This Way Up insomnia: what should you know?

You may lie awake, wake repeatedly or wake earlier than planned and struggle to return to sleep. Daytime sleepiness, irritability, low motivation and difficulty concentrating can follow. Stress, burnout, depression, generalised anxiety disorder, travel across time zones, pain, caffeine, alcohol or an irregular schedule may contribute. These links work in different ways, so insomnia does not by itself identify a mental health condition. A sleep diary can show patterns that are hard to recall at an appointment.

Keep a regular wake time, use the bed mainly for sleep and get daylight and gentle activity during the day. If you remain awake and alert, move briefly to a quiet, dim setting and return when sleepy. Reduce caffeine later in the day, avoid alcohol as a sleep aid and keep phones outside the bed routine where possible. Do not change prescribed medicines or start sleeping tablets without clinical advice. Cognitive behavioural treatment for insomnia may be discussed when the problem persists.

Book a clinical review when poor sleep continues, affects work or driving, or leaves you struggling with daytime functioning. Seek prompt help if insomnia accompanies thoughts of self-harm, severe agitation, confusion, unusual high energy with little need for sleep or breathing pauses at night. Daytime sleepiness that makes driving unsafe requires immediate practical caution. A clinician can review mood, medicines, substances, physical symptoms and sleep habits.

What might be maintaining my insomnia? Would a sleep diary or structured therapy help? Could a medicine, caffeine, alcohol, mood change or another symptom be involved? What should I do about daytime sleepiness and driving? Are any sleep medicines appropriate for me?