Almost everyone has had a poor night's sleep. A heavy stretch at work, a worry or an illness breaks up sleep, and most of the time the rhythm settles on its own once the situation calms down. The problem arises when insomnia stays on and starts to live a life of its own. The doctor's job is to tell a temporary sleep problem from long-term insomnia, recognise any illness that may lie behind it, and point towards a treatment whose effect lasts.
Short-term and long-term insomnia
Short-term insomnia lasts a few weeks at most and usually has an identifiable cause: stress, a life change, pain, travel or shift work. Temporary sleep problems are often a normal reaction to a stressful situation.
Under Finnish Current Care guidelines, long-term insomnia means trouble falling asleep, staying asleep or waking too early on at least three nights a week for at least three months, with an effect on how you function during the day. By this stage the original cause has often gone, but worry about sleep, lying awake in bed and an irregular rhythm keep the insomnia going.
A single bad night is not dangerous, and sleep does not need to be measured to the minute. What matters is how you cope during the day.
What you can do yourself
The foundation of insomnia treatment is behavioural, not a medicine. You can start on its principles yourself:
- A regular rhythm. Get up at the same time every morning, weekends included. Waking anchors the sleep rhythm better than bedtime does.
- Bed is for sleeping. Go to bed only when you are sleepy. If sleep does not come in about 20 minutes, get up, do something calm in dim light and return only when you are sleepy again.
- Do not make up for lost sleep. Long daytime naps and going to bed early fragment the night's sleep. A short nap of under half an hour before mid-afternoon is a different matter.
- Restricting time in bed is an effective treatment method, but how it is carried out and its safe limits are planned together with a professional.
- A calm evening. Caffeine only in the morning, and no alcohol as a sleep aid: it helps you drop off but breaks up the second half of the night. Bright screens and work matters away an hour before bed.
- Move during the day, preferably outdoors in daylight. Hard exercise is best not left to late evening.
- Worry time. During the day, write down what is going round in your head and what you will do about it tomorrow. Nothing needs solving in bed.
- A sleep diary over a couple of weeks is the most valuable information for the doctor: times of going to bed, falling asleep and waking, and daytime alertness.
These are the same principles that cognitive behavioural therapy for insomnia (CBT-I) is built on. Delivered with guidance, it is the first-line treatment for long-term insomnia, and its effect lasts after the treatment ends.
Where sleeping tablets fit
A sleeping tablet can help over a short period of a couple of weeks at most, when short-term insomnia is severe. The first-line treatment for long-term insomnia is CBT-I, and any medication is assessed individually. Benzodiazepines and similar drugs lose their effect with long-term use, cause dependence, and in older people increase falls and memory problems. If a sleeping tablet has been used for a long time, it should not be stopped abruptly but tapered according to a plan with a doctor. Melatonin can help shift the rhythm and helps some older people, but it is not a cure-all either.
When a doctor's assessment is worthwhile
- the insomnia has lasted more than a month despite self-care
- tiredness affects work, driving or everyday life
- signs of sleep apnoea: loud snoring, pauses in breathing noticed by a partner, morning headache, waking unrefreshed however long you sleep, or dozing off during the day
- signs of depression: low mood, nothing holds your interest, waking in the small hours, hopelessness
- restless legs or pain keep you awake
- the insomnia started after a new medicine was begun
- you regularly use a sleeping tablet or alcohol to get to sleep
The doctor looks into whether an illness lies behind it, such as sleep apnoea, a thyroid disorder, depression or pain, and treats that. Treatment of insomnia on its own can often be started remotely, and if sleep apnoea is suspected the doctor refers you for a sleep study.
Go to the emergency department or call 112 immediately if
- you have thoughts of harming yourself or fear you cannot keep yourself safe
- you have not slept for several nights and are confused, see or hear things others do not, or act in ways that are not like you
- the insomnia comes with chest pain, shortness of breath or sudden severe anxiety that does not let up
MIELI Mental Health Finland offers appointment-based support in English by video or phone. Its Finnish-language crisis helpline, 09 2525 0111, answers around the clock. If you are in immediate danger or cannot keep yourself safe, call 112.
How Treat can help
In Treat you can describe your insomnia in your own words and the service asks the follow-up questions. A licensed doctor usually assesses the situation within minutes during service hours, tells you what the insomnia is most likely about, gives care instructions and refers you for tests or ongoing care if needed. Treat is not an emergency service: in an emergency, call 112.
This article is general health information and does not replace an individual assessment by a doctor.