Insomnia
Insomnia is difficulty initiating or maintaining sleep despite adequate opportunity, accompanied by daytime fatigue, distress or impaired function.
Key points
- Time awake in bed, irregular schedules and worry about sleep can perpetuate insomnia after the original trigger resolves.
- Sleep apnoea, restless legs, pain, mood disorders, stimulants and alcohol require cause-specific management.
- Cognitive behavioural therapy for insomnia produces more durable benefit than relying on sedative medicine alone.
The listings below are not a universal sleep solution; age, breathing risk, falls, interactions and symptom duration affect safety.
Clarifying the sleep problem
A two-week sleep diary captures schedule, awakenings, naps and substances. Snoring with witnessed pauses suggests apnoea, while an urge to move the legs suggests restless legs. Mania can present as reduced need for sleep without fatigue and needs urgent mental-health assessment.
Treatment choices
CBT-I combines consistent wake time, stimulus control, sleep-window adjustment and work on unhelpful beliefs. Short-term hypnotics have selected roles but can cause next-day impairment, falls, tolerance or dependence. Melatonin is more useful for circadian timing disorders than as a universal sedative.
When to seek urgent care
Get urgent help for suicidal thoughts, severe agitation or confusion, hallucinations, inability to sleep for several nights with escalating risky behaviour, or dangerous drowsiness while driving.




