About one in five people has some difficulty with sleeping. However, there
are many things you can do to help yourself. This leaflet aims to show you
some of them. For example, simple things like winding down before bedtime,
avoiding certain foods and drinks, and a bedtime routine can help. Further
ways to promote sleep in more difficult cases include relaxation techniques,
regular exercise, and behavioural and cognitive therapies. Sleeping tablets
are not the best way to help with sleep problems because you can get
addicted to them, and they often stop working if you take them regularly
Understanding normal sleep
normal night's sleep has three main parts.:
Quiet sleep. This is divided into stages 1-4. Each stage becomes more
'deep'. Quiet sleep is sometimes called deep sleep.
Rapid Eye Movement (REM) sleep. REM sleep is when the brain is very
active, but the body is limp, apart from the eyes which move rapidly. Most
dreaming occurs during REM sleep.
Short periods of waking for 1-2 minutes.
Each night, about 4-5 periods of quiet sleep alternate with 4-5 periods of
REM sleep. In addition, several short periods of waking for 1-2 minutes
occur about every two hours or so, but occur more frequently towards the end
of the night's sleep. The graph below shows a typical normal pattern of
sleep in a young adult.
Normally, you do not remember the times that you wake if they last less
than two minutes. If you are distracted during the wakeful times (for
example, a partner snoring, traffic noise, etc), then the wakeful times
tend to last longer, and you are more likely to remember them.
What is insomnia?
Insomnia means poor sleep. About one in five adults does not get as much
sleep as they would like. Poor sleep can mean:
Not being able to get off to sleep.
Waking up too early.
Waking for long periods in the night.
Not feeling refreshed after a night's sleep.
If you have poor sleep, you may be tired in the daytime, have reduced
concentration, become irritable, or just not function well.
What is a normal amount of sleep?
Different people need different amounts of sleep. Some people function
well and are not tired during the day with just 3-4 hours' sleep a night.
Most people need more than this. To need 6-8 hours per night is average.
Most people establish a pattern that is normal for them in their early
adult life. However, as you become older, it is normal to sleep less. Many
people in their 70s sleep less than six hours per night.
So, everyone is different. What is important is that the amount of sleep
that you get is sufficient for you, and that you usually feel refreshed
and not sleepy during the daytime. Therefore, the strict medical
definition of insomnia is ...'difficulty in getting to sleep, difficulty
staying asleep, early wakening, or non-restorative sleep despite adequate
time and opportunity to sleep, resulting in impaired daytime functioning,
such as poor concentration, mood disturbance, and daytime tiredness'.
What are the causes of poor sleep?
Poor sleep may develop for no apparent reason. However, there are a number
of possible causes which include the following:
Concern about wakefulness
You may remember the normal times of being awake in the night. You may
feel that to wake in the night is not normal, and worry about getting back
off to sleep. You may 'clock watch', and check the time each time you wake
up. This may make you irritated or anxious, and you are more likely to
remember the times of wakefulness. You may then have an impression of
having a bad night's sleep, even if the total amount of time asleep was
Poor sleep is often temporary. This may be because of stress, a work or
family problem, jet-lag, a change of routine, a strange bed, etc. Poor
sleep in these situations usually improves in time.
Anxiety or depression
You may find it difficult to switch off your anxieties about work, home or
personal problems. Also, poor sleep is sometimes due to depression. Other
symptoms of depression include: a low mood, lethargy, poor concentration,
tearfulness, and persistent negative thoughts. Depression is common.
Treatment of depression or anxiety often cures the poor sleep too.
This sometimes occurs in people who snore, most commonly in obese people.
In this condition the large airways narrow or collapse as you fall asleep.
This not only causes snoring, but also reduces the amount of oxygen that
gets to the lungs. This causes you to wake up to breathe properly. You may
wake up many times each night which may result in daytime tiredness. See
separate leaflet called 'Sleep Apnoea' for details. Note:
most people who snore do not have sleep apnoea, and sleep well.
Various illnesses keep some people awake. For example, illness causing
pain, leg cramps, breathlessness, indigestion, cough, itch, hot flushes,
mental health problems, etc.
These can interfere with sleep. There are three common culprits.
Alcohol - many people take an alcoholic drink to help
sleep. Alcohol actually causes broken sleep and early morning
Caffeine - which is in tea, coffee, some soft drinks such
as cola, and even chocolate. It is also in some painkiller tablets and
other drugs (check the ingredients on the drug packet). Caffeine is a
stimulant and may cause poor sleep.
Nicotine (from smoking) is a stimulant, and it would help
not to smoke.
For example, ecstasy, cocaine, cannabis and amphetamines can affect sleep.
Some drugs sometimes interfere with sleep. For example, diuretics ('water
tablets'), some antidepressants, steroids, beta blockers, some slimming
tablets, painkillers containing caffeine, and some cold remedies
containing pseudoephedrine. Also, if you suddenly stop taking regular
sleeping tablets or other sedative drugs, this can cause 'rebound' poor
Some people just need less sleep than others. If your sleep pattern has
not changed, and you do not feel sleepy during the day, then you are
probably getting enough sleep. Older people and people who do little
exercise tend to need less sleep. Some people think they should be able to
nap during the day - and sleep eight hours at night!
A vicious cycle
Whatever the initial cause, worry about poor sleep, and worry about
feeling tired the next day, are common reasons for the problem to become
What can I do to help improve poor sleep?
This section will discuss five topics which can help to promote better
sleep - understanding some facts, sleep hygiene, relaxation techniques,
daytime exercise, and cognitive and behavioural treatments. In effect,
these can be used in a step-wise fashion. You need only go on to the next
'step' if the previous step is not very helpful, but each step requires a
greater degree of effort.
Understanding some facts
It is often helpful to understand that short periods of waking each night
are normal. Some people are reassured about this and so do not become
anxious when they find themselves awake in the night. Also, remember that
worry about poor sleep can itself make things worse. Also, it is common to
have a few bad nights if you have a period of stress, anxiety or worry.
This is often just for a short time and a normal sleep pattern often
resumes after a few days.
General tips for sleeping better (often called 'Sleep
The following are commonly advised to help promote sleep and are often all
that is necessary:
Reduce caffeine - do not have
any food, drugs, or drinks that contain caffeine or other stimulants for
six hours before bedtime (see above). Some people have found that
cutting out caffeine completely through the entire day has helped.
Do not smoke within six hours
Do not drink alcohol within six
hours before bedtime.
Do not have a heavy meal just
before bedtime (although a light snack may be helpful).
Do not do any strenuous exercise within four hours of
bedtime (but exercise earlier in the day is
Body rhythms - try to get into
a routine of wakefulness during the day, and sleepiness at night. The
body becomes used to rhythms or routines. If you keep to a pattern, you
are more likely to sleep well. Therefore:
No matter how tired you are, do not sleep or nap during
It is best to go to bed only when sleepy-tired in the
Switch the light out as soon as you get into bed.
Always get up at the same time each day, seven days a
week, however short the time asleep. Use an alarm to help with this.
Resist the temptation to 'lie-in' - even after a poor night's sleep.
Do not use weekends to 'catch up' on sleep, as this may upset the
natural body rhythm that you have got used to in the week.
The bedroom should be a quiet,
relaxing place to sleep.
It should not be too hot, cold, or noisy.
Earplugs and eye shades may be useful if you are
sleeping with a snoring or wakeful partner.
Make sure the bedroom is dark with good curtains to
stop early morning sunlight.
Don't use the bedroom for activities such as work,
eating or television.
Consider changing your bed if it is old, or not
Hide your alarm clock under your bed. Many people will
'clock watch' and this does not help you to get off to sleep.
Mood and atmosphere - try to
relax and 'wind down' with a routine before going to bed. For example:
A stroll followed by a bath, some reading, and a warm
drink (without caffeine) may be relaxing in the late evening.
Do not do anything that is mentally demanding within 90
minutes of going to bed - such as studying.
Go to bed when sleepy-tired.
Some people find playing soft music is helpful at
bedtime. Try a player with a time switch that turns the music off
after about 30 minutes.
If you cannot get off to sleep after 20-30 minutes
- then get up. Go into another room, and do something else such as
reading or watching TV rather than brooding in bed. Go back to bed when
sleepy. You can repeat this as often as necessary until you are asleep.
These aim to reduce your mental and physical arousal before going to bed.
Relaxation techniques may help even if you are not anxious, but find it
hard to get off to sleep. There are a number of techniques. For example,
progressive muscular relaxation has been shown to help promote sleep. This
technique consists of tensing and relaxing various muscle groups in
sequence. See separate leaflet called 'Relaxation Exercises' where
it is described more fully.
Your GP or a counsellor may be able to recommend a tape or CD that takes
you through deep breathing exercises, and other methods to help you relax.
Regular daytime exercise can help you to feel more relaxed and tired at
bedtime. This may help you to sleep better. (However, you should not do
exercise near to bedtime if you have insomnia.) If possible, do some
exercise on most days. Even a walk in the afternoon or early evening is
better than nothing. However, ideally, you should aim for at least 30
minutes of moderate exercise on five or more days a week.
Moderate exercise means that you get warm and slightly out of breath. You
do not need to go to a gym! Brisk walking, jogging, cycling, climbing
stairs, heavy DIY, heavy gardening, dancing, and heavy housework are all
moderate-intensity physical exercises. See separate leaflet called
'Physical Activity For Health' for more details.
Although exercise to improve sleep is often thought of as 'common sense' -
there is some research evidence to back this up. One research study looked
at some older people with primary insomnia. The study compared a group of
people who embarked on a programme of moderate intensity exercise to a
group who did not exercise. After 16 weeks, on average, the 'exercise
group' had a significantly improved quality of sleep, a reduced time taken
to fall to sleep, and an increased time spent asleep, compared with the
group who did not do exercise. (See references at the end for details.)
If you would like to discuss any of the
mental health issues raised on this page or find out how counselling might
A non-profit making organisation that aims to
raise awareness of the importance of a good night's sleep to
health and wellbeing. It provides helpful advice and tips on how
to improve sleep quality and on how to choose the right bed for
optimum sleeping comfort. It is funded by the National Bed
Federation - the trade association for British bed manufacturers
- but works independently and does not recommend or endorse
specific companies or products. It produces a number of free
Sleep Apnoea Trust
The Sleep Apnoea Trust Association (SATA) exists to improve the lives of
sleep apnoea patients, their partners and their families.
Managed entirely by volunteers, SATA is the leading UK charity working in
the field of sleep apnoea.
From its modest beginnings, Cry-sis has developed to become a
well-respected and national charity. The stated aims remain 'to be
efficient and effective in providing self-help and support to
families with excessively crying, sleepless and demanding babies'.
Anxiety UK is a national registered charity formed 40 years ago by a
sufferer of agoraphobia for those affected by anxiety disorders. Today they
are still a user-led organisation, run by sufferers and ex-sufferers of
anxiety disorders, supported by a high-profile medical advisory panel.
Anxiety UK works to relieve and support those living with anxiety disorders
by providing information, support and understanding via an extensive range
helps people take control of their mental health. We do this by providing
high-quality information and advice, and campaigning to promote and protect
good mental health for everyone. How can we help you
Back to the top
In this section you will find a
selection of leaflets you can download or print.
Leaflet from Royal College of Psychiatrists
Self Help leaflet from Get-Self-Help
Self help leaflet from NHS Northumberland
Self help leaflet from MoodJuice
Swindon and District Samaritans has been
offering emotional support to those in crisis for more than 40 years. You
can call or email 24hrs a day.
Local branch of the national charity providing support,
resources and drop-in sessions.