What should you know about really bad insomnia?

Insomnia may leave you exhausted while making sleep feel out of reach. You might notice daytime sleepiness, irritability, low motivation, or difficulty concentrating. Stress, burnout, anxiety, depression, travel across time zones, pain, medicines, caffeine, alcohol and an irregular schedule can all contribute. Insomnia is a condition in its own right; poor sleep does not by itself identify one underlying cause.

A clinician can ask about your sleep pattern, mental health, physical symptoms, substances and medicines. A sleep diary can show when the problem starts, how often you wake and how it affects your day.

Keep a steady wake time, including after a difficult night. Use the bed for sleep rather than prolonged worrying; if you are awake and alert, move to a dim, quiet activity and return when sleepy. Get daylight and gentle activity during the day, keep the bedroom cool and dark, and reduce late caffeine, nicotine, alcohol and bright screens. Avoid driving or other safety-sensitive tasks when sleepy. A GP can discuss cognitive behavioural therapy for insomnia and review medicines that may be disturbing sleep.

Arrange a medical review when sleeplessness is repeatedly impairing work, study, mood or safety, or when self-care has not helped. Seek urgent help if you feel unable to stay safe, have thoughts of harming yourself, or have several nights of very little sleep with unusually high energy, racing thoughts or risky behaviour. Get prompt assessment for breathing pauses, severe pain, confusion or sudden neurological symptoms.

Ask what may be maintaining your insomnia, whether a sleep diary or assessment is useful, and which treatment fits your pattern. Mention snoring or gasping, restless legs, mood changes, every medicine and supplement, and your caffeine or alcohol routine.