What should you know about permanent insomnia?

Insomnia may involve difficulty falling asleep, waking repeatedly, waking too early, or feeling that sleep is not refreshing. When this continues, worry about sleep can become part of the pattern: you may spend longer awake in bed, watch the clock, or change your schedule unpredictably. These responses can make the next night harder without meaning that your sleep is permanently damaged.

Possible contributors include stress, low mood, anxiety, shift work, travel across time zones, pain, breathing problems, medicines, caffeine, alcohol and an irregular sleep routine. Daytime effects can include tiredness, irritability and difficulty concentrating. A clinician may ask about your sleep pattern, daytime functioning, medicines and other symptoms to identify the most useful next step.

Keep a regular wake-up time, including after a poor night, and use the bed mainly for sleep. If you remain awake and alert, get up briefly for a quiet activity in dim light and return when sleepy. Keep the bedroom comfortable and reduce bright screens, caffeine and alcohol close to bedtime. Morning daylight and regular daytime movement can help anchor your body clock.

Arrange a medical assessment if sleep difficulty is ongoing, distressing or affecting work, driving, mood or relationships. Cognitive behavioural therapy for insomnia can address unhelpful sleep thoughts and routines. Do not start, stop or regularly use sleeping medicines without discussing their benefits, side effects and safe duration with a clinician.

Seek prompt medical advice if sleep loss is accompanied by severe low mood, thoughts of self-harm, unusually elevated energy with little need for sleep, confusion, breathing pauses, chest pain or a safety concern while driving. Contact a clinician when persistent insomnia comes with loud snoring, restless legs, ongoing pain, medication changes or marked daytime sleepiness, because another sleep or health problem may need attention.

Ask what may be contributing to your sleep pattern, whether another condition or medicine should be checked, and whether cognitive behavioural therapy for insomnia is suitable. Bring a short sleep diary showing bedtime, estimated time to fall asleep, awakenings, wake time, naps, caffeine and daytime symptoms. This can make the discussion more specific.