Difficulty getting to sleep

Delayed sleep onset may happen when your internal clock is out of step with your required bedtime, such as after travel or changing shifts. Worry, burnout and depression can alter sleep drive, while reflux, an overactive thyroid or breathing interruptions may keep the body alert. Ask whether you are sleepy but unable to settle, or not sleepy at the chosen time; that distinction can guide the assessment.

Note your sleep and wake times, naps, evening drinks, medicines and daytime symptoms. Loud snoring, choking sounds, morning headaches or witnessed pauses in breathing should be mentioned to a clinician.

Choose a regular wake time and seek natural light soon after waking. Keep exercise earlier if late activity makes you alert. Reduce caffeine later in the day and create a predictable, low-stimulation wind-down. If you are awake and tense in bed, get up for a quiet activity in dim light, then return when drowsy. Avoid borrowing sleeping tablets or mixing sedating products with alcohol. A clinician can recommend structured behavioural treatment when the difficulty persists.

Book an appointment when delayed sleep repeatedly affects work, driving, mood or memory, or follows a medicine change. Get urgent help for self-harm thoughts, confusion, severe distress, or very little sleep with unusually high energy, racing thoughts or impulsive actions.

What might be delaying my sleep, and should we review my medicines or symptoms? Could I have insomnia, anxiety, reflux, thyroid disease or sleep apnoea? Which non-drug treatment should I try first?