at least three nights a week for at least three months. Be distressed or have problems functioning due to your sleeping problem. Not have another condition which could affect sleep, ie mental or physical illnesses or another sleep disorder. Avoid caffeine, smoking and alcohol, especially in the hours before bedtime. Avoid heavy meals or strenuous exercise shortly before going to bed. Go to bed and get up at the same time each day. Regular daytime exercise helps you feel more relaxed and tired at bedtime. This section will discuss five topics which can help to promote better sleep: Understanding some facts. Sleep hygiene. Relaxation techniques. Daytime exercise. Psychological treatments called cognitive and behavioural therapies. In effect, these can be used in a step-wise fashion. You need only go on to the next step if the previous step is not very helpful, but each step requires a greater degree of effort. Understanding some facts It is often helpful to understand that short periods of waking each night are normal. Some people are reassured about this and so do not become anxious when they find themselves awake in the night. Also, remember that worry about poor sleep can itself make things worse. Also, it is common to have a few bad nights if you have a period of stress, anxiety or worry. This is often just for a short time and a normal sleep pattern often resumes after a few days. General tips for sleeping better (often called sleep hygiene) The following are commonly advised to help promote sleep in people with sleep difficulties, and may be all that is necessary: Reduce caffeine - do not have any food, medicines, or drinks that contain caffeine or other stimulants for six hours before bedtime (see above). Some people have found that cutting out caffeine completely through the day has helped. Do not smoke within six hours before bedtime. Do not drink alcohol within six hours before bedtime. Do not have a heavy meal just before bedtime (although a light snack may be helpful). Do not do any strenuous exercise within four hours of bedtime (but exercising earlier in the day is helpful). Body rhythms - try to get into a routine of wakefulness during the day and sleepiness at night. The body becomes used to rhythms or routines. If you keep to a pattern, you are more likely to sleep well. Therefore: No matter how tired you are, do not sleep or nap during the day. It is best to go to bed only when sleepy-tired in the late evening. Switch the light out as soon as you get into bed. Always get up at the same time each day, seven days a week, however short the time asleep. Use an alarm to help with this. Resist the temptation to lie in - even after a poor night's sleep. Do not use weekends to catch up on sleep, as this may upset the natural body rhythm that you have got used to in the week. The bedroom should be a quiet, relaxing place to sleep: It should not be too hot, cold, or noisy. Earplugs and eye shades may be useful if you are sleeping with a snoring or wakeful partner. Make sure the bedroom is dark with good curtains to stop early morning sunlight. Don't use the bedroom for activities such as work, eating or television. Consider changing your bed if it is old, or not comfortable. Hide your alarm clock under your bed. Many people will clock-watch and this does not help you to get off to sleep. Mood and atmosphere - try to relax and wind down with a routine before going to bed. For example: A stroll followed by a bath, some reading, and a warm drink (without caffeine) may be relaxing in the late evening. Do not do anything mentally demanding within 90 minutes of going to bed - such as studying. Go to bed when sleepy-tired. Some people find playing soft music is helpful at bedtime. Try a player with a time switch that turns the music off after about 30 minutes. If you cannot get off to sleep after 20-30 minutes - then get up. It's best not to just lie in bed, worrying about getting to sleep. Get up and do something you find relaxing until you feel sleepy, and then go back to bed. Relaxation techniques These aim to reduce your mental and physical arousal before going to bed. Relaxation techniques may help even if you are not anxious but find it hard to get off to sleep. There are a number of techniques. For example, progressive muscular relaxation has been shown to help promote sleep. This technique consists of tensing and relaxing various muscle groups in sequence. For more information, see the leaflet called Relaxation exercises. You can find a podcast or app that takes you through deep-breathing exercises, and other methods to help you relax. See Further Reading below. Daytime exercise Regular daytime exercise can help you to feel more relaxed and tired at bedtime. This may help you to sleep better. (However, you should not do exercise near to bedtime if you have insomnia.) If possible, do some exercise on most days. Even a walk in the afternoon or early evening is better than nothing. However, ideally, you should aim for at least 30 minutes of moderate exercise on five or more days a week. Moderate exercise means that you get warm and slightly out of breath. You do not need to go to a gym! Brisk walking, jogging, cycling, climbing stairs, heavy DIY, heavy gardening, dancing and heavy housework are all moderate-intensity physical exercises. See the separate leaflet called Exercise and physical activity . Behavioural and cognitive therapies If you have severe persistent poor sleep, your doctor may refer you to a psychologist or other health professional for psychological treatments. These are various therapies which help re-train your brain and the way you feel, think or behave. Research studies have found that there is a good chance that behavioural and cognitive therapies will improve sleep in adults with insomnia. Increasingly, research has also shown that some of these therapies can be delivered digitally (ie through an app, online, etc). There are various types of therapy and they include the following: Stimulus-control therapy . This helps you to re-associate the bed and bedroom with sleep and to re-establish a consistent sleep/wake pattern. Sleep restriction therapy . Very briefly, the principle of this treatment is that you limit the time that you spend in bed at night. As things improve, the time in bed is then lengthened. An example of the way that this may be done in practice is as follows: First, you may be asked to find out how much you are actually sleeping each night. You can do this by keeping a sleep diary . You may then be advised to restrict the amount of time that you spend in bed to the time that you actually sleep each night. For example, if you spend eight hours in bed each night but you sleep for only six hours then your allowed time in bed would be six hours. So, in this example, say you normally go to bed at 11 pm, get to sleep at 1 am and get up at 7 am. To restrict your time in bed to six hours, you may be advised to go to bed at 1 am but still get up at 7 am. You then make weekly adjustments to the allowed time in bed, depending on the time spent asleep. (You need to keep on with the sleep diary.) When 90% of the time spent in bed is spent asleep then the allowed time spent in bed is increased by 15 minutes, by going to bed 15 minutes earlier. In the above example, you would then go to bed at 12.45 am. Adjustments are made each week until you are sleeping for a longer length most nights. Relaxation training . This teaches you ways of reducing tension. For example, this may include the progressive muscle relaxation technique as described earlier, plus various other techniques described earlier. Paradoxical intention . This involves staying passively awake, avoiding any intention to fall asleep. It is used for people who have trouble getting to sleep (but not maintaining sleep). Biofeedback . With this technique, you are connected to electrical sensors which give you feedback by sounds and lights to show you what your body is doing. This is to help you control certain body functions (such as muscle tension). Cognitive therapy . Cognitive therapy is often used in combination with a behavioural intervention (such as stimulus control, sleep restriction, or relaxation training); this is then called cognitive behavioural therapy (CBT) . See the separate article CBT for insomnia: how does it work? for more details. Accessing sleep-focused therapy There are various different ways to access sleep-focused therapy. What's available on the NHS varies a little depending on where you are. Your GP may be able to refer you for sessions led by a psychotherapist or psychologist. These can be individual or group sessions, and may be in-person, over the phone, or via video call. There are also online courses and apps. Sleepio is one example of an app that uses cognitive behavioural therapy for insomnia (CBT-I). Sleepio was recommended for use by the UK's National Institute for Health and Care Excellence (NICE) in 2022. In some areas of the UK it's available free on the NHS; in other places you may need to pay a subscription. Other resources include: Sleepstation (also available free on the NHS in some areas). Calm, a meditation app (free trial, then paid). Headspace, a guided meditation app (free trial, then paid). Pzizz, an app that aims to help you relax and fall asleep quicker (free download, with in-app purchases and subscription). See the separate article How to improve your sleep behaviour for more details. Sleeping tablets are not usually advised for insomnia The main types of sleeping tablets are in a class of medicines called benzodiazepines and a class called Z drugs. To read more about why these medicines may be prescribed, see the separate leaflet called Benzodiazepines and Z drugs . In the past, sleeping tablets were commonly prescribed. However, they have been shown to have problems and are now not commonly prescribed. If a sleeping tablet is prescribed, it is usually just a short course (a week or so) to get over a particularly bad patch. Possible problems with sleeping tablets include: Drowsiness the next day. You may not be safe to drive or to operate machinery. Clumsiness and confusion in the night if you have to get up. For example, if you have had a sleeping tablet, you may fall over if you get up in the night to go to the toilet. (Older people who take sleeping tablets have an increased risk of falling and breaking their hip.) Tolerance to sleeping tablets may develop if you take them regularly. This means that, in time, the usual dose has no effect. You then need a higher dose to help with sleep. In time, the higher dose then has no effect, and so on. Some people become addicted to (dependent on) sleeping tablets and have withdrawal symptoms if the tablets are stopped suddenly. Other medicines that may be used to help sleep include melatonin and some antihistamines . Herbal remedies are used by some people to help with sleep. For example, valerian. However, research studies have shown that there is very little evidence to show that these work. Therefore, they are not recommended. Long-term use of sleeping tablets has been linked with serious health problems, such as an increased risk of dementia, and an increased risk of earlier death. If you've been taking sleeping tablets for a long time, your doctor should regularly review them with you, including discussing the benefits and harms. If you want to stop, they are no longer helping, or they are becoming harmful, your doctor may suggest stopping them - usually in a gradual way and with support. See a doctor if you feel that illness or medication is causing poor sleep . Treating any underlying condition that is causing the problem, if possible, can help to promote sleep. In particular, depression and anxiety are common causes of poor sleep and can often be treated.
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Download [Download](https://pdf.patient.info/?url=https%3A%2F%2Fpatient.info%2Fmental-health%2Finsomnia-poor-sleep) Article PDF has been downloaded - Share #### Share - [Share via email](mailto:?subject=Patient%20-%20Insomnia&body=https%3A%2F%2Fpatient.info%2Fmental-health%2Finsomnia-poor-sleep) - [Share via Facebook](https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fpatient.info%2Fmental-health%2Finsomnia-poor-sleep) - [Share via LinkedIn](https://www.linkedin.com/sharing/share-offsite/?url=https%3A%2F%2Fpatient.info%2Fmental-health%2Finsomnia-poor-sleep) - [Share via X](https://x.com/intent/post?text=Patient%20-%20Insomnia&url=https%3A%2F%2Fpatient.info%2Fmental-health%2Finsomnia-poor-sleep) - [Share via WhatsApp](https://api.whatsapp.com/send?text=Patient%20-%20Insomnia%20https%3A%2F%2Fpatient.info%2Fmental-health%2Finsomnia-poor-sleep) - [Copy link](https://patient.info/mental-health/insomnia-poor-sleep#copy) Article link copied to clipboard - Language #### Language - [English](https://patient.info/mental-health/insomnia-poor-sleep) - [Deutsch](https://de.patient.info/mental-health/insomnia-poor-sleep) - [Español](https://es.patient.info/mental-health/insomnia-poor-sleep) - [Français](https://fr.patient.info/mental-health/insomnia-poor-sleep) - [Italiano](https://it.patient.info/mental-health/insomnia-poor-sleep) - [Português](https://pt.patient.info/mental-health/insomnia-poor-sleep) - Discussion - Audio Version In this series:[Snoring](https://patient.info/mental-health/insomnia-poor-sleep/snoring)[Sleepwalking](https://patient.info/mental-health/insomnia-poor-sleep/sleepwalking)[Sleep paralysis](https://patient.info/mental-health/insomnia-poor-sleep/sleep-paralysis)[Sleeping tablets](https://patient.info/mental-health/insomnia-poor-sleep/sleeping-tablets)[Benzodiazepines and Z drugs](https://patient.info/mental-health/insomnia-poor-sleep/benzodiazepines-and-z-drugs) As many as one in three people can have some difficulty with sleeping. However, there are many things you can do to help yourself. This leaflet aims to show you some of them. For example, simple things like winding down before bedtime, avoiding certain foods and drinks, and a bedtime routine can help. EDITORS NOTES [Dr Krishna Vakharia](https://patient.info/authors/dr-krishna-vakharia), 24th November 2023 There is a new oral medication that NICE has recommended called daridorexant. This can only be used under certain conditions. Your doctor will discuss if it is suitable for you. For further information take a look at the further reading section. Do you need support with anxiety, depression or stress? Get Onebright CBT private therapy appointments sooner than NHS services. £99 per session – delivered virtually. CBT will help you get better by making you more aware of the connection between your thoughts, feelings and behaviours so you can feel healthy and happy. [Find out more](https://onebright.com/patient-info/) ![OneBright logo](https://images.ctfassets.net/xxv4b9mbhlgd/4xLeUTH6nAJVUufRHOQPu7/19f5b88126201fa0ace776206316013e/Onebright_on_Dark_RGB.png) ### In this article: - [What is insomnia?](https://patient.info/mental-health/insomnia-poor-sleep#what-is-insomnia) - [What is a normal amount of sleep?](https://patient.info/mental-health/insomnia-poor-sleep#what-is-a-normal-amount-of-sleep) - [Understanding normal sleep](https://patient.info/mental-health/insomnia-poor-sleep#understanding-normal-sleep) - [What causes insomnia?](https://patient.info/mental-health/insomnia-poor-sleep#what-causes-insomnia) - [Insomnia classifications](https://patient.info/mental-health/insomnia-poor-sleep#insomnia-classifications) - [How can I sleep better?](https://patient.info/mental-health/insomnia-poor-sleep#how-can-i-sleep-better) - [What about sleeping tablets?](https://patient.info/mental-health/insomnia-poor-sleep#what-about-sleeping-tablets) - [A final note](https://patient.info/mental-health/insomnia-poor-sleep#a-final-note) - [Further reading and references](https://patient.info/mental-health/insomnia-poor-sleep#furtherreading) ## What is insomnia? [Dr Roger Henderson, MBBS](https://patient.info/authors/dr-roger-henderson) ## What is insomnia? Insomnia means poor sleep. About one third of adults do not get as much sleep as they would like. Poor sleep can mean: - Not being able to get off to sleep. - Waking up too early. - Waking for long periods in the night. - Not feeling refreshed after a night's sleep. If you have poor sleep, particularly over a long period of time, it can severely affect your life, as it can cause: - [Tiredness (fatigue)](https://patient.info/signs-symptoms/tiredness-fatigue) and loss of energy in the daytime. - Poor concentration. - Loss of interest in usual activities. - Irritability. - [Depression](https://patient.info/mental-health/depression-leaflet) and [anxiety](https://patient.info/mental-health/anxiety). - Inability to do things as well or as much as usual - for example, work, social activities, exercise. Errors might occur at work or whilst driving, which could have serious consequences. - A worse quality of life. ## What is a normal amount of sleep? [Back to contents](https://patient.info/mental-health/insomnia-poor-sleep#toc) Different people need different amounts of sleep. Children need more sleep than adults. For adults, the minimum we need is about 6 hours per night. On average, most adults need between 6 and 9 hours of sleep to feel refreshed. Most people establish a pattern that is normal for them in their early adult life. However, as you become older, it is normal to sleep less. For most people it takes less than thirty minutes to fall asleep. So, everyone is different. What is important is that the amount of sleep that you get should be sufficient for you, and that you usually feel refreshed and not sleepy during the daytime. Therefore, the strict medical definition of insomnia is: 'Difficulty in getting to sleep, difficulty staying asleep, early wakening, or non-restorative sleep despite adequate time and opportunity to sleep, resulting in impaired daytime functioning, such as poor concentration, mood disturbance, and daytime tiredness.' Further ways to promote sleep in more difficult cases include relaxation techniques, regular exercise and certain psychological therapies. Sleeping tablets are not the best way to help with sleep problems because they don't fix the cause of insomnia, you can get addicted to them, and they often stop working if you take them regularly. ## Understanding normal sleep [Back to contents](https://patient.info/mental-health/insomnia-poor-sleep#toc) A normal night's sleep has three main parts: - Quiet sleep. This is divided into stages 1-4. Each stage becomes more deep. Quiet sleep is sometimes called deep sleep. - Rapid eye movement (REM) sleep. REM sleep occurs when the brain is very active but the body is limp, apart from the eyes which move rapidly. Most dreaming occurs during REM sleep. - Short periods of waking for 1-2 minutes. Each night, about 4-5 periods of quiet sleep alternate with 4-5 periods of REM sleep. In addition, several short periods of waking for 1-2 minutes occur about every two hours or so, but occur more frequently towards the end of the night's sleep. The graph below shows a typical normal pattern of sleep in a young adult. ## Hypnogram ![Hypnogram - a chart of a normal night's sleep](https://patient.info/images/default_image.png) Normally, you do not remember the times that you wake if they last less than two minutes. If you are distracted during the wakeful times (for example, a partner snoring, traffic noise, etc) then the wakeful times tend to last longer and you are more likely to remember them. ## What causes insomnia? [Back to contents](https://patient.info/mental-health/insomnia-poor-sleep#toc) Poor sleep may develop for no apparent reason. However, there are a number of possible causes which include the following: ### Concern about wakefulness You may remember the normal times of being awake in the night. You may feel that to wake in the night is not normal, and worry about getting back off to sleep. You may clock-watch and check the time each time you wake up. This may make you irritated or anxious, and you are more likely to remember the times of wakefulness. You may then have an impression of having a bad night's sleep, even when the total amount of time asleep was normal. ### Temporary problems Poor sleep is often temporary. This may be because of stress, a work or family problem, jet lag, a change of routine, a new baby, a strange bed, etc. Poor sleep in these situations usually improves in time. ### Stress, anxiety or depression You may find it difficult to switch off your [anxieties](https://patient.info/mental-health/anxiety) about work, home or personal problems. Also, poor sleep is sometimes due to [depression](https://patient.info/mental-health/depression-leaflet). Other symptoms of depression include a low mood, lethargy, poor concentration, tearfulness and persistent negative thoughts. Depression is common. Treatment of depression or anxiety often cures the poor sleep too. ### Sleep apnoea This sometimes occurs in people who snore, most commonly in obese people. In this condition the large airways narrow or collapse as you fall asleep. This not only causes snoring but also reduces the amount of oxygen that gets to the lungs. This causes you to wake up to breathe properly. You may wake up many times each night which may result in daytime tiredness. [See the separate leaflet called Sleep apnoea](https://patient.info/signs-symptoms/tiredness-fatigue/obstructive-sleep-apnoea-syndrome). Note: most people who snore do not have sleep apnoea and they do sleep well. ### Other illnesses Various illnesses keep some people awake. For example, illness causing pain, [leg cramps](https://patient.info/bones-joints-muscles/cramps-in-the-leg), breathlessness, [indigestion](https://patient.info/digestive-health/dyspepsia-indigestion), [cough](https://patient.info/chest-lungs/cough-leaflet), itch, hot flushes, mental health problems, etc. ### Stimulants These can interfere with sleep. There are three common culprits. - [Alcohol](https://patient.info/healthy-living/alcohol-and-liver-disease/alcohol-and-sensible-drinking) - many people take an alcoholic drink to help sleep. Alcohol does help you get to sleep quicker, but then causes broken, poor-quality sleep and early morning wakefulness. - Caffeine - which is in tea, coffee, some soft drinks such as cola, and even chocolate. It is also in some painkiller tablets and other medicines (check the ingredients on the medicine packet). Caffeine is a stimulant and may cause poor sleep. - Nicotine (from [smoking](https://patient.info/healthy-living/quit-smoking-cessation)) is a stimulant, so it would help not to smoke. ### Other recreational drugs [Other recreational drugs](https://patient.info/healthy-living/recreational-drugs) (for example, ecstasy, cocaine, cannabis and amphetamines) can affect sleep. ### Prescribed medicines Some medicines sometimes interfere with sleep. For example, 'water tablets' (diuretics), some antidepressants, [steroids](https://patient.info/treatment-medication/steroids), [beta-blockers](https://patient.info/heart-health/beta-blockers), painkillers containing caffeine, and some cold remedies containing pseudoephedrine. Also, if you suddenly stop taking regular sleeping tablets or other sedative medicines, this can cause rebound poor sleep. ### Screen time There is some evidence that the time we spend looking at electronic screens can affect our sleep. It may be that certain types of light from e-readers and electronic tablets can disrupt control of our natural day-and-night cycle. There are studies which suggest we may sleep better after reading a printed book or a particular kind of screen before bedtime. There are also some studies which show that in children and adolescents, more time using electronic devices in the daytime is linked to less good sleep at night. It's best to avoid using screens within an hour or two of bed. Try to keep devices like phones and laptops out of reach of the bed, or, ideally, outside the bedroom entirely. ### Unrealistic expectations Some people just need less sleep than others. If your sleep pattern has not changed, and you do not feel sleepy during the day, you are probably getting enough sleep. Older people and people who do little exercise tend to need less sleep. Some people think they should be able to nap during the day - and sleep eight hours at night\! ### A vicious cycle Whatever the initial cause, worry about poor sleep and worry about feeling tired the next day are common reasons for the problem to become worse. ### Sleep paralysis Some people may also experience waking from sleep but then being unable to move or speak for a period of time. Some people experience the same problems when they are falling asleep. [See the separate leaflet called Sleep paralysis](https://patient.info/mental-health/insomnia-poor-sleep/sleep-paralysis). ## Insomnia classifications [Back to contents](https://patient.info/mental-health/insomnia-poor-sleep#toc) There are different definitions and classifications of poor sleep (insomnia) around, which can make things confusing. Doctors may classify insomnia into one of the following categories: ### By type - Primary insomnia is insomnia that occurs when no illness or other secondary cause (comorbidity) is identified. Primary insomnia accounts for about one in five cases of long-term insomnia. - Secondary (or comorbid) insomnia occurs when insomnia is a symptom of, or is associated with, other conditions. These can be medical or mental health conditions, or drug or substance misuse (as discussed above). ### By duration - Short-term if insomnia lasts days to weeks, and up to three months. - Long-term (or persistent) if insomnia lasts for three months or longer. ### By a combination of factors Some authorities use the term 'chronic insomnia disorder'. To have this diagnosis, you would: - Have problems sleeping for at least three nights a week for at least three months. - Be distressed or have problems functioning due to your sleeping problem. - Not have another condition which could affect sleep, ie mental or physical illnesses or another sleep disorder. ## How can I sleep better? [Back to contents](https://patient.info/mental-health/insomnia-poor-sleep#toc) - Avoid caffeine, smoking and alcohol, especially in the hours before bedtime. - Avoid heavy meals or strenuous exercise shortly before going to bed. - Go to bed and get up at the same time each day. - Regular daytime exercise helps you feel more relaxed and tired at bedtime. This section will discuss five topics which can help to promote better sleep: - Understanding some facts. - Sleep hygiene. - Relaxation techniques. - Daytime exercise. - Psychological treatments called cognitive and behavioural therapies. In effect, these can be used in a step-wise fashion. You need only go on to the next step if the previous step is not very helpful, but each step requires a greater degree of effort. ### Understanding some facts It is often helpful to understand that short periods of waking each night are normal. Some people are reassured about this and so do not become anxious when they find themselves awake in the night. Also, remember that worry about poor sleep can itself make things worse. Also, it is common to have a few bad nights if you have a period of stress, anxiety or worry. This is often just for a short time and a normal sleep pattern often resumes after a few days. ### General tips for sleeping better (often called sleep hygiene) The following are commonly advised to help promote sleep in people with sleep difficulties, and may be all that is necessary: - Reduce caffeine - do not have any food, medicines, or drinks that contain caffeine or other stimulants for six hours before bedtime (see above). Some people have found that cutting out caffeine completely through the day has helped. - Do not smoke within six hours before bedtime. - Do not drink alcohol within six hours before bedtime. - Do not have a heavy meal just before bedtime (although a light snack may be helpful). - Do not do any strenuous exercise within four hours of bedtime (but exercising earlier in the day is helpful). - Body rhythms - try to get into a routine of wakefulness during the day and sleepiness at night. The body becomes used to rhythms or routines. If you keep to a pattern, you are more likely to sleep well. Therefore: - No matter how tired you are, do not sleep or nap during the day. - It is best to go to bed only when sleepy-tired in the late evening. - Switch the light out as soon as you get into bed. - Always get up at the same time each day, seven days a week, however short the time asleep. Use an alarm to help with this. Resist the temptation to lie in - even after a poor night's sleep. Do not use weekends to catch up on sleep, as this may upset the natural body rhythm that you have got used to in the week. - The bedroom should be a quiet, relaxing place to sleep: - It should not be too hot, cold, or noisy. - Earplugs and eye shades may be useful if you are sleeping with a snoring or wakeful partner. - Make sure the bedroom is dark with good curtains to stop early morning sunlight. - Don't use the bedroom for activities such as work, eating or television. - Consider changing your bed if it is old, or not comfortable. - Hide your alarm clock under your bed. Many people will clock-watch and this does not help you to get off to sleep. - Mood and atmosphere - try to relax and wind down with a routine before going to bed. For example: - A stroll followed by a bath, some reading, and a warm drink (without caffeine) may be relaxing in the late evening. - Do not do anything mentally demanding within 90 minutes of going to bed - such as studying. - Go to bed when sleepy-tired. - Some people find playing soft music is helpful at bedtime. Try a player with a time switch that turns the music off after about 30 minutes. - If you cannot get off to sleep after 20-30 minutes - then get up. It's best not to just lie in bed, worrying about getting to sleep. Get up and do something you find relaxing until you feel sleepy, and then go back to bed. ### Relaxation techniques These aim to reduce your mental and physical arousal before going to bed. Relaxation techniques may help even if you are not anxious but find it hard to get off to sleep. There are a number of techniques. For example, progressive muscular relaxation has been shown to help promote sleep. This technique consists of tensing and relaxing various muscle groups in sequence. For more information, see the leaflet called [Relaxation exercises.](https://patient.info/features/mental-health/relaxation-exercises) You can find a podcast or app that takes you through deep-breathing exercises, and other methods to help you relax. See Further Reading below. ### Daytime exercise Regular daytime exercise can help you to feel more relaxed and tired at bedtime. This may help you to sleep better. (However, you should not do exercise near to bedtime if you have insomnia.) If possible, do some exercise on most days. Even a walk in the afternoon or early evening is better than nothing. However, ideally, you should aim for at least 30 minutes of moderate exercise on five or more days a week. Moderate exercise means that you get warm and slightly out of breath. You do not need to go to a gym! Brisk walking, jogging, cycling, climbing stairs, heavy DIY, heavy gardening, dancing and heavy housework are all moderate-intensity physical exercises. [See the separate leaflet called Exercise and physical activity](https://patient.info/healthy-living/physical-activity-for-health). ### Behavioural and cognitive therapies If you have severe persistent poor sleep, your doctor may refer you to a psychologist or other health professional for psychological treatments. These are various therapies which help re-train your brain and the way you feel, think or behave. Research studies have found that there is a good chance that behavioural and cognitive therapies will improve sleep in adults with insomnia. Increasingly, research has also shown that some of these therapies can be delivered digitally (ie through an app, online, etc). There are various types of therapy and they include the following: Stimulus-control therapy. This helps you to re-associate the bed and bedroom with sleep and to re-establish a consistent sleep/wake pattern. Sleep restriction therapy. Very briefly, the principle of this treatment is that you limit the time that you spend in bed at night. As things improve, the time in bed is then lengthened. An example of the way that this may be done in practice is as follows: - First, you may be asked to find out how much you are actually sleeping each night. You can do this by keeping a [sleep diary](https://patient.info/features/healthy-living/sleep-diary). - You may then be advised to restrict the amount of time that you spend in bed to the time that you actually sleep each night. For example, if you spend eight hours in bed each night but you sleep for only six hours then your allowed time in bed would be six hours. So, in this example, say you normally go to bed at 11 pm, get to sleep at 1 am and get up at 7 am. To restrict your time in bed to six hours, you may be advised to go to bed at 1 am but still get up at 7 am. - You then make weekly adjustments to the allowed time in bed, depending on the time spent asleep. (You need to keep on with the sleep diary.) - When 90% of the time spent in bed is spent asleep then the allowed time spent in bed is increased by 15 minutes, by going to bed 15 minutes earlier. In the above example, you would then go to bed at 12.45 am. - Adjustments are made each week until you are sleeping for a longer length most nights. Relaxation training. This teaches you ways of reducing tension. For example, this may include the progressive muscle relaxation technique as described earlier, plus various other techniques described earlier. Paradoxical intention. This involves staying passively awake, avoiding any intention to fall asleep. It is used for people who have trouble getting to sleep (but not maintaining sleep). Biofeedback. With this technique, you are connected to electrical sensors which give you feedback by sounds and lights to show you what your body is doing. This is to help you control certain body functions (such as muscle tension). Cognitive therapy. Cognitive therapy is often used in combination with a behavioural intervention (such as stimulus control, sleep restriction, or relaxation training); this is then called [cognitive behavioural therapy (CBT)](https://patient.info/mental-health/cognitive-behavioural-therapy-cbt-leaflet). [See the separate article CBT for insomnia: how does it work?](https://patient.info/features/healthy-living/cbt-for-insomnia-how-does-it-work) for more details. ### Accessing sleep-focused therapy There are various different ways to access sleep-focused therapy. What's available on the NHS varies a little depending on where you are. Your GP may be able to refer you for sessions led by a psychotherapist or psychologist. These can be individual or group sessions, and may be in-person, over the phone, or via video call. There are also online courses and apps. Sleepio is one example of an app that uses cognitive behavioural therapy for insomnia (CBT-I). Sleepio was recommended for use by the UK's National Institute for Health and Care Excellence (NICE) in 2022. In some areas of the UK it's available free on the NHS; in other places you may need to pay a subscription. Other resources include: - Sleepstation (also available free on the NHS in some areas). - Calm, a meditation app (free trial, then paid). - Headspace, a guided meditation app (free trial, then paid). - Pzizz, an app that aims to help you relax and fall asleep quicker (free download, with in-app purchases and subscription). [See the separate article How to improve your sleep behaviour](https://patient.info/features/healthy-living/how-to-improve-your-sleep-behaviour) for more details. ## What about sleeping tablets? [Back to contents](https://patient.info/mental-health/insomnia-poor-sleep#toc) ### Sleeping tablets are not usually advised for insomnia The main types of [sleeping tablets](https://patient.info/mental-health/insomnia-poor-sleep/sleeping-tablets) are in a class of medicines called benzodiazepines and a class called Z drugs. [To read more about why these medicines may be prescribed, see the separate leaflet called Benzodiazepines and Z drugs](https://patient.info/mental-health/insomnia-poor-sleep/benzodiazepines-and-z-drugs). In the past, sleeping tablets were commonly prescribed. However, they have been shown to have problems and are now not commonly prescribed. If a sleeping tablet is prescribed, it is usually just a short course (a week or so) to get over a particularly bad patch. Possible problems with sleeping tablets include: - Drowsiness the next day. You may not be safe to drive or to operate machinery. - Clumsiness and confusion in the night if you have to get up. For example, if you have had a sleeping tablet, you may fall over if you get up in the night to go to the toilet. (Older people who take sleeping tablets have an increased risk of falling and breaking their hip.) - Tolerance to sleeping tablets may develop if you take them regularly. This means that, in time, the usual dose has no effect. You then need a higher dose to help with sleep. In time, the higher dose then has no effect, and so on. - Some people become addicted to (dependent on) sleeping tablets and have withdrawal symptoms if the tablets are stopped suddenly. Other medicines that may be used to help sleep include [melatonin](https://patient.info/medicine/melatonin-tablets-for-insomnia-adaflex-circadin) and some [antihistamines](https://patient.info/allergies-blood-immune/allergies/antihistamines). Herbal remedies are used by some people to help with sleep. For example, valerian. However, research studies have shown that there is very little evidence to show that these work. Therefore, they are not recommended. Long-term use of sleeping tablets has been linked with serious health problems, such as an increased risk of dementia, and an increased risk of earlier death. If you've been taking sleeping tablets for a long time, your doctor should regularly review them with you, including discussing the benefits and harms. If you want to stop, they are no longer helping, or they are becoming harmful, your doctor may suggest stopping them - usually in a gradual way and with support. ## A final note [Back to contents](https://patient.info/mental-health/insomnia-poor-sleep#toc) See a doctor if you feel that illness or medication is causing poor sleep. Treating any underlying condition that is causing the problem, if possible, can help to promote sleep. In particular, depression and anxiety are common causes of poor sleep and can often be treated. #### Patient picks for [Sleep and insomnia](https://patient.info/mental-health/insomnia-poor-sleep) [![Sleep debt calculator](https://patient.info/images/default_image.png)Healthy living Sleep debt calculator Open the sleep debt calculator. by Patient infomatics team](https://patient.info/healthy-living/sleep-debt-calculator) [![Sleeping tablets](https://patient.info/images/default_image.png)Healthy living Sleeping tablets Doctors avoid prescribing sleeping tablets if possible due to the problems they can cause and the concern that you could become dependent on them. by Dr Colin Tidy, MRCGP](https://patient.info/mental-health/insomnia-poor-sleep/sleeping-tablets) ### Further reading and references - [Buysse DJ, Germain A, Moul DE, et al](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=21263078) ; Efficacy of brief behavioral treatment for chronic insomnia in older adults. Arch Intern Med. 2011 May 23;171(10):887-95. Epub 2011 Jan 24. - [Buysse DJ](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=23423416) ; Insomnia. JAMA. 2013 Feb 20;309(7):706-16. doi: 10.1001/jama.2013.193. - [Luik AI, Kyle SD, Espie CA](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=28553574) ; Digital Cognitive Behavioral Therapy (dCBT) for Insomnia: a State-of-the-Science Review. Curr Sleep Med Rep. 2017;3(2):48-56. doi: 10.1007/s40675-017-0065-4. Epub 2017 May 8. - [Qaseem A, Kansagara D, Forciea MA, et al](https://www.acpjournals.org/doi/10.7326/m15-2175) ; Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2016 Jul 19;165(2):125-33. doi: 10.7326/M15-2175. Epub 2016 May 3. - [Wilson S, Anderson K, Baldwin D, et al](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=31271339) ; British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update. J Psychopharmacol. 2019 Aug;33(8):923-947. doi: 10.1177/0269881119855343. Epub 2019 Jul 4. - [Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults](https://www.nice.org.uk/guidance/ng215) ; NICE guidance (April 2022) - [Sleepio to treat insomnia and insomnia symptoms](https://www.nice.org.uk/guidance/mtg70) ; NICE medical technologies guidance, May 2022 - [Insomnia](https://cks.nice.org.uk/topics/insomnia/) ; NICE CKS, April 2024 (UK access only) - [Sleep Diary](https://thesleepcharity.org.uk/wp-content/uploads/The-Sleep-Charity-Sleep-Diary.pdf) ; The Sleep Charity. - Sleepio app - Sleepstation app - Calm app - Headspace app - Pzizz app ## Article history The information on this page is written and peer reviewed by qualified clinicians. - ###### Next review due: 22 Jun 2027 - ###### 23 Jun 2024 \\| Latest version Last updated by [Dr Doug McKechnie, MRCGP](https://patient.info/authors/dr-doug-mckechnie) Peer reviewed by [Dr Colin Tidy, MRCGP](https://patient.info/authors/dr-colin-tidy) ## Join the conversation Share your thoughts or experiences with others in our [patient communities.](https://community.patient.info/) Disclaimer: The views expressed in the community do not represent medical advice. For any health concerns, consult your GP or healthcare provider. ![flu eligibility checker](https://images.ctfassets.net/xxv4b9mbhlgd/67ZL1sw5SwXVH5pETgnbmd/00adebe6fc9061807a7a9a14f77bcd68/Untitled_design-24.png) #### Ask, share, connect. Browse discussions, ask questions, and share experiences across hundreds of health topics. Browse forums ![symptom checker](https://images.ctfassets.net/xxv4b9mbhlgd/4YO2oGN3nTyecJaazD5OMM/a915fdc3dae8d6afe9c93dcfa4c2cfcf/Desktop.png) #### Feeling unwell? Assess your symptoms online with our free symptom checker Check symptoms #### Sign up to the Patient newsletter Your weekly dose of clear, trustworthy health advice - written to help you feel informed, confident and in control. By subscribing you accept our [Privacy Policy](https://patient.info/privacy-policy). You can unsubscribe at any time. We never sell your data. Our clinical information meets the standards set by the NHS in their Standard for Creating Health Content guidance. 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Readable Markdown	What is insomnia? Insomnia means poor sleep. About one third of adults do not get as much sleep as they would like. Poor sleep can mean: - Not being able to get off to sleep. - Waking up too early. - Waking for long periods in the night. - Not feeling refreshed after a night's sleep. If you have poor sleep, particularly over a long period of time, it can severely affect your life, as it can cause: - [Tiredness (fatigue)](https://patient.info/signs-symptoms/tiredness-fatigue) and loss of energy in the daytime. - Poor concentration. - Loss of interest in usual activities. - Irritability. - [Depression](https://patient.info/mental-health/depression-leaflet) and [anxiety](https://patient.info/mental-health/anxiety). - Inability to do things as well or as much as usual - for example, work, social activities, exercise. Errors might occur at work or whilst driving, which could have serious consequences. - A worse quality of life. Different people need different amounts of sleep. Children need more sleep than adults. For adults, the minimum we need is about 6 hours per night. On average, most adults need between 6 and 9 hours of sleep to feel refreshed. Most people establish a pattern that is normal for them in their early adult life. However, as you become older, it is normal to sleep less. For most people it takes less than thirty minutes to fall asleep. So, everyone is different. What is important is that the amount of sleep that you get should be sufficient for you, and that you usually feel refreshed and not sleepy during the daytime. Therefore, the strict medical definition of insomnia is: 'Difficulty in getting to sleep, difficulty staying asleep, early wakening, or non-restorative sleep despite adequate time and opportunity to sleep, resulting in impaired daytime functioning, such as poor concentration, mood disturbance, and daytime tiredness.' Further ways to promote sleep in more difficult cases include relaxation techniques, regular exercise and certain psychological therapies. Sleeping tablets are not the best way to help with sleep problems because they don't fix the cause of insomnia, you can get addicted to them, and they often stop working if you take them regularly. A normal night's sleep has three main parts: - Quiet sleep. This is divided into stages 1-4. Each stage becomes more deep. Quiet sleep is sometimes called deep sleep. - Rapid eye movement (REM) sleep. REM sleep occurs when the brain is very active but the body is limp, apart from the eyes which move rapidly. Most dreaming occurs during REM sleep. - Short periods of waking for 1-2 minutes. Each night, about 4-5 periods of quiet sleep alternate with 4-5 periods of REM sleep. In addition, several short periods of waking for 1-2 minutes occur about every two hours or so, but occur more frequently towards the end of the night's sleep. The graph below shows a typical normal pattern of sleep in a young adult. Hypnogram ![Hypnogram - a chart of a normal night's sleep](https://patient.info/images/default_image.png) Normally, you do not remember the times that you wake if they last less than two minutes. If you are distracted during the wakeful times (for example, a partner snoring, traffic noise, etc) then the wakeful times tend to last longer and you are more likely to remember them. Poor sleep may develop for no apparent reason. However, there are a number of possible causes which include the following: ### Concern about wakefulness You may remember the normal times of being awake in the night. You may feel that to wake in the night is not normal, and worry about getting back off to sleep. You may clock-watch and check the time each time you wake up. This may make you irritated or anxious, and you are more likely to remember the times of wakefulness. You may then have an impression of having a bad night's sleep, even when the total amount of time asleep was normal. ### Temporary problems Poor sleep is often temporary. This may be because of stress, a work or family problem, jet lag, a change of routine, a new baby, a strange bed, etc. Poor sleep in these situations usually improves in time. ### Stress, anxiety or depression You may find it difficult to switch off your [anxieties](https://patient.info/mental-health/anxiety) about work, home or personal problems. Also, poor sleep is sometimes due to [depression](https://patient.info/mental-health/depression-leaflet). Other symptoms of depression include a low mood, lethargy, poor concentration, tearfulness and persistent negative thoughts. Depression is common. Treatment of depression or anxiety often cures the poor sleep too. ### Sleep apnoea This sometimes occurs in people who snore, most commonly in obese people. In this condition the large airways narrow or collapse as you fall asleep. This not only causes snoring but also reduces the amount of oxygen that gets to the lungs. This causes you to wake up to breathe properly. You may wake up many times each night which may result in daytime tiredness. [See the separate leaflet called Sleep apnoea](https://patient.info/signs-symptoms/tiredness-fatigue/obstructive-sleep-apnoea-syndrome). Note: most people who snore do not have sleep apnoea and they do sleep well. ### Other illnesses Various illnesses keep some people awake. For example, illness causing pain, [leg cramps](https://patient.info/bones-joints-muscles/cramps-in-the-leg), breathlessness, [indigestion](https://patient.info/digestive-health/dyspepsia-indigestion), [cough](https://patient.info/chest-lungs/cough-leaflet), itch, hot flushes, mental health problems, etc. ### Stimulants These can interfere with sleep. There are three common culprits. - [Alcohol](https://patient.info/healthy-living/alcohol-and-liver-disease/alcohol-and-sensible-drinking) - many people take an alcoholic drink to help sleep. Alcohol does help you get to sleep quicker, but then causes broken, poor-quality sleep and early morning wakefulness. - Caffeine - which is in tea, coffee, some soft drinks such as cola, and even chocolate. It is also in some painkiller tablets and other medicines (check the ingredients on the medicine packet). Caffeine is a stimulant and may cause poor sleep. - Nicotine (from [smoking](https://patient.info/healthy-living/quit-smoking-cessation)) is a stimulant, so it would help not to smoke. ### Other recreational drugs [Other recreational drugs](https://patient.info/healthy-living/recreational-drugs) (for example, ecstasy, cocaine, cannabis and amphetamines) can affect sleep. ### Prescribed medicines Some medicines sometimes interfere with sleep. For example, 'water tablets' (diuretics), some antidepressants, [steroids](https://patient.info/treatment-medication/steroids), [beta-blockers](https://patient.info/heart-health/beta-blockers), painkillers containing caffeine, and some cold remedies containing pseudoephedrine. Also, if you suddenly stop taking regular sleeping tablets or other sedative medicines, this can cause rebound poor sleep. ### Screen time There is some evidence that the time we spend looking at electronic screens can affect our sleep. It may be that certain types of light from e-readers and electronic tablets can disrupt control of our natural day-and-night cycle. There are studies which suggest we may sleep better after reading a printed book or a particular kind of screen before bedtime. There are also some studies which show that in children and adolescents, more time using electronic devices in the daytime is linked to less good sleep at night. It's best to avoid using screens within an hour or two of bed. Try to keep devices like phones and laptops out of reach of the bed, or, ideally, outside the bedroom entirely. ### Unrealistic expectations Some people just need less sleep than others. If your sleep pattern has not changed, and you do not feel sleepy during the day, you are probably getting enough sleep. Older people and people who do little exercise tend to need less sleep. Some people think they should be able to nap during the day - and sleep eight hours at night\! ### A vicious cycle Whatever the initial cause, worry about poor sleep and worry about feeling tired the next day are common reasons for the problem to become worse. ### Sleep paralysis Some people may also experience waking from sleep but then being unable to move or speak for a period of time. Some people experience the same problems when they are falling asleep. [See the separate leaflet called Sleep paralysis](https://patient.info/mental-health/insomnia-poor-sleep/sleep-paralysis). There are different definitions and classifications of poor sleep (insomnia) around, which can make things confusing. Doctors may classify insomnia into one of the following categories: ### By type - Primary insomnia is insomnia that occurs when no illness or other secondary cause (comorbidity) is identified. Primary insomnia accounts for about one in five cases of long-term insomnia. - Secondary (or comorbid) insomnia occurs when insomnia is a symptom of, or is associated with, other conditions. These can be medical or mental health conditions, or drug or substance misuse (as discussed above). ### By duration - Short-term if insomnia lasts days to weeks, and up to three months. - Long-term (or persistent) if insomnia lasts for three months or longer. ### By a combination of factors Some authorities use the term 'chronic insomnia disorder'. To have this diagnosis, you would: - Have problems sleeping for at least three nights a week for at least three months. - Be distressed or have problems functioning due to your sleeping problem. - Not have another condition which could affect sleep, ie mental or physical illnesses or another sleep disorder. - Avoid caffeine, smoking and alcohol, especially in the hours before bedtime. - Avoid heavy meals or strenuous exercise shortly before going to bed. - Go to bed and get up at the same time each day. - Regular daytime exercise helps you feel more relaxed and tired at bedtime. This section will discuss five topics which can help to promote better sleep: - Understanding some facts. - Sleep hygiene. - Relaxation techniques. - Daytime exercise. - Psychological treatments called cognitive and behavioural therapies. In effect, these can be used in a step-wise fashion. You need only go on to the next step if the previous step is not very helpful, but each step requires a greater degree of effort. ### Understanding some facts It is often helpful to understand that short periods of waking each night are normal. Some people are reassured about this and so do not become anxious when they find themselves awake in the night. Also, remember that worry about poor sleep can itself make things worse. Also, it is common to have a few bad nights if you have a period of stress, anxiety or worry. This is often just for a short time and a normal sleep pattern often resumes after a few days. ### General tips for sleeping better (often called sleep hygiene) The following are commonly advised to help promote sleep in people with sleep difficulties, and may be all that is necessary: - Reduce caffeine - do not have any food, medicines, or drinks that contain caffeine or other stimulants for six hours before bedtime (see above). Some people have found that cutting out caffeine completely through the day has helped. - Do not smoke within six hours before bedtime. - Do not drink alcohol within six hours before bedtime. - Do not have a heavy meal just before bedtime (although a light snack may be helpful). - Do not do any strenuous exercise within four hours of bedtime (but exercising earlier in the day is helpful). - Body rhythms - try to get into a routine of wakefulness during the day and sleepiness at night. The body becomes used to rhythms or routines. If you keep to a pattern, you are more likely to sleep well. Therefore: - No matter how tired you are, do not sleep or nap during the day. - It is best to go to bed only when sleepy-tired in the late evening. - Switch the light out as soon as you get into bed. - Always get up at the same time each day, seven days a week, however short the time asleep. Use an alarm to help with this. Resist the temptation to lie in - even after a poor night's sleep. Do not use weekends to catch up on sleep, as this may upset the natural body rhythm that you have got used to in the week. - The bedroom should be a quiet, relaxing place to sleep: - It should not be too hot, cold, or noisy. - Earplugs and eye shades may be useful if you are sleeping with a snoring or wakeful partner. - Make sure the bedroom is dark with good curtains to stop early morning sunlight. - Don't use the bedroom for activities such as work, eating or television. - Consider changing your bed if it is old, or not comfortable. - Hide your alarm clock under your bed. Many people will clock-watch and this does not help you to get off to sleep. - Mood and atmosphere - try to relax and wind down with a routine before going to bed. For example: - A stroll followed by a bath, some reading, and a warm drink (without caffeine) may be relaxing in the late evening. - Do not do anything mentally demanding within 90 minutes of going to bed - such as studying. - Go to bed when sleepy-tired. - Some people find playing soft music is helpful at bedtime. Try a player with a time switch that turns the music off after about 30 minutes. - If you cannot get off to sleep after 20-30 minutes - then get up. It's best not to just lie in bed, worrying about getting to sleep. Get up and do something you find relaxing until you feel sleepy, and then go back to bed. ### Relaxation techniques These aim to reduce your mental and physical arousal before going to bed. Relaxation techniques may help even if you are not anxious but find it hard to get off to sleep. There are a number of techniques. For example, progressive muscular relaxation has been shown to help promote sleep. This technique consists of tensing and relaxing various muscle groups in sequence. For more information, see the leaflet called [Relaxation exercises.](https://patient.info/features/mental-health/relaxation-exercises) You can find a podcast or app that takes you through deep-breathing exercises, and other methods to help you relax. See Further Reading below. ### Daytime exercise Regular daytime exercise can help you to feel more relaxed and tired at bedtime. This may help you to sleep better. (However, you should not do exercise near to bedtime if you have insomnia.) If possible, do some exercise on most days. Even a walk in the afternoon or early evening is better than nothing. However, ideally, you should aim for at least 30 minutes of moderate exercise on five or more days a week. Moderate exercise means that you get warm and slightly out of breath. You do not need to go to a gym! Brisk walking, jogging, cycling, climbing stairs, heavy DIY, heavy gardening, dancing and heavy housework are all moderate-intensity physical exercises. [See the separate leaflet called Exercise and physical activity](https://patient.info/healthy-living/physical-activity-for-health). ### Behavioural and cognitive therapies If you have severe persistent poor sleep, your doctor may refer you to a psychologist or other health professional for psychological treatments. These are various therapies which help re-train your brain and the way you feel, think or behave. Research studies have found that there is a good chance that behavioural and cognitive therapies will improve sleep in adults with insomnia. Increasingly, research has also shown that some of these therapies can be delivered digitally (ie through an app, online, etc). There are various types of therapy and they include the following: Stimulus-control therapy. This helps you to re-associate the bed and bedroom with sleep and to re-establish a consistent sleep/wake pattern. Sleep restriction therapy. Very briefly, the principle of this treatment is that you limit the time that you spend in bed at night. As things improve, the time in bed is then lengthened. An example of the way that this may be done in practice is as follows: - First, you may be asked to find out how much you are actually sleeping each night. You can do this by keeping a [sleep diary](https://patient.info/features/healthy-living/sleep-diary). - You may then be advised to restrict the amount of time that you spend in bed to the time that you actually sleep each night. For example, if you spend eight hours in bed each night but you sleep for only six hours then your allowed time in bed would be six hours. So, in this example, say you normally go to bed at 11 pm, get to sleep at 1 am and get up at 7 am. To restrict your time in bed to six hours, you may be advised to go to bed at 1 am but still get up at 7 am. - You then make weekly adjustments to the allowed time in bed, depending on the time spent asleep. (You need to keep on with the sleep diary.) - When 90% of the time spent in bed is spent asleep then the allowed time spent in bed is increased by 15 minutes, by going to bed 15 minutes earlier. In the above example, you would then go to bed at 12.45 am. - Adjustments are made each week until you are sleeping for a longer length most nights. Relaxation training. This teaches you ways of reducing tension. For example, this may include the progressive muscle relaxation technique as described earlier, plus various other techniques described earlier. Paradoxical intention. This involves staying passively awake, avoiding any intention to fall asleep. It is used for people who have trouble getting to sleep (but not maintaining sleep). Biofeedback. With this technique, you are connected to electrical sensors which give you feedback by sounds and lights to show you what your body is doing. This is to help you control certain body functions (such as muscle tension). Cognitive therapy. Cognitive therapy is often used in combination with a behavioural intervention (such as stimulus control, sleep restriction, or relaxation training); this is then called [cognitive behavioural therapy (CBT)](https://patient.info/mental-health/cognitive-behavioural-therapy-cbt-leaflet). [See the separate article CBT for insomnia: how does it work?](https://patient.info/features/healthy-living/cbt-for-insomnia-how-does-it-work) for more details. ### Accessing sleep-focused therapy There are various different ways to access sleep-focused therapy. What's available on the NHS varies a little depending on where you are. Your GP may be able to refer you for sessions led by a psychotherapist or psychologist. These can be individual or group sessions, and may be in-person, over the phone, or via video call. There are also online courses and apps. Sleepio is one example of an app that uses cognitive behavioural therapy for insomnia (CBT-I). Sleepio was recommended for use by the UK's National Institute for Health and Care Excellence (NICE) in 2022. In some areas of the UK it's available free on the NHS; in other places you may need to pay a subscription. Other resources include: - Sleepstation (also available free on the NHS in some areas). - Calm, a meditation app (free trial, then paid). - Headspace, a guided meditation app (free trial, then paid). - Pzizz, an app that aims to help you relax and fall asleep quicker (free download, with in-app purchases and subscription). [See the separate article How to improve your sleep behaviour](https://patient.info/features/healthy-living/how-to-improve-your-sleep-behaviour) for more details. ### Sleeping tablets are not usually advised for insomnia The main types of [sleeping tablets](https://patient.info/mental-health/insomnia-poor-sleep/sleeping-tablets) are in a class of medicines called benzodiazepines and a class called Z drugs. [To read more about why these medicines may be prescribed, see the separate leaflet called Benzodiazepines and Z drugs](https://patient.info/mental-health/insomnia-poor-sleep/benzodiazepines-and-z-drugs). In the past, sleeping tablets were commonly prescribed. However, they have been shown to have problems and are now not commonly prescribed. If a sleeping tablet is prescribed, it is usually just a short course (a week or so) to get over a particularly bad patch. Possible problems with sleeping tablets include: - Drowsiness the next day. You may not be safe to drive or to operate machinery. - Clumsiness and confusion in the night if you have to get up. For example, if you have had a sleeping tablet, you may fall over if you get up in the night to go to the toilet. (Older people who take sleeping tablets have an increased risk of falling and breaking their hip.) - Tolerance to sleeping tablets may develop if you take them regularly. This means that, in time, the usual dose has no effect. You then need a higher dose to help with sleep. In time, the higher dose then has no effect, and so on. - Some people become addicted to (dependent on) sleeping tablets and have withdrawal symptoms if the tablets are stopped suddenly. Other medicines that may be used to help sleep include [melatonin](https://patient.info/medicine/melatonin-tablets-for-insomnia-adaflex-circadin) and some [antihistamines](https://patient.info/allergies-blood-immune/allergies/antihistamines). Herbal remedies are used by some people to help with sleep. For example, valerian. However, research studies have shown that there is very little evidence to show that these work. Therefore, they are not recommended. Long-term use of sleeping tablets has been linked with serious health problems, such as an increased risk of dementia, and an increased risk of earlier death. If you've been taking sleeping tablets for a long time, your doctor should regularly review them with you, including discussing the benefits and harms. If you want to stop, they are no longer helping, or they are becoming harmful, your doctor may suggest stopping them - usually in a gradual way and with support. See a doctor if you feel that illness or medication is causing poor sleep. Treating any underlying condition that is causing the problem, if possible, can help to promote sleep. In particular, depression and anxiety are common causes of poor sleep and can often be treated.
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