Five things to try when sleep will not come

People lying awake at night should try not to force sleep, according to the NHS’s Every Mind Matters advice: if still awake after around 20 minutes, it says to get up, sit somewhere comfortable and go back to bed when sleepy.

Insomnia means regularly having problems sleeping, and it usually gets better by changing sleeping habits, its insomnia page says. The NHS calls it long-term once it has lasted three months or longer.

Five of the suggestions on the NHS pages:

• Only going to bed when sleepy.
• Writing worries down: for people who often worry in bed, making a list of the next day’s tasks before going to sleep.
• A quiet, dark, cool room, which people may find easier to sleep in; earplugs and an eye mask are among the ideas.
• Clocks out of view and the phone face down, to reduce light.
• Getting up at the same time every day, rather than sleeping in after a bad night.

For long-term insomnia, NICE says cognitive behavioural therapy for insomnia, known as CBTi, is the standard first treatment once advice on sleeping habits has been offered. Its guidance of 18 October 2023 on the sleeping drug daridorexant adds that access to CBTi varies across the UK, and that for some people it does not work or is unsuitable.

The NHS says a GP may offer cognitive behavioural therapy, face to face or through an online programme, to help change the thoughts and behaviours that keep someone from sleeping.

A 2015 review in the Annals of Internal Medicine pooled 20 trials covering 1,162 adults with chronic insomnia. Compared with people who had no active treatment, those given cognitive behavioural therapy fell asleep about 19 minutes sooner and were awake about 26 minutes less after first dropping off. Total sleep time rose by about eight minutes, but the range of estimates included no change at all. The reviewers described CBTi as an effective treatment for adults with chronic insomnia.

The review has limits, its authors said. It covered only face-to-face therapy, so it says nothing about online programmes, and it left out people whose insomnia came with another medical, sleep or psychiatric disorder. Estimates for later check-ups were less clear, though the changes seemed to last.

The NHS says to see a GP if changing sleeping habits has not helped, if the trouble has lasted for months, or if it is making daily life hard to cope with. GPs now rarely prescribe sleeping pills, which can have serious side effects and lead to dependence, the NHS says.