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Insomnia | Rarunga moe

Key points about insomnia

If you have trouble getting to sleep or staying asleep you may have insomnia (rarunga moe).
Causes of insomnia include stress, alcohol, caffeine and nicotine, mental health issues, other sleep problems, and some health conditions or medicines.
In the short term, insomnia can reduce your performance at work and put you at risk of accidents. If it lasts it can also affect your health and mood.
Things that can help include good sleep hygiene, cognitive behavioural therapy, sleep apps and, in some cases, medicines.
See your healthcare provider if you feel sleepy during the day and your job requires you to drive or operate machinery.

Insomnia is a sleep disorder. It can affect how much sleep you get and the quality of that sleep.

If you have insomnia, you may experience:

difficulty getting to or falling asleep
difficulty staying asleep (poor sleep quality)
waking up too early.

There are different forms of insomnia. For example, delayed sleep phase syndrome (DSPS) is like jet lag, but doesn’t go away over time. The people with DSPS are the night owls. Read more about sleep and your body clock.

If you have insomnia, you won't get enough good quality sleep and will be tired during the day. This can lead to poor work performance and an increased risk of car and work accidents. It also makes it harder to concentrate, remember things, make decisions and solve difficult problems.

Insomnia over many months or years can also affect your health and mood. It can increase your risk of depression, anxiety, heart disease, high blood pressure and diabetes.

The good news is that there are things you can do to help your sleep and reduce your risk of being affected by problems caused by insomnia.

The recommended amount of sleep for an adult is between 7–9 hours. The amount of sleep you need varies depending on your age and what else is happening in your life. If you wake up feeling refreshed and can function well throughout the day, you're getting enough sleep. Read more about how much sleep is enough.

Often insomnia starts in a time of stress and passes when the stress does. However, many other things can also cause insomnia.

Common causes of insomnia:
alcohol (overuse or withdrawal) nicotine (smoking) caffeine at night poor bedtime routine and sleep habits shift work noise or light a room that is too hot or too cold uncomfortable beds, or using beds for anything other than sleep or sex recreational drugs such as cocaine or ecstasy mosquitoes or other bugs caring for babies and young children periodic limb movement disorder (where leg movements disturb sleep)	partner disturbance jet lag snoring and breathing difficulties such as obstructive sleep apnoea teeth grinding while asleep restless leg syndrome ongoing pain peri- and post-menopause mental health conditions such as depression or anxiety health conditions such as COPD, reflux, obesity, urinary incontinence, heart failure some medicines.

Common causes of insomnia:

alcohol (overuse or withdrawal)
nicotine (smoking)
caffeine at night
poor bedtime routine and sleep habits
shift work
noise or light
a room that is too hot or too cold
uncomfortable beds, or using beds for anything other than sleep or sex
recreational drugs such as cocaine or ecstasy
mosquitoes or other bugs
caring for babies and young children
periodic limb movement disorder (where leg movements disturb sleep)

partner disturbance
jet lag
snoring and breathing difficulties such as obstructive sleep apnoea
teeth grinding while asleep
restless leg syndrome
ongoing pain
peri- and post-menopause
mental health conditions such as depression or anxiety
health conditions such as COPD, reflux, obesity, urinary incontinence, heart failure
some medicines.

Symptoms of insomnia may include:

tiredness and fatigue in the day
poor concentration and memory
loss of interest in usual activities
irritability
depression and anxiety
poor work performance
being at risk of work or motor vehicle accidents
poor quality of life
poor social functioning
poor libido.

Your doctor will ask you questions about your sleep patterns, sleep routine, sleep habits and whether you have any health conditions. They will also ask you about your general wellbeing and mental health, and whether you have any stress or anxiety.

It's a good idea to record your sleep in a sleep diary(external link) for 2 weeks before going to see your doctor.

Your doctor will ask you to fill in a questionnaire, such as the Epworth Sleepiness Score(external link), to find out how severe your insomnia is and whether it has affected your daily functioning. Your partner or family/whānau members may be asked if they have noticed your sleep pattern.

Blood tests may also be done to rule out other conditions that can cause the same symptoms. Some people may be referred to a sleep clinic for further tests and treatment.

Treatment of insomnia aims to reduce the impact on your daytime functioning and improve your sleep quality. Although insomnia can go away on its own, it's important to talk to your doctor if your sleep problems continue.

Treatment of insomnia includes:

treatment of any underlying cause such as physical or mental health conditions
practising good sleep hygiene and habits
cognitive behavioural therapy (CBT)
medicines such as melatonin, zopiclone, temazepam, amitriptyline or over-the-counter medicines.

You may be referred to a sleep specialist to find out other causes if these treatments don't work for you.

Sleep hygiene

Sleep hygiene refers to aspects of your lifestyle and bedtime environment that make it easier or harder to get better quality sleep.

Changes you can make to improve your sleep hygiene include:

going to bed at the same time every night – this will help set your biological clock so you start to feel drowsy at bedtime
creating your own bedtime ritual, eg, writing down the things on your mind that are worrying you or that you need to do tomorrow, making a hot, milky drink or taking a warm bath – start your ritual at the same time each night
reducing or avoiding caffeine, cigarettes and alcohol, especially in the evenings
avoiding large meals late in the evening – but don’t go to bed hungry (have a late snack if you need to)
exercising outdoors early or in the middle of the day (but not too close to your bedtime)
avoiding TV, computer screens and mobile phones for an hour or two before bed, as the artificial light interferes with your natural cues to sleep
unwinding before bed by reading or listening to music
not using your bed for work or catching up on social media
making sure your bedroom is cool, dimly lit or dark and as quiet and comfortable for sleep as possible
turning around any bedroom clocks – clock-watching makes insomnia worse
using mindfulness or relaxation techniques.

Cognitive behavioural therapy for insomnia (CBTi)

A type of short-term counselling called cognitive behavioural therapy (CBT) can help you to improve your sleep by teaching you how to manage anxiety and negative thoughts that keep you awake. A special form of CBT that focuses on insomnia, called CBTi, helps you learn how to calm your mind when you’re trying to sleep. CBT can be done by your doctor, a sleep therapist or through online CBT programmes.

Online programmes include:

Sleepio(external link)
CBT for Insomnia(external link)
The Sleep School(external link) (a cost is involved).

Sleep apps

There are a variety of sleep apps available for use on your smartphone or tablet that can be helpful if you have insomnia. Some apps track your sleep habits, similar to a sleep diary, to help you develop good sleep routines. Other apps help you to fall asleep by using calming visual graphics and relaxing music.

Medicines for sleep

Medicines for managing sleep problems are usually only considered when lifestyle changes (sleep hygiene) or CBTi have been unsuccessful. Medicines for sleep problems may be effective in the short term but there is no evidence of long-term efficacy or safety. Medicines used to help your sleeping may also be addictive.

Medicines that are used for insomnia include:

sleeping tablets (also called hypnotics) such as zopiclone
over-the-counter sleeping tablets
benzodiazepine drugs, such as temazepam and lorazepam
melatonin
antidepressants (if you also have depression)
sedating antihistamines, although these are not recommended as they can make you drowsy the next day, which can affect your concentration and driving and increase the risk of accidents and falls.

Other supplements are also used for insomnia, but the evidence that these are effective is either limited or does not exist. If you have been prescribed medicines for sleep, your doctor will talk to you about your safety to drive(external link), as some of these medicines can have side effects. Read more about medicines for sleep problems.

Talk to your doctor to find out the best treatment option for you.

Insomnia can cause daytime sleepiness and fatigue. If you need to drive, this can be extremely dangerous. Driver fatigue is one of the most common causes of motor vehicle accidents in New Zealand.

If you experience drowsiness during the day, it is important to stop driving and let your doctor know. Your doctor will need to find out the causes of your sleepiness and treat it accordingly. It is also a legal requirement for you to only drive when you are medically fit, including not driving if you are too tired and sleepy.

The New Zealand Transport Agency has some fatigue resources(external link) to make it easier to manage driver fatigue. Also read more about drowsy driving tips(external link).

See your GP as soon as possible if you feel very sleepy during the day while driving or your job involves operating machinery or aircraft.

The following links take you to other websites that provide further information on insomnia. Be aware that websites from other countries may contain information that differs from New Zealand recommendations.

Sleep problems(external link) Ministry of Health, NZ
Insomnia(external link) Sleep Health Foundation, US
Insomnia(external link) NHS, UK
Insomnia(external link) Patient Info, UK
Insomnia (beyond the basics)(external link) UpToDate, US
Tips for getting a good night's sleep(external link) Here to Help, Canada
The complete guide to insomnia and how you can manage it(external link) How To Sleep, UK