Sleep difficulty

Overview

Sleep difficulty, also called insomnia, means having trouble falling asleep, staying asleep, or waking up too early and not being able to get back to sleep. It can affect your energy, mood, and ability to function during the day.

Yes, sleep difficulty is extremely common. About one in three people in the UK experience some form of insomnia at some point in their lives.

Sleep difficulty can affect people of all ages, but it is more common in women, older adults, and people who are stressed, anxious, or have certain medical conditions.

Symptoms

Common symptoms

• trouble falling asleep at night
• waking up during the night and struggling to get back to sleep
• waking up too early in the morning
• feeling tired or not refreshed after sleep
• daytime sleepiness, irritability, or difficulty concentrating

Symptoms in children

• difficulty settling down at bedtime
• frequent night waking or crying
• resistance to going to bed
• daytime drowsiness, mood swings, or behavioural problems

Symptoms in older adults

• lighter sleep and waking up more often during the night
• needing to use the bathroom more frequently at night
• early morning waking
• napping during the day and then having trouble sleeping at night

Causes

Main causes

• stress from work, school, or personal life
• anxiety or depression
• poor sleep habits like irregular bedtimes or using screens before bed
• caffeine, nicotine, or alcohol close to bedtime
• medical conditions such as chronic pain, asthma, or an overactive thyroid

Risk factors

• being female (hormonal changes can affect sleep)
• being over 60 years old
• having a family history of insomnia
• working night shifts or irregular hours
• having a mental health condition like anxiety or depression

When to see a doctor

See a doctor urgently if:

• if sleep difficulty is accompanied by chest pain, severe headache, or trouble breathing
• if you feel you might harm yourself or someone else

Book a routine appointment if:

• if poor sleep has lasted for more than a few weeks and affects your daily life
• if you feel very tired, irritable, or unable to concentrate during the day
• if you have tried self-help methods and they have not helped

Diagnosis

Your doctor will ask about your sleep patterns, lifestyle, and any medical conditions or medications that might affect sleep. They may ask you to keep a sleep diary for a week or two.

Tests that may be done

• no special test is usually needed
• if another condition is suspected, your doctor may order blood tests or refer you to a sleep specialist

What to expect at your appointment

Your doctor will listen to your concerns and work with you to find the cause. They may suggest simple changes first, like improving your sleep routine, or refer you for talking therapy like cognitive behavioural therapy for insomnia (CBT-I).

Treatment

Treatment for sleep difficulty focuses on finding the underlying cause and improving sleep habits. Most people get better with self-care and non-medical approaches.

Self-care at home

• keep a consistent sleep schedule – go to bed and wake up at the same time every day, even on weekends
• create a relaxing bedtime routine, like reading or taking a warm bath
• avoid caffeine, nicotine, and alcohol in the evening
• limit screen time (phones, tablets, TV) at least an hour before bed
• make your bedroom comfortable – dark, quiet, and cool
• get regular physical activity, but not too close to bedtime

Medical treatments

If self-care is not enough, your doctor may suggest talking therapies like cognitive behavioural therapy for insomnia (CBT-I). In some cases, short-term medications may be considered, but they are not a first choice and should be used only under medical supervision. Always discuss options with your healthcare provider.

When is surgery considered?

Surgery is not a treatment for sleep difficulty. If sleep problems are caused by a condition like sleep apnoea or a breathing issue, your doctor may recommend other treatments, but not surgery specifically for insomnia.

Living with this condition

Living with sleep difficulty can be challenging, but small changes can make a big difference. Be patient with yourself and focus on improving your sleep habits gradually.

Lifestyle tips

• stay active during the day – even a short walk can help
• get natural light, especially in the morning
• avoid long naps – if you nap, keep it under 30 minutes
• manage stress with relaxation techniques like deep breathing or mindfulness

Diet and exercise

Eat a balanced diet and avoid heavy meals close to bedtime. Regular exercise can improve sleep quality, but try to finish exercise at least a few hours before bed.

Mental health and emotional wellbeing

Poor sleep can affect your mood, memory, and ability to handle stress. It can also increase anxiety and depression. Talking to someone you trust or seeking professional help is important.

Prevention

You can reduce your risk of sleep difficulty by practicing good sleep habits (sleep hygiene) and managing stress. However, some causes like age or family history cannot be prevented.

Vaccines

There are no vaccines for sleep difficulty. Vaccines protect against infections, which may indirectly improve sleep if you are sick less often.

Screening programmes

There is no routine screening for sleep difficulty. Your doctor may ask about sleep during regular check-ups, especially if you have risk factors.

Complications

If left untreated

• chronic fatigue and daytime sleepiness
• increased risk of accidents or injuries
• higher chance of developing depression or anxiety
• worsening of other health problems like high blood pressure or diabetes

Long-term outlook

Most people with sleep difficulty improve with simple lifestyle changes and support. Even if it lasts a long time, there are effective treatments available. With the right help, you can get better sleep and improve your quality of life.

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