Mixed insomnia: what you should know

You may lie awake at bedtime, wake repeatedly, or wake earlier than planned and struggle to return to sleep. The pattern can be linked with stress, changes in routine, mood symptoms, travel across time zones, medicines, caffeine, alcohol, pain or another sleep problem.

The word mixed describes two sleep difficulties occurring together: sleep-onset insomnia, which makes it hard to get to sleep, and sleep-maintenance insomnia, which causes waking during the night or too early in the morning. Poor sleep can leave you tired, irritable or less able to concentrate the next day.

A clinician may ask when the problem began, how often it happens, your bedtime and wake time, naps, snoring, restless sensations, and any recent emotional or physical changes. A sleep diary can show whether the pattern follows shift work, jet lag, worry or an inconsistent schedule. Mixed insomnia is a description of a sleep pattern; the underlying reason still needs to be considered.

Keep a steady wake time, including after a poor night, and use the bed mainly for sleep. Give yourself a quiet wind-down period with dimmer light and avoid checking the clock repeatedly. Keep the bedroom comfortable, dark and quiet; limit caffeine later in the day and avoid using alcohol as a sleep aid.

If you are awake and becoming frustrated, leave the bed for a calm activity in low light and return when sleepy. Record sleep, naps, medicines and daytime symptoms for several days before an appointment. A clinician may discuss cognitive behavioural therapy for insomnia, review medicines and health conditions, or assess symptoms such as daytime sleepiness and difficulty concentrating.

Arrange a medical assessment if disrupted sleep keeps returning, affects work or driving, or leaves you struggling to function during the day. Seek prompt help for severe daytime sleepiness, especially if you might fall asleep while driving, or if loud snoring, choking or witnessed pauses in breathing accompany the sleep problem.

Contact a healthcare professional urgently if sleeplessness comes with thoughts of self-harm, severe confusion, or unusually elevated energy with little need for sleep. Do not start, stop or combine sleep medicines without advice; some products can cause next-day impairment or interact with other medicines.

Ask: What might be contributing to both trouble falling asleep and night waking? Could another condition, medicine or substance be affecting my sleep? Would a sleep diary or sleep study help? Which treatment is suitable for my pattern, and how can I avoid next-day drowsiness?