Insomnia – What to do when counting sheep isn’t working

The effects of living during a global pandemic and the ongoing disruptions to normal life have taken a heavy toll on sleep for many people. In the past year, cases of insomnia in the population have risen dramatically.

One study from the University of Southampton found that sleep problems had increased from 1 in 6 people to 1 in 4. Google reported a 56% increase in people searching for information about insomnia online.

COVID-related or not, not getting enough sleep leaves people at greater risk of long-term health issues. These include obesity, cardio-vascular disease, diabetes, and mental health problems such as anxiety and depression.

Insomnia sleeping

What is insomnia?

The word ‘insomnia’ is used a lot, but what does it actually mean?

  • Difficulty getting to sleep or staying asleep and/or experiencing sleep that isn’t refreshing
  • Poor sleep three or more nights per week
  • Difficulty getting to sleep or staying awake for more than 30 minutes
  • Sleep problems for more than six months
  • Marked distress and/or having a bad effect on social life or employment, or other significant problems because of poor sleep

There is increasing evidence that with persistent insomnia, the automatic process of getting off to sleep and staying asleep becomes disrupted.

When this automatic nature of sleep is disrupted, the natural rhythms and timings around sleep become more sensitive to our emotions and our behaviour.

For example, people with sleep problems can end up spending too much time in bed compared to the amount of sleep they are actually getting. So they associate being in bed with being upset and trying hard to put things right but failing.

Being preoccupied and worried about sleep may make a big difference between being a good sleeper and having insomnia.

Insomnia often comes with the feeling of being misunderstood. You may be left feeling that you just have to live with it. It might also be suggested that you are depressed. Though sometimes this may be correct, not all insomniacs have depression. Teenaged insomniacs, who tend to be very irritable, get labelled as difficult or moody.

If left untreated, insomnia increases the risk of mental health problems, poor focus and engagement at work or school, and difficulties in relationships. So what options are there?

What are the recommended treatments for insomnia?

Doctors have a tricky task when when it comes to persistent insomnia.

Medication can be prescribed, but sleeping pills are recommended for short-term use only. Many people find that they keep having problems getting to sleep or staying asleep, even when taking sleeping pills. The good effects of medication tend to wear off, too. This then requires a different drug or higher dose, which comes with the risk of becoming dependant on tablets to help sleep.

The other option is antidepressant medication, either to treat any underlying depression or because of the sedative side effect when taken at night. However the evidence base for this is not strong.

The best evidence-based treatment for insomnia is Cognitive Behavioural Therapy (CBT). The result of trials suggests that CBT can be highly effective for up to 70% of those with chronic insomnia, and so should be the go-to treatment where available.

How does CBT for insomnia work?

CBT for insomnia starts with a careful assessment of sleep problems by looking at the history of sleep issues and using a sleep diary to see what’s going on. Meanwhile, the therapist and client identify specific goals for treatment.

Client and therapist work together to understand patterns that may be keeping sleep problems going. Motivational work is done by trying to tackle sleep problems and managing any fears. Sleep hygiene and relaxation techniques are reviewed, including the effects of caffeine, nicotine, alcohol, diet, and exercise. Pre-bedtime routine is assessed to create an environment when sleep is most likely.

Behavioural techniques are used to schedule healthy sleep patterns. This may require a sleep restriction programme and ongoing sleep monitoring. Cognitive techniques are used to tackle the impact of worry on sleep. This requires a thought diary and tackling and managing worry and stress.

Recommended reading and self-help optionsSleepio app

Professor Colin Espie has been researching sleep and sleep problems for over 30 years. His book Overcoming Insomnia and Sleep Problems is a self-help guide using CBT techniques to help manage sleep problems.

Professor Espie also heads up the team behind Sleepio – an online and app-based sleep improvement plan that uses CBT to overcome poor sleep. 76% of Sleepio users with long-term sleep problems achieve healthy sleep.

For more information, please contact us directly for a chat by phoning us on 01608 737614 or by emailing

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