Extreme insomnia: what you should know

Insomnia includes difficulty falling asleep, waking repeatedly, or waking too early despite having an opportunity to rest. Stress, pain, shift work, caffeine, medicines, and an irregular schedule can contribute. [Burnout](/conditions/burnout/), [Depression](/conditions/depression/), [Generalised Anxiety Disorder](/conditions/generalised-anxiety-disorder/), and [Jet Lag](/conditions/jet-lag/) may also disturb sleep. Daytime effects can include [Daytime Sleepiness](/symptoms/daytime-sleepiness/) and [Difficulty Concentrating](/symptoms/difficulty-concentrating/).

Keep a regular wake time, get daylight soon after waking, and use the bed mainly for sleep. Make the room dark, quiet, and comfortably cool. Avoid caffeine late in the day, alcohol as a sleep aid, and stimulating screens close to bedtime. If you remain awake and frustrated, leave the bed for a quiet activity in low light and return when sleepy. Keep a brief sleep diary showing bedtime, waking, naps, substances, and daytime symptoms; this helps a clinician choose treatment. Do not start or combine sleeping medicines without advice.

Arrange a clinical review when sleep difficulty persists, keeps returning, or affects work, driving, mood, or relationships. Seek urgent help for thoughts of self-harm, severe confusion, feeling unusually energised without needing sleep, hallucinations, chest pain, or breathing difficulty. Do not drive or operate machinery when very sleepy. [Difficulty Sleeping](/symptoms/difficulty-sleeping/) is worth discussing when it becomes a repeated pattern rather than an isolated poor night.

Ask what might be disrupting your sleep, whether another condition or medicine is involved, whether talking therapy could help, and how to make a safe plan for restoring sleep.