Trouble Sleeping
Trouble getting to sleep, staying asleep or waking too early. Short spells after stress usually pass. Insomnia lasting 3 months or more is best fixed with CBT-I, not tablets.
The insomnia ladder
Start at the bottom. CBT-I is the real treatment: it works for most people and keeps working after you stop. Tablets are a short-term crutch.
- Step 1 · Self-careSleep habitsSame wake-up time every day, morning light, no caffeine after midday, screens down an hour before bed.
- Works
- Small benefit in trials; on its own rarely fixes long-term insomnia
- Cost
- Free
- How long
- Daily, for good
- Watch for
- Lying in bed for hours trying harder. Sleep doesn’t respond to effort
Sleep is the only thing that gets worse the harder you try.
- Step 2 · Self-careOnline CBT-IA structured self-help version of CBT for insomnia, such as the free This Way Up Insomnia Program (4 online modules).
- Works
- In a large trial, about 1 in 2 recovered at a year vs 1 in 4 given sleep advice; a bit below therapist-led CBT-I
- Cost
- Free
- How long
- About 6–10 weeks
- Watch for
- A rough first couple of weeks if you try sleep restriction. It gets better
The best free thing on this page, and nobody advertises it.
- Step 3 · PharmacySlow-release melatonin (55 and over)A pharmacist-only short course for people 55 and over. Other forms need a prescription.
- Works
- A small benefit: asleep about 7–9 minutes sooner than a dummy treatment
- Cost
- About $35 for 30 tablets
- How long
- Up to 13 weeks
- Watch for
- Headache, next-day drowsiness. Gummies from overseas often don’t contain what the label says
A nudge, not a knockout.
- Step 4 · Allied healthCBT-I with a psychologist4 to 8 sessions covering sleep scheduling, rethinking sleep worries and winding down.
- Works
- About 7 in 10 people sleep noticeably better and around 4 in 10 recover fully; the benefits last
- Cost
- About $150–250 a session; Medicare rebates with a GP mental health treatment plan
- How long
- 4–8 sessions over 6–10 weeks
- Watch for
- Sleep restriction makes you more tired for a week or two before it helps
Homework for your bedroom. Annoying, effective.
- Step 5 · PrescriptionShort-term sleeping tabletsSuch as temazepam or zolpidem, for a few nights in a crisis.
- Works
- In over-60s, about 1 in 13 sleep better but 1 in 6 get side effects; stop working quickly
- Cost
- Under the $25 PBS co-payment, about $10–20
- How long
- A few nights only
- Watch for
- Next-day drowsiness, falls, memory problems, dependence. Sleepwalking or sleep-driving with zolpidem
A short loan, with interest.
- Step 6 · PrescriptionOrexin-blocking tabletsNewer medicines (daridorexant, lemborexant or suvorexant) when CBT-I isn’t enough.
- Works
- Vs dummy treatment: about 20 minutes less awake at night and asleep about 10 minutes sooner. Small to moderate benefit
- Cost
- Private script, roughly $60–100 a month
- How long
- Can be used for months, with review
- Watch for
- Next-day drowsiness, headache, vivid dreams. Not with narcolepsy
Better than the old tablets, still not better than CBT-I.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Sedating antihistamines (such as doxylamine)Next-day grogginess, little benefit, and not suitable for older people. A hangover without the party.
- ValerianMost trials find little or no benefit over a dummy treatment. Smells like old socks, works like a sugar pill.
- MagnesiumSmall, low-quality studies. Unlikely to fix insomnia unless you’re actually low.
- CBD oilLittle good evidence for insomnia, and it isn’t cheap. Expensive vibes.
- Sleep trackersNot a treatment, and chasing a perfect score can make sleep worse. Your watch doesn’t know how you feel.
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’re awake after about 20 minutes, get up, do something calm in dim light, and return when sleepy.
- Alcohol gets you to sleep and then wrecks the second half of the night.
- Keep naps under 30 minutes and before 3 pm.
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: your GP can help you reduce them slowly.
Common questions
What is the best treatment for insomnia?
CBT for insomnia (CBT-I), usually 4 to 8 sessions with a psychologist or a free online program such as This Way Up. It helps most people, and the benefits last.
Does melatonin help you sleep?
Slow-release melatonin gives a small benefit for people over 55, as a short course from a pharmacy. Other forms need a prescription.
Are sleeping tablets safe long term?
No. Long-term use risks dependence, falls, memory problems and next-day drowsiness, especially in older people. Don’t stop them suddenly: your GP can help you reduce them slowly.
What should I do if I can’t fall asleep?
If you’re still awake after about 20 minutes, get up, do something calm in dim light, and return when sleepy. Get up at the same time every day, even after a bad night.
How much sleep do I need?
Most adults need 7 to 9 hours. Needs vary, so the best test is how you feel during the day. Some people do well on less than they think, and worrying about sleep can make insomnia worse.
Why do I wake up at 3am?
Brief waking during the night is normal, but stress, alcohol, reflux, needing to pass urine, hot flushes, pain or sleep apnoea can make it harder to get back to sleep. If you can’t settle after about 20 minutes, get up and do something calm until sleepy.
Does magnesium help sleep?
There’s little good evidence that magnesium helps sleep in people who aren’t low in it. CBT for insomnia and a regular wake-up time work much better.
Helpful resources
- This Way Up Insomnia ProgramFree 4-module online CBT-I course you can start yourself. Australia.
- CBT-i Coach appFree app from the US Department of Veterans Affairs with a sleep diary and CBT-I tools. Also on Android.
- Sleep Health Foundation: CBT-IExplains CBT-I and links to a directory of psychologists trained in it. Free.
Evidence and more information
- Healthdirect: Insomnia
- Sleep Health Foundation: CBT for insomnia
- Healthdirect: Melatonin
- This Way Up: Insomnia Program
- Ritterband et al, JAMA Psychiatry 2017: online CBT-I trial
- Ferracioli-Oda et al, PLoS One 2013: melatonin meta-analysis
- Glass et al, BMJ 2005: sleeping tablets in older people
- Mignot et al, Lancet Neurology 2022: daridorexant trials
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