Struggling to get enough restful sleep?

Which part of the night is hardest?

Insomnia is a sleep problem in which it is hard to fall asleep, stay asleep or sleep long enough, even when the conditions for rest are right. Think of your last difficult night and answer these questions:

• What was hardest: falling asleep, sleeping without waking up, or not waking too early?
• How much time did you spend in bed, and how much of it did you actually sleep?
• How long have you had sleep problems, and how many nights a week do they occur?
• Do you feel restored after sleep?
• Do you have daytime sleepiness, tiredness, irritability or difficulty concentrating?
• Do you have low mood, anxiety, loss of interest or unusual changes in energy?

Your answer to the first question will show which of the similar states is closer to yours: they are described in the section “Insomnia comes in different forms”.

What does a sleepless night look like for different people?

Polina finds it hardest to fall asleep, Ruslan and Yarema to sleep without waking, and for Bozhena the night ends too early. To choose the right help, it is important to understand which of these is yours: the section “Insomnia comes in different forms” will help.

If at least one of these stories resembles yours, note which part of the night is hardest for you. If none of them fits, answer the questions in the section “Which part of the night is hardest?”.

Insomnia comes in different forms

The word “insomnia” covers several different difficulties. Compare which is closer to your nights.

• Trouble falling asleep. You lie awake for a long time after turning off the light. See the page on difficulty falling asleep.
• Frequent waking. You fall asleep normally but wake several times during the night, like Ruslan in our example. Read more on the page about frequent night awakenings.
• Early waking. You wake long before the alarm and cannot get back to sleep. Compare with the description of early morning awakening.
• Unrefreshing sleep. You sleep long enough but do not feel rested in the morning. See the page on unrefreshing sleep.

These difficulties often combine or alternate from night to night. Note this: it is important for the doctor to know how your nights change.

When and to whom to go with insomnia

For new or persistent physical symptoms, start with a family doctor. Further investigations depend on your symptoms and examination, not a standard checklist. Mood or anxiety difficulties can also be discussed with a psychiatrist, who will ask how your nights and days go and discuss help with you.

The format of the first appointment is described on the initial psychiatric consultation page. You can see the specialists’ areas of work on the clinic’s doctors page.

Routine and help for persistent insomnia

Here is what usually helps to get sleep back on track:

• A steady routine. Go to bed and get up at roughly the same time and avoid long periods in bed during the day.
• Not lying awake for hours. If sleep does not come for a long time, it is better to get up briefly, do something calm and go back to bed when you feel sleepy again.
• Caffeine, alcohol and night-time reading. Pay attention to caffeine, alcohol and other substances that affect sleep. If, like Yarema in our example, you read the news after a night-time alert, try not to open your feed after the all-clear: the alert signal will warn you about the next one anyway.

For chronic insomnia, one of the leading treatments is cognitive behavioural therapy for insomnia (CBT-I). It includes not only “sleep hygiene” advice but also work on your routine, behaviour and anxious expectations about sleep. Do not take sleeping pills regularly or increase the dose without consulting a doctor.

What can keep sleep difficulties going?

Sleep can be disrupted by stress, pain, an irregular schedule, caffeine, alcohol or some medicines. Anxiety about the night itself can also keep insomnia going, as with Polina in our example, who expects from the evening that she will not sleep again.

If low mood and loss of interest in life persist along with poor sleep, a doctor may also assess for depression. Insomnia on its own does not yet mean that you have this disorder.

Poor sleep: your next step

1. If your need for sleep has sharply decreased and you are experiencing unusually high energy, rapid speech or thinking, impulsivity, or a noticeable change in behaviour, evaluation by a specialist is needed.
2. If insomnia comes with loud snoring, pauses in breathing during sleep or marked daytime sleepiness, a consultation is especially important: tell your doctor about these signs too.
3. If insomnia comes with marked anxiety, low mood or chronic pain, a consultation is also especially important.
4. If sleep problems last several weeks, occur regularly or noticeably affect your performance, mood, concentration or quality of life, see a doctor.
5. If difficult nights started recently after an obvious stress, start with the steps in the section “Routine and help for persistent insomnia”. If things have not improved after a few weeks, go back to point 4.