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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 8 therapies linked to Insomnia.

Therapy Evidence Notes
Cognitive Behavioural Therapist
strong

CBT for insomnia (CBT-I) is the gold-standard treatment for ongoing insomnia.

Autogenic Training Practitioner
moderate

Relaxation training that helps the body wind down for sleep.

EFT Practitioner
moderate

Tapping-based technique used supportively for sleeplessness and bedtime worry.

Hypnotherapist
moderate

Relaxation and suggestion used to improve sleep onset and quality.

Mindfulness Practitioner
moderate

Reduces the arousal and rumination that maintain insomnia.

NLP Practitioner
moderate

Techniques to change the thoughts and habits that disrupt sleep.

Tension and Trauma Practitioner
moderate

Releases stored tension that can keep the body too wired for sleep.

Yoga Therapist
moderate

Evening breath and movement practices that support better sleep.

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.