Understanding anti-insomnia treatment

The right approach depends on whether the main problem is falling asleep, staying asleep, waking too early or having sleep that feels unrefreshing. Daytime effects and the duration of the problem also guide care.

Difficulty sleeping can be maintained by an irregular schedule, long daytime naps, late caffeine, alcohol, pain, medicines or worry about not sleeping. Jet lag can temporarily shift the body clock. Depression, generalised anxiety disorder and burnout may also occur alongside sleep disturbance, so mood and stress symptoms belong in the assessment.

A structured psychological treatment for insomnia works on behaviours and thoughts that keep the sleep problem going. Its methods can include a stable rising time, using bed only for sleep, adjusting time in bed and learning ways to reduce sleep-related arousal.

Keep the same waking time, seek daylight after waking, reserve the bed for sleep, and leave it for a quiet dimly lit activity if you remain awake and frustrated. Reduce late caffeine and nicotine, avoid using alcohol as a sleep aid, and make the room dark, quiet and comfortably cool.

Do not combine sleeping tablets with alcohol, opioids or other sedatives unless the prescriber has explicitly reviewed the combination. Avoid driving or hazardous work if a product causes next-day drowsiness. Record bedtimes, waking, naps, caffeine and daytime sleepiness to give a clinician a clearer pattern.

Arrange a consultation when poor sleep persists, impairs work or driving, or comes with loud snoring, choking during sleep, restless legs, persistent low mood, intense anxiety or problematic substance use. A clinician can review medicines and check for a sleep, physical or mental health condition.

Seek urgent help if you might harm yourself or someone else, become severely confused, have hallucinations, or go without sleep while feeling unusually energised, agitated or reckless. After taking a sedative, emergency care is needed for slowed or difficult breathing, collapse or inability to wake normally.

Ask whether any current medicine could disturb sleep, whether behavioural therapy is available, what a proposed sleep medicine may do the next morning, how long it should be used, and how it should be stopped.