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Sleep Condition

Insomnia

Insomnia is the most common sleep disorder in the UK, affecting around one in three people at some point. It involves persistent difficulty falling asleep, staying asleep, or waking too early — leaving you feeling unrefreshed and affecting your daytime functioning. The most effective treatment is not sleeping pills but a structured psychological approach called CBT-I, which produces lasting results.

See therapies that may help

What is Insomnia?

Insomnia is defined as persistent difficulty with sleep initiation, maintenance, duration or quality that occurs despite adequate opportunity for sleep, and that results in daytime impairment. To meet clinical criteria, it should occur at least three nights per week for at least three months (chronic insomnia).

Short-term (acute) insomnia affects most people at some point — triggered by stress, illness, shift work or life events — and usually resolves naturally. Chronic insomnia is often maintained by the behaviours and thought patterns that develop in response to poor sleep, rather than by the original trigger.

Insomnia is both a condition in its own right and a common symptom of other conditions including anxiety, depression, chronic pain and menopause. Treating insomnia often improves the associated condition, and vice versa.

Signs and symptoms

Signs of insomnia include:

  • Difficulty falling asleep at the start of the night (sleep onset insomnia)
  • Waking frequently during the night and struggling to return to sleep
  • Waking significantly earlier than intended and being unable to get back to sleep
  • Sleep that feels unrefreshing or non-restorative despite adequate time in bed
  • Daytime consequences: fatigue, low mood, irritability, difficulty concentrating, reduced performance
  • Preoccupation with sleep — worrying about not sleeping before bedtime
  • Spending excessive time in bed trying to force sleep

How therapy can help

Cognitive behavioural therapy for insomnia (CBT-I) is the recommended first-line treatment for chronic insomnia — rated more effective than sleeping medication in clinical trials, and producing more durable results. Unlike medication, CBT-I addresses the perpetuating factors that maintain insomnia rather than masking symptoms.

CBT-I typically includes:

  • Sleep restriction therapy — temporarily reducing time in bed to consolidate sleep and rebuild sleep drive
  • Stimulus control — reassociating the bed with sleep rather than wakefulness and worry
  • Cognitive restructuring — addressing unhelpful beliefs about sleep (e.g. "I must get 8 hours or I can't function")
  • Sleep hygiene education — though sleep hygiene alone is insufficient for chronic insomnia
  • Relaxation techniques — progressive muscle relaxation, imagery and other approaches to reduce physiological arousal at bedtime

Other approaches include hypnotherapy, mindfulness-based therapy, and acupuncture, which many people find helpful alongside or instead of CBT-I.

Seeking help

If poor sleep has been affecting your life for more than a month, it is worth seeking support rather than continuing to rely on willpower or medication alone. Chronic insomnia rarely improves without addressing the perpetuating factors.

GPs can prescribe sleeping medication for short-term use, but NICE guidelines recommend CBT-I as the first-line treatment for chronic insomnia. Ask your GP about referral to a sleep clinic or psychological therapies service. Sleepio is a digital CBT-I programme available free via some NHS services and GP practices.

Private therapists offering CBT-I can be found through BABCP (British Association for Behavioural and Cognitive Psychotherapies) or through sleep specialist directories.

Therapies that may help with Insomnia

Showing 16 therapies linked to Insomnia.

Therapy Evidence Notes
Aromatherapist
limited

Some people find scent/massage relaxing; encourage sleep hygiene.

Hypnotherapist
moderate

Often used for sleep-onset issues driven by rumination.

Yoga Therapist
moderate

Relaxation practices may support sleep; encourage sleep hygiene.

Acupressurist
limited

May help some people when stress drives sleep disruption.

Acupuncturist
limited

Often sought when stress is a factor; sleep hygiene still key.

Herbal Medicine Practitioner
mixed

Check interactions

Mindfulness Practitioner
moderate

Helpful for switching off; support sleep hygiene too.

Reflexologist
limited

Often used as part of relaxation routine; support sleep hygiene.

Reiki Practitioner
limited

May support relaxation; encourage sleep hygiene.

Shiatsu Practitioner
limited

May support relaxation and switching off.

Colour Therapist
limited

If used, treat as relaxation routine support.

Craniosacral Therapist
limited

May help some people relax; encourage sleep hygiene.

Crystal Therapist
limited

If used, treat as part of a calming bedtime routine.

Energy Medicine Practitioner
limited

Adjunct relaxation approach; encourage sleep hygiene.

Indian Head Masseuse
limited

May support relaxation before sleep.

Flower Essences Therapist
limited

Adjunct relaxation support.

Frequently asked questions

What is the most effective treatment for insomnia?

CBT-I (cognitive behavioural therapy for insomnia) is the most effective treatment for chronic insomnia, outperforming sleeping pills in head-to-head clinical trials and producing more durable results. It works by addressing the perpetuating behaviours and thoughts that maintain insomnia rather than simply inducing sleep.

Why are sleeping pills not recommended for long-term insomnia?

Sleeping pills can be helpful for short-term insomnia (1–4 weeks) but are not recommended long-term because tolerance develops quickly, dependency is a risk, sleep quality is often reduced (particularly deep sleep), and they do nothing to address the underlying causes. CBT-I produces better outcomes without these downsides.

How long does CBT-I take?

A standard course of CBT-I runs 6–8 sessions. Many people see significant improvement within 4 sessions, though sleep restriction — one of the key components — requires commitment as it initially makes you feel more tired before sleep consolidates.

Can insomnia cause depression or anxiety?

Yes — there is a bidirectional relationship. Insomnia increases the risk of developing depression and anxiety, and depression and anxiety frequently cause or worsen insomnia. Treating insomnia often improves mood and anxiety levels, and addressing mental health conditions often improves sleep.

How much sleep do I actually need?

Sleep need varies between individuals, typically ranging from 6–9 hours for adults. What matters more than a fixed number is how you feel — whether you wake feeling refreshed and can function well during the day. Focusing on a rigid sleep target can itself become a source of performance anxiety that worsens insomnia.