Clinical insomnia: what should you know?

You may lie awake for a long time, wake repeatedly, or wake earlier than planned and struggle to return to sleep. The following day can bring daytime sleepiness, low energy, irritability or difficulty concentrating. The pattern can be linked with stress, anxiety, depression, burnout, travel across time zones, pain, medicines, caffeine or an irregular sleep schedule. Difficulty sleeping on an occasional night is common; clinical insomnia is considered when the problem keeps returning or leaves you struggling during the day.

A clinician may ask about your sleep timing, routines, mood, substances, medicines and other symptoms. A sleep diary can show patterns that are hard to recall from memory. Assessment also helps distinguish insomnia from another sleep problem or a condition affecting sleep.

Keep a consistent wake time, use the bed mainly for sleep, and dim bright screens before bedtime. If you remain awake and alert, get up briefly for a quiet activity and return when sleepy. Avoid late caffeine, nicotine and heavy meals, and keep the bedroom dark, quiet and comfortably cool. Do not start or stop sleeping tablets without medical advice; some medicines can cause next-day drowsiness or interact with other treatments.

Arrange a GP appointment if sleep difficulty is recurring, affecting work or driving, or accompanied by low mood or persistent worry. Cognitive behavioural therapy for insomnia may address unhelpful sleep patterns and the thoughts that keep them going.

Seek prompt medical advice if severe sleep loss is accompanied by confusion, unusual agitation, thoughts of self-harm, or inability to function safely. Avoid driving when sleepy. Urgent support is also appropriate if anxiety or depression feels overwhelming, or if a new medicine appears to have triggered the change.

Ask what might be maintaining your sleep problem, whether another condition or medicine should be checked, and whether a sleep diary or structured therapy would help. Discuss a safe plan if you are considering medication and how to review progress.