Insomnia

Insomnia is when you find it difficult getting to sleep or staying asleep for long enough to feel refreshed the next morning. It can affect your quality of life if you feel tired and find it hard to concentrate during the day.

man looking out window

About insomnia

It’s important to have enough good quality sleep in order to function properly – it helps to rest and repair your body and mind. Most adults need around seven to nine hours’ sleep each night.

Insomnia is thought to affect about a third of people in the UK. You’re more likely to have difficulty sleeping as you get older because your sleep pattern changes – half of people over 65 have insomnia at some point.

Symptoms of insomnia

If you have insomnia, it means that despite having the time and opportunity to get enough sleep, you may:

  • have difficulty getting to sleep
  • difficulty staying asleep (waking up often and finding it hard to get back to sleep)
  • wake up early in the morning
  • feel tired, irritable and unable to concentrate the next day

You might have such problems for a few weeks (short-term insomnia) or they may carry on for longer (long-term insomnia). If you continue to have trouble sleeping over a long time, it can really start to affect all aspects of your life – including work or school, and your social and home life. It can also make you more likely to develop various health problems such as obesity, diabetes, high blood pressure, heart problems and depression.

Causes of insomnia

There can be many things that contribute to insomnia. Here are just some of the potential causes. 

  • Environmental factors such as noise, light seeping through your blinds, an uncomfortable bed or feeling too hot or cold can all affect your ability to sleep.
  • Lifestyle habits such as an irregular sleep routine, eating late at night, not getting enough exercise, or exercising too late at night can make it difficult to sleep.
  • Something causing you temporary stress or worry such as a new job, work stress, financial concerns or a bereavement in the family may keep you awake.
  • Having a mental health condition such as stress, anxiety or depression may cause insomnia.
  • Jet lag and shift work can disturb your sleep patterns.
  • Drinking alcohol can have a significant impact on your quality of sleep. Many people see alcohol as a way to help with sleep problems; but the effect it has on your sleep can make the situation worse.
  • Too much caffeine – for instance, drinking lots of tea and coffee – can keep you awake.
  • Certain medicines including antidepressants and medicines for high blood pressure and epilepsy can affect how well you sleep.
  • Certain health conditions such as an overactive thyroid, asthma, acid reflux or heart disease can make it hard to sleep. Night sweats due to the menopause may cause insomnia. For more information on this, see our FAQ: Can the menopause cause insomnia?

Self help for insomnia

It’s worth thinking about ways to improve your sleep habits and routines to help you to sleep well. This is often referred to as ‘sleep hygiene’. Here are some do’s and don’ts to try.

Dos

  • Establish a regular bedtime routine by going to bed and getting up at roughly the same times every day. Try not to sleep in late to compensate for a bad night’s sleep.
  • Make sure you get some regular exercise, but don’t do any strenuous activity within four hours of going to bed because this might disturb your sleep.
  • Try to relax before bedtime. You could try having a warm bath, a warm milky drink, reading or listening to soothing music to help you relax. Some people find meditation or mindfulness techniques helpful. There are guides available online that you can try for free.
  • If you can’t sleep within half an hour or so, get up and do something relaxing like reading until you feel tired enough to sleep. If something is on your mind, write it down and aim to deal with it the next day.
  • Make sure your bedroom is comfortable – not too hot, cold, noisy or bright – and you have a supportive, comfy mattress on your bed.
  • Where possible, try to avoid using your bedroom for work.

Don’ts

  • Don’t have any drinks that contain caffeine or alcohol within six hours of going to bed.
  • Don’t smoke before you go to bed.
  • Don’t eat a heavy or rich meal late at night.
  • Try not to clock-watch. It might make you feel more frustrated about being awake and stop you getting back to sleep.
  • Try to have a break from screen time, including phones and tablets before bed. Using these devices at bedtime is associated with inadequate sleep – particularly in children.
  • Don’t take naps during the day. It can make it difficult for you to sleep at night.

Seeking help for insomnia

If you’ve tried the self-help measures and you’re still having trouble sleeping, it’s worth seeing your GP for advice. Your GP will ask you about your sleep patterns and how lack of sleep might be impacting your life. They may also examine you to look for any signs of a physical condition that could affect your sleep. Most of the time, your GP will be able to tell if you’re having sleep problems and what might be causing them just from talking to you.

If there doesn’t seem to be an obvious cause for your insomnia, they may suggest keeping a sleep diary for a couple of weeks. It can be a good idea to do this before your appointment. Record things like:

  • the time you go to bed
  • how long it takes you to get to sleep
  • how often you wake up during the night and for how long
  • what time you wake up in the morning
  • if you feel tired during the day or have any naps
  • your mealtimes and how much alcohol and caffeine you drink during the day
  • how much exercise you do or any significant events during the day

Devices that track your sleep can often give you an estimate of the amount of sleep you’re getting. But they’re not always very accurate, so you shouldn’t rely on them. If your GP thinks you might have a specific sleep disorder, they may refer you to a sleep specialist for more tests. For more information, see our FAQ, What do tests for insomnia involve?

If you need help now

This page is designed to provide general health information. If you need help now, please use the following services.

If you think you might harm yourself or are worried someone else might come to immediate harm, call the emergency services on 999 or go to your local accident and emergency department.

Treatment of insomnia

If you have any health conditions that could be affecting your sleep, your GP will make sure you’re receiving the right treatment for these. For instance, if you’re waking up due to pain or hot flushes, your GP can prescribe treatment. They will also go through the sleep hygiene measures listed in the section, Self-help for insomnia. They may suggest some of the following treatment options.  

Behavioural therapies

If you’ve been having trouble sleeping for several weeks or more, your GP may suggest referring you to psychological services to try a behavioural therapy. These may include the following.

  • Cognitive behavioural therapy (CBT) can help you to recognise and deal with any negative thoughts and habits around your sleep. CBT is often combined with one of the other methods.
  • Stimulus-control therapy can help you to re-associate your bed and bedroom with going to sleep and to create a regular sleep routine.
  • Relaxation therapy can help you relax your muscles and clear your mind of distracting thoughts.
  • Sleep-restriction therapy limits the amount of time you spend in bed to the time when you actually go to sleep. You can then gradually increase the time you spend in bed as your sleep improves.

Your GP may refer you to an appropriate specialist who can provide these therapies, or they may provide you with self-help materials. In some areas, your GP may be able to give you access to online CBT-based self-help tools, such as Sleepio.

Medicines

Doctors only recommend medicines for insomnia (sleeping pills) as a last resort, if you’re unable to function during the day because of insomnia. These medicines are often associated with side-effects such as making you feel sleepy the next day. They also become gradually less effective the longer you take them, and you can become dependent on them if you take them for a long time. If you take them, you should only use them for as short a time as possible.

The main types of sleeping tablets include the following.

  • Antihistamines, which you can buy over-the-counter from your pharmacy without a prescription. Examples are Nytol, Phenergan and Sominex. These aren’t suitable if you’re pregnant, breastfeeding or have certain health conditions. If you’re in any doubt, check with your pharmacist or doctor before taking them.
  • Hypnotic medicines, which your GP may prescribe for a limited time if your insomnia is having a really severe effect on your day-to-day life. Examples include benzodiazepines, such as temazepam or loprazolam, and non-benzodiazepine ‘z-drugs’, such as zopiclone, zaleplon or zolpidem.
  • Melatonin, which your doctor may prescribe for up to 13 weeks, if you’re over 55 and are having ongoing problems with insomnia. Melatonin is a hormone that your body produces, which helps to control your sleep pattern. It’s worth bearing in mind that it can cause some side-effects like headaches and joint pain.

If you take sleeping pills, be sure to follow any advice from your doctor or pharmacist, and take note of any warnings in the information leaflet. These may include not driving or operating machinery during the day after using them, for example.

Complementary therapies

There isn’t enough good quality research to show whether complementary therapies like acupuncture, homeopathy and herbal remedies help with insomnia, but some people do try them. If you decide to give them a try, make sure you choose a reputable practitioner, registered with the appropriate regulatory body.

Frequently asked questions

  • Can the menopause cause insomnia? Yes, insomnia is common during the menopause – often because of symptoms such as hot flushes and night sweats. Making a few lifestyle changes can help to reduce hot flushes and night sweats. Try wearing lighter clothing or sleeping in a cooler room. And try to avoid potential triggers, such as spicy food, caffeine, smoking and alcoholic drinks.If you’re finding it difficult to manage symptoms of the menopause, your GP may suggest trying hormone replacement therapy (HRT). This can help to control your symptoms, which in turn, may help you to sleep. There are risks and benefits of taking HRT, so it’s important to talk these through with your GP.
  • How do I know if I’m getting a good night’s sleep?The amount of sleep you need is individual to you, but most adults need about seven to nine hours’ sleep a night. General signs of a good night’s sleep include:
    • it taking you less than half an hour to fall asleep
    • you have fewer than three ‘mini wakes’ (when you briefly wake up for a minute or two) – throughout the night
    • feeling refreshed once you’ve woken up in the morning
      If you’re having trouble getting to sleep and feel that it’s affecting your life, contact your GP for advice.
  • What do tests for insomnia involve? Most people with insomnia can be diagnosed simply by describing their symptoms to their GP. If your GP thinks your insomnia may be caused by a specific sleep disorder, they may refer you to a sleep clinic or a specialist for further tests. Such disorders include sleep apnoea and restless leg syndrome. Specific sleep disorder tests include the following.
    • Actigraphy. This can track your sleep habits over extended periods of several days or more. You wear a small, wristwatch-sized device that monitors your movement in relation to times of day.
    • A polysomnography test can record your brain activity, eye movements, sleep quality, heart rate and blood pressure, and assess your breathing. You’ll usually need to stay overnight at a sleep clinic for this test, although some private clinics offer a service where it can be performed in your own home.
      Your doctor may use these tests alongside sleep diaries to identify any sleep-related problems that you may have.

Heart Disease

Heart disease includes conditions that narrow or block blood vessels (coronary heart disease). This can lead to a heart attack, angina and some strokes. Heart disease also covers conditions that affect your heart’s muscle, valves or cause abnormal rhythms (arrhythmias).

What are the symptoms of cardiovascular heart disease?

Symptoms of heart disease vary based on what condition you have and can include:

  • chest pain
  • pain, weakness or numb legs and/or arms
  • breathlessness
  • very fast or slow heartbeat, or palpitations
  • feeling dizzy, lightheaded or faint
  • fatigue
  • swollen limbs.

Flu jab

Anyone with a heart and circulatory condition is advised to have the flu jab annually.

What increases my risk of cardiovascular heart disease?

A risk factor is something that increases the chance of getting a condition. The more you have, the higher your chance of CVD. Even if you can’t change all your risk factors, there are steps you can take to reduce your risk.

There are several risk factors for CVD, including:

How is cardiovascular heart disease diagnosed?

Diagnosis of coronary heart disease depends on your symptoms and what condition your doctor thinks you may have.

Tests may be based on your family history and can include:

What is the treatment for cardiovascular heart disease?

Treatment will depend on your condition, but usually includes:

Bulimia nervosa prt 2

Diagnosis

If your primary care provider suspects you have bulimia, he or she will typically:

  • Talk to you about your eating habits, weight-loss methods and physical symptoms
  • Do a physical exam
  • Request blood and urine tests
  • Request a test that can identify problems with your heart (electrocardiogram)
  • Perform a psychological evaluation, including a discussion of your attitude toward your body and weight
  • Use the criteria for bulimia listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Your primary care provider may also request additional tests to help pinpoint a diagnosis, rule out medical causes for weight changes and check for any related complications.

Treatment

When you have bulimia, you may need several types of treatment, although combining psychotherapy with antidepressants may be the most effective for overcoming the disorder.

Treatment generally involves a team approach that includes you, your family, your primary care provider, a mental health professional and a dietitian experienced in treating eating disorders. You may have a case manager to coordinate your care.

Here’s a look at bulimia treatment options and considerations.

Psychotherapy

Psychotherapy, also known as talk therapy or psychological counseling, involves discussing your bulimia and related issues with a mental health professional. Evidence indicates that these types of psychotherapy help improve symptoms of bulimia:

  • Cognitive behavioral therapy to help you normalize your eating patterns and identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones
  • Family-based treatment to help parents intervene to stop their teenager’s unhealthy eating behaviors, to help the teen regain control over his or her eating, and to help the family deal with problems that bulimia can have on the teen’s development and the family
  • Interpersonal psychotherapy, which addresses difficulties in your close relationships, helping to improve your communication and problem-solving skills

Ask your mental health professional which psychotherapy he or she will use and what evidence exists that shows it’s beneficial in treating bulimia.

Medications

Antidepressants may help reduce the symptoms of bulimia when used along with psychotherapy. The only antidepressant specifically approved by the Food and Drug Administration to treat bulimia is fluoxetine (Prozac), a type of selective serotonin reuptake inhibitor (SSRI), which may help even if you’re not depressed.

Nutrition education

Dietitians can design an eating plan to help you achieve healthy eating habits to avoid hunger and cravings and to provide good nutrition. Eating regularly and not restricting your food intake is important in overcoming bulimia.

Hospitalization

Bulimia can usually be treated outside of the hospital. But if symptoms are severe, with serious health complications, you may need treatment in a hospital. Some eating disorder programs may offer day treatment rather than inpatient hospitalization.

Treatment challenges in bulimia

Although most people with bulimia do recover, some find that symptoms don’t go away entirely. Periods of bingeing and purging may come and go through the years, depending on your life circumstances, such as recurrence during times of high stress.

If you find yourself back in the binge-purge cycle, follow-up sessions with your primary care provider, dietitian and/or mental health professional may Dechelp you weather the crisis before your eating disorder spirals out of control again. Learning positive ways to cope, creating healthy relationships and managing stress can help prevent a relapse.

If you’ve had an eating disorder in the past and you notice your symptoms returning, seek help from your medical team immediately.

Lifestyle and home remedies

In addition to professional treatment, follow these self-care tips:

  • Stick to your treatment plan. Don’t skip therapy sessions and try not to stray from meal plans, even if they make you uncomfortable.
  • Learn about bulimia. Education about your condition can empower you and motivate you to stick to your treatment plan.
  • Get the right nutrition. If you aren’t eating well or you’re frequently purging, it’s likely your body isn’t getting all of the nutrients it needs. Talk to your primary care provider or dietitian about appropriate vitamin and mineral supplements. However, getting most of your vitamins and minerals from food is typically recommended.
  • Stay in touch. Don’t isolate yourself from caring family members and friends who want to see you get healthy. Understand that they have your best interests at heart and that nurturing, caring relationships are healthy for you.
  • Be kind to yourself. Resist urges to weigh yourself or check yourself in the mirror frequently. These may do nothing but fuel your drive to maintain unhealthy habits.
  • Be cautious with exercise. Talk to your primary care provider about what kind of physical activity, if any, is appropriate for you, especially if you exercise excessively to burn off post-binge calories.

Alternative medicine

Dietary supplements and herbal products designed to suppress the appetite or aid in weight loss may be abused by people with eating disorders. Weight-loss supplements or herbs can have serious side effects and dangerously interact with other medications.

Weight-loss and other dietary supplements don’t need approval by the Food and Drug Administration (FDA) to go on the market. And natural doesn’t always mean safe. If you choose to use dietary supplements or herbs, discuss the potential risks with your primary care provider.

Coping and support

You may find it difficult to cope with bulimia when you’re hit with mixed messages by the media, culture, coaches, family, and maybe your own friends or peers. So how do you cope with a disease that can be deadly when you’re also getting messages that being thin is a sign of success?

  • Remind yourself what a healthy weight is for your body.
  • Resist the urge to diet or skip meals, which can trigger binge eating.
  • Don’t visit websites that advocate or glorify eating disorders.
  • Identify troublesome situations that trigger thoughts or behaviors that may contribute to your bulimia, and develop a plan to deal with them.
  • Have a plan in place to cope with the emotional distress of setbacks.
  • Look for positive role models who can help boost your self-esteem.
  • Find pleasurable activities and hobbies that can help distract you from thoughts about bingeing and purging.
  • Build up your self-esteem by forgiving yourself, focusing on the positive, and giving yourself credit and encouragement.

Get support

If you have bulimia, you and your family may find support groups helpful for encouragement, hope and advice on coping. Group members can truly understand what you’re going through because they’ve been there. Ask your doctor if he or she knows of a group in your area.

Coping advice for parents

If you’re the parent of someone with bulimia, you may blame yourself for your child’s eating disorder. But eating disorders have many causes, and parenting style is not considered a cause. It’s best to focus on how you can help your child now.

Here are some suggestions:

  • Ask your child what you can do to help. For example, ask if your teenager would like you to plan family activities after meals to reduce the temptation to purge.
  • Listen. Allow your child to express feelings.
  • Schedule regular family mealtimes. Eating at routine times is important to help reduce binge eating.
  • Let your teenager know any concerns you have. But do this without placing blame.

Remember that eating disorders affect the whole family, and you need to take care of yourself, too. If you feel that you aren’t coping well with your teen’s bulimia, you might benefit from professional counseling. Or ask your child’s primary care provider about support groups for parents of children with eating disorders.

Preparing for your appointment

Here’s some information to help you get ready for your appointment, and what to expect from your health care team. Ask a family member or friend to go with you, if possible, to help you remember key points and give a fuller picture of the situation.

What you can do

Before your appointment, make a list of:

  • Your symptoms, even those that may seem unrelated to the reason for your appointment
  • Key personal information, including any major stresses or recent life changes
  • All medications, vitamins, herbal products, over-the-counter medications or other supplements you’re taking, and their dosages
  • Questions to ask your doctor, so you can make the most of your time together

Some questions to ask your primary care provider or mental health professional include:

  • What kinds of tests do I need? Do these tests require any special preparation?
  • What treatments are available, and which do you recommend?
  • Is there a generic alternative to the medicine you’re prescribing for me?
  • How will treatment affect my weight?
  • Are there any brochures or other printed material I can have? What websites do you recommend?

Don’t hesitate to ask other questions during your appointment.

What to expect from your doctor

Your primary care provider or mental health professional will likely ask you a number of questions. He or she may ask:

  • How long have you been worried about your weight?
  • Do you think about food often?
  • Do you ever eat in secret?
  • Have you ever vomited because you were uncomfortably full?
  • Have you ever taken medications for weight loss?
  • Do you exercise? If so, how often?
  • Have you found any other ways to lose weight?
  • Are you having any physical symptoms?
  • Have any of your family members ever had symptoms of an eating disorder, or have any been diagnosed with an eating disorder?

Your primary care provider or mental health professional will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your appointment time.

Post-traumatic stress disorder (PTSD)

What is PTSD?

Post-traumatic stress disorder (PTSD) is a type of anxiety disorder which you may develop after being involved in, or witnessing, traumatic events. The condition was first recognised in war veterans and has been known by a variety of names, such as ‘shell shock’. But it’s not only diagnosed in soldiers – a wide range of traumatic experiences can cause PTSD.

“When something traumatic happens in your life it rocks you to the core. The world is no longer a safe place. It becomes somewhere that bad things can and do happen.”

What is it like to have PTSD

When is it diagnosed?

When you go through something you find traumatic it’s understandable to experience some symptoms associated with PTSD afterwards, such as feeling numb or having trouble sleeping. This is sometimes described as an ‘acute stress reaction’.

Many people find that these symptoms disappear within a few weeks, but if your symptoms last for longer than a month, you might be given a diagnosis of PTSD. Your GP might refer you to a specialist before this if your symptoms are particularly severe.

“I started experiencing symptoms of PTSD after my boyfriend died. I suffered extremely vivid flashbacks that could happen at any time, anywhere, and were deeply distressing… I threw myself into another relationship very quickly to try and avoid how I was feeling, but then also would not express much affection to my new partner.”

Are there different types of PTSD?

If you are given a diagnosis of PTSD, you might be told that you have mild, moderate or severe PTSD. This explains what sort of impact your symptoms are having on you currently – it’s not a description of how frightening or upsetting your experiences might have been.

PTSD may be described differently in some situations:

  • Delayed-onset PTSD – if your symptoms emerge more than six months after experiencing trauma, this might be described as ‘delayed PTSD’ or ‘delayed-onset PTSD’.
  • Complex PTSD – if you experienced trauma at an early age or it lasted for a long time, you might be given a diagnosis of ‘complex PTSD’. (See our page on complex PTSD for more information.)
  • Birth trauma – PTSD that develops after a traumatic experience of childbirth is also known as ‘birth trauma’. (See our page on PTSD and birth trauma for more information.)

If you experience some PTSD symptoms while supporting someone close to you who’s experienced trauma, this is sometimes known as ‘secondary trauma’.

“I couldn’t understand why I felt like my brain wasn’t functioning – I couldn’t remember things, I couldn’t process things. It was like my brain had just slowed down and ground to a halt.”

Experiences of facing stigma

There are lots of misconceptions about PTSD. For example, people may wrongly assume it means you are ‘dwelling’ on past events. They might even suggest that you should ‘get over it’ or ‘move on’. But having PTSD isn’t a choice or a sign of weakness, and it’s important to remember that you are not alone.