Insomnia - Treatment 

Treating insomnia 

Sleeping tablets are usually only prescribed for the short-term treatment of insomnia  

Complementary and alternative therapies

There's very limited evidence to suggest that either acupuncture or hypnotherapy are effective for treating insomnia.

Certain herbal remedies, such as chamomile and passionflower, have been reported to have positive effects. However, they haven't been thoroughly clinically tested, so their effectiveness and long-term safety is unknown.

Compare your options

Take a look at a simple guide to the pros and cons of different treatments for insomnia

The first step in treating insomnia is to find out whether the problem is being caused by an underlying medical condition.

If it is, once the condition has been treated, your insomnia may disappear without the need for further medical help.

Good sleep hygiene

Your GP will be able to advise you about what you can do at home to help you sleep. This is known as good sleep hygiene and includes:

  • establishing fixed times for going to bed and waking up (try to avoid sleeping in after a poor night's sleep)
  • trying to relax before going to bed
  • maintaining a comfortable sleeping environment (not too hot, cold, noisy or bright)
  • avoiding napping during the day
  • avoiding caffeine, nicotine and alcohol late at night 
  • avoiding exercise within four hours of bedtime (although exercise in the middle of the day is beneficial)
  • avoiding eating a heavy meal late at night
  • avoiding watching or checking the clock throughout the night
  • only using the bedroom for sleeping and sex

Read more simple methods that may help prevent insomnia.

If you have long-term insomnia (lasting more than four weeks) your GP may: 

  • recommend cognitive and behavioural treatments
  • prescribe a short course of sleeping tablets for immediate relief or to manage a particularly bad period of insomnia; however, they aren't recommended for long-term use 

Cognitive and behavioural treatments

The aim of cognitive behavioural therapy for insomnia (CBT-I) is to change unhelpful thoughts and behaviours that may be contributing to your insomnia. It may be recommended if you've had sleep problems for more than four weeks.

CBT-I can include:

  • stimulus-control therapy - which aims to help you associate the bedroom with sleep and establish a consistent sleep/wake pattern
  • sleep restriction therapy - limiting the amount of time spent in bed to the actual amount of time spent asleep, creating mild sleep deprivation; sleep time is then increased as your sleeping improves
  • relaxation training - aims to reduce tension or minimise intrusive thoughts that may be interfering with sleep
  • paradoxical intention - you try to stay awake and avoid any intention of falling asleep; it's only used if you have trouble getting to sleep, but not maintaining sleep
  • biofeedback - sensors connected to a machine are placed on your body to measure your body’s responses, such as muscle tension and heart rate; the machine produces pictures or sounds to help you control your breathing and body responses

CBT-I is sometimes carried out by a specially trained GP. Alternatively, you may be referred to a clinical psychologist.

You'll usually have four or five sessions of CBT-I, each lasting about an hour. As part of the treatment you may be asked to keep a daily record of your sleep (a sleep diary).

In the UK, there are a number of places that provide specialist sleep services such as CBT-I. These include:

The website of the British Sleep Society (BSS) also has a post code search that you can use to find your nearest sleep centre.

Sleeping tablets

Sleeping tablets (hypnotics) are medications that encourage sleep. They may be considered:

  • if your insomnia symptoms are very severe
  • to help ease short-term insomnia
  • if the good sleep hygiene and cognitive and behavioural treatments mentioned above prove ineffective 

However, doctors are usually reluctant to prescribe sleeping tablets because although they help relieve the symptoms of insomnia, they don't treat the cause.

If you have long-term insomnia, sleeping tablets are unlikely to help. Your doctor may consider referring you to a clinical psychologist to discuss other approaches to treatment.

Read more about why sleep medication only offers short-term relief.

You should be prescribed the smallest effective dose possible for the shortest time necessary (for no longer than a week). In some cases, you may be advised to only take the medication two or three nights a week, rather than every night.

Sleeping tablets can sometimes cause side effects, such as a feeling that you're hungover and daytime drowsiness.

It's best to take sleeping tablets at night, before you go to bed. Sometimes, particularly in older people, the hangover effects may last into the next day, so be cautious if it's likely that you'll be driving the next day (see below for more advice about driving).

It's very easy to become dependent on sleeping tablets, even after a short-term course. Therefore, if you're taking sleeping tablets regularly (every night), you should consider reducing them or stopping them altogether. Speak to your GP for advice.

Short-acting benzodiazepines or the newer 'Z medicines' (see below) are the preferred medicines for insomnia and are only available on prescription.

Benzodiazepines

Benzodiazepines are tranquillisers that can reduce anxiety and promote calmness, relaxation and sleep.

These medicines should only be considered if you have severe insomnia or it's causing extreme distress.

Benzodiazepines will make you feel sleepy and can lead to dependency. Therefore, only short-acting benzodiazepines (with short-lasting effects) should be used to treat insomnia. Temazepam is the benzodiazepine that's often prescribed.

Benzodiazepines can have many potential side effects. See the link to temazepam above for a full list of possible side effects.

Z medicines

Z medicines are a newer type of short-acting medicines that work in a similar way to benzodiazepines. They include: 

  • zaleplon
  • zolpidem
  • zopiclone

Zaleplon

Zaleplon is licensed to treat people with insomnia who have difficulty falling asleep.

It should only be used at the lowest possible dose and for a maximum of up to two weeks.

Common side effects of zaleplon (affecting more than one in 100 people) include:

Less common side effects (affecting more than one in 1,000 people) include:

  • apathy (lack of interest)
  • balance and co-ordination problems
  • concentration problems
  • changed sense of smell
  • dizziness
  • hallucinations (seeing things that aren't real)

Read more about zaleplon.

Zolpidem

Zolpidem is licensed for the short-term treatment of debilitating insomnia or where it's causing severe stress.

It should only be used at the lowest possible dose and for a maximum of up to four weeks.

Common side effects of zolpidem include:

Less common side effects include confusion and double vision.

Read more about zolpidem.

Zopiclone

Zopiclone is licensed for the short-term treatment of insomnia including difficulty falling asleep, waking up during the night and long-term insomnia that's debilitating or causing severe distress.

It should only be used at the lowest possible dose and for a maximum of up to four weeks.

Common side effects of zopiclone include:

  • dry mouth 
  • metallic taste in your mouth
  • sleepiness

Less common side effects include:

  • dizziness, nausea and vomiting
  • drowsiness
  • headaches

Read more about zopiclone.

Z medicines can also sometimes cause psychiatric reactions, such as anger, irritability, agitation, aggressiveness, delusion, nightmares and hallucinations.

You should stop taking your medication and see your GP immediately if you experience any of these psychiatric reactions.

There's little difference between Z medicines and benzodiazepines. If one doesn't work, swapping to another is unlikely to have a different effect.

The National Institute for Health and Care Excellence (NICE) guidance contains more about the use of zaleplon, zolpidem and zopiclone for the short-term management of insomnia (PDF, 83.3kb).

Antidepressants

Antidepressants are sometimes prescribed for people with insomnia, and can be particularly useful if a person also has a history of depression.

Melatonin (Circadin)

Medicines that contain melatonin have been shown to be effective in relieving insomnia for up to 26 weeks in elderly people.

Melatonin is a naturally occurring hormone that helps regulate the sleep cycle (known as the circadian rhythm).

Circadin is the only medicine containing melatonin. It's licensed to treat insomnia and is only available on prescription for people who are 55 years of age or over.

Circadin is designed as a short-term treatment for insomnia and shouldn't be taken for more than three weeks. It's not recommended for people with a history of kidney disease or liver disease.

Side effects of Circadin are uncommon but can include:

If you're finding these side effects troublesome, stop taking Circadin and contact your GP.

Driving

If you have insomnia, it may affect your ability to drive. Medical conditions that cause sleepiness should be reported to the Driver & Vehicle Licensing Agency (DVLA).

GOV.UK has more information about telling the DVLA about a medical condition or disability.




Page last reviewed: 09/12/2013

Next review due: 09/12/2015

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Comments

The 4 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Opolewroclaw said on 12 January 2014

I have suffered from extremely bad imsomnia for many years, and untill recently found that nothing helped, and then my GP remembered some old sleeping aids which really worked and have meant sleep for the first time in ages.

I notice they are not mentioned here but my GP prescribed me Secobarbital 100mg and after taking one 15 mins later was asleep.

If nothing else works ask your GP about these.

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SL91 said on 19 March 2013

Karry Gee

Please let me know you have read this because i have created an account just so i can reply to you.

Firstly i would recommend that you see another doctor because, unfortunately, yours does not seem to be as concerned as his/her profession demands.

Secondly, I have been taught through psychology that we should not give advice to people such as which medicines to take. So although you feel that the antidepressants are not needed, please do not take yourself off them before consulting a doctor, as this can have adverse side effects.

When you see a new doctor, may i suggest that you explain to them exactly what you have written in your comment on this site. You are entitled as a patient to push for a second opinion. If you feel that your depression is caused by your insomnia please mention this to them. Try explaining that you would like to solve the underlying problem rather than just trying to alleviate the symptoms in the short term.

Thirdly, it sounds as if you have been suffering for a while and have tried every avenue, so you are also within your right to push your GP for a referral to a specialist.

In the meantime, please don't feel embarrassed because you are not alone. Many people have insomnia and will experience the same effects as you. As advised as it is not to take naps during the day, you can not continue functioning without sleep and it will stress you out. If you have found that keeping yourself awake during the day does not help anyway, by all means take a nap when you feel you need to and set your alarm for about an hour- but don't clock watch.

Hope this is of help.

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Karry Gee said on 17 January 2013

I need some guidance because I have a severe sleep problem that is deteriorating by the night.
I have terrible nightmares and they seem to happen every single night now . The dreams/nightmares are so vivid that I find myself checking if they are dreams or retained memories . I once checked out the possibility that I had married someone when I was 18 and then "done a runner" . I checked at the local registry office . I hadn't done it fortunately. These incidents wake me 12 -15 times a night , sometimes because I cry or scream out but usually because the bedclothes are soaked through. I have paralysis type experiences every night whilst trying to go to sleep . I am at the end of my tether , I am so tired but I cannot sleep easily. The doctor put me on antidepressants but I didn't feel depressed until I couldn't sleep . Nothing major has happened in my recent life to cause depression or anxiety and am generally a happy person but I cannot cope any more. I am so tired all the time and the dreams are so frightening and horrible. The other morning I was mortified to find that I had wet the bed -I am 54 and post menopausal , I have a relatively healthy lifestyle, don't smoke or drink very much and don't drink coffee at all. Happily married , lovely family - I am so tired of telling the Doctor that its not depression but a sleep problem but I see his eyes cloud over when I try and explain how this lack of sleep manifests and the horrific nightmares, paralysis and constant dreaming .
I am now desperate - I would even consider a short course of sleeping pills to get me a few nights sleep . I have tried all the recommended lifestyle changes but nothing works and exhaustion is affecting me . If anyone can help me , please tell me where to go for help . I am so tired I am crying whilst typing this - please can someone point me in the right direction ?

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Charlie Dick said on 12 December 2011

i found restricting my sleep very helpful. it sounds odd - sleeping less - but going to bed half an hour earlier and getting up the same time every morning with an alarm clock - even if i had a bad nights sleep - has gradually improved the quality of my sleep. i still wake up 5-6 times a night but i go straight back to sleep again. its not easy getting up in the morning or keeping awake in the evenings - but i'm less tired now and dont nap during the day.

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