Trouble Sleeping
Difficulty getting to sleep, staying asleep or waking too early, with tiredness during the day. Short spells after stress are common and usually pass. Insomnia lasting 3 months or more is best treated with a specific talking therapy (CBT-i), not tablets.
Treatment options
Ratings show how strong the research is.
- Strong evidenceCBT for insomnia (CBT-i)The first-line treatment. Usually 4 to 8 sessions with a psychologist, or a free online program such as This Way Up or MindSpot. Helps most people, and the benefits last.
- Moderate evidenceOrexin-blocking tabletsNewer prescription medicines (such as suvorexant, lemborexant or daridorexant) when CBT-i isn’t enough. Can cause next-day drowsiness.
- Limited evidenceMelatoninSlow-release tablets give a small benefit for people over 55, from a pharmacy, for a short course. Other forms need a prescription.
- Limited evidenceSleep hygiene aloneGood habits help, but on their own rarely fix long-term insomnia.
- Limited evidenceShort-term sleeping tabletsSuch as temazepam or zolpidem, for a few nights in a crisis. Less effective than CBT-i and they stop working quickly.
- Not recommendedLong-term sleeping tabletsRisk of dependence, falls, memory problems and next-day drowsiness, especially in older people.
- Not recommendedSedating antihistaminesPharmacy sleep aids such as doxylamine cause next-day grogginess and aren’t suitable for older people.
What you can do
- Get up at the same time every day, even after a bad night and on weekends.
- Go to bed only when sleepy. If you can’t sleep after about 20 minutes, get up, do something calm in dim light, and return when sleepy.
- Get outdoor light in the morning. Keep screens and lights low in the hour before bed.
- No caffeine after midday. Alcohol worsens sleep later in the night.
- Keep naps under 30 minutes and before 3 pm.
- If worries keep you awake, set aside a "worry time" earlier in the evening to write down plans.
See your GP if
- Trouble sleeping most nights for 3 months or more
- Loud snoring, gasping or pauses in breathing at night, or dozing while driving
- Low mood, anxiety, pain or restless legs keep you awake
- You rely on sleeping tablets or alcohol to sleep
Don’t drive if you feel drowsy. Don’t stop long-term sleeping tablets suddenly: ask your GP about reducing them slowly.
Evidence and more information
maladywise.com/sleep/