Insomnia

Most adults need somewhere between seven and nine hours, but the range of normal is wide and it narrows with age. Chasing a target figure is itself a common perpetuating factor: people spend longer in bed trying to reach a number, which dilutes their sleep across more hours and makes it lighter and more broken. The better measure is how you function during the day, not what the tracker on your wrist reports.

CBT-I is a structured programme, usually over several weeks, that targets what keeps insomnia going. It typically includes restricting time in bed to consolidate sleep, re-associating the bed with sleeping rather than lying awake, a consistent rise time, and working on the beliefs and anxiety that build up around sleep. It is more effective than medication in the long term, and its benefits persist after the programme ends. It is recommended as first-line treatment in adults with chronic insomnia.

They have a place for short-term use in an acute situation, such as a bereavement or a crisis, generally for a few weeks at most. The problem is prolonged use: effectiveness fades, tolerance develops, and stopping produces rebound insomnia that feels like proof the tablets were needed. If you are already on long-term hypnotics, they are not stopped abruptly. A planned, gradual reduction alongside CBT-I is far more likely to succeed.

Yes, sleep-maintenance insomnia is as much insomnia as difficulty getting off. Waking briefly in the night is normal; the problem is being unable to get back to sleep. Early-morning waking with low mood, loss of appetite and loss of interest can point to depression, while waking with a dry mouth, headache or a partner reporting snoring points towards sleep apnoea. Which pattern it is changes the treatment, which is why the detail matters.

Frequently, and this is a large part of what specialist assessment is for. Restless legs make it hard to get off to sleep. Sleep apnoea fragments the night without the person remembering waking. A delayed body clock looks exactly like insomnia if the required rise time is early. Pain, medication and alcohol are all common contributors. Treating the underlying cause resolves the insomnia in a way that sleep hygiene advice alone never will.

Not for straightforward insomnia, which is diagnosed from the history and a sleep diary. A sleep study is arranged when the history suggests another disorder underneath, such as apnoea or periodic limb movements, or when the picture does not fit. Being asked to keep a two-week sleep diary before your appointment is common and genuinely useful: it reveals patterns that are almost impossible to recall accurately.

It can do more harm than good. Consumer devices estimate sleep stages from movement and heart rate and are not accurate enough to diagnose anything, but they are very good at generating anxiety about a poor score, which is itself a perpetuating factor. Some people become preoccupied with their sleep data to the point that it worsens their sleep. A simple written diary of when you went to bed, roughly when you slept and how you felt is more useful clinically.