Insomnia: what to try yourself and when to seek help

The line between poor sleep and insomnia is fairly clear. We speak of chronic insomnia when difficulty falling asleep, waking in the night or waking too early in the morning happens at least three times a week, lasts more than three months and affects your day. Insomnia like this does not usually resolve on its own and becomes more entrenched as a habit with every month.

The measures worth trying first are unexciting and effective. Get up at the same time every day, even after a bad night and even at weekends; the time you get up matters more for your rhythm than the time you go to bed. Use the bed for sleep and sex, not for work, your phone or watching screens. If you do not fall asleep in about twenty minutes, get up and do something calm in dim light until you feel sleepy. Give up daytime naps. Do not drink coffee or energy drinks after early afternoon. Keep the room cool, dark and quiet, and stop looking at the clock.

Alcohol is the most common wrong solution. It does help you fall asleep faster, but it breaks the second half of the night into shallow awakenings, so you wake up tired. Something similar applies to effort itself: the harder you try to fall asleep, the more awake you are. That is exactly why the aim with insomnia is to shorten the time you spend awake in bed, not to lengthen your time in it.

Sleeping pills have their place for short-term problems, for example after a difficult event. For chronic insomnia they are not the first choice, because their effect wears off after weeks and stopping them is harder than starting was. Do not take medicines from someone else and do not stop them all at once; agree on gradual withdrawal with your doctor.

Sometimes insomnia is not the main illness but a sign of one. Loud snoring with pauses in breathing noticed by a partner, and marked daytime sleepiness, point to sleep-related breathing disorders. An unpleasant feeling in the legs in the evening that makes you want to move them is typical of restless legs syndrome. The cause can also be pain, frequent urination at night, thyroid disease, the menopause and some medicines. In these cases, talk to your personal doctor first, as the cause determines the treatment.

When insomnia persists, or when it comes with anxiety, low mood and feeling overwhelmed, treatment at the psychiatry and psychotherapy clinic makes sense. Cognitive behavioural therapy for insomnia is the first-choice treatment for chronic insomnia, and its effects last longer than those of sleeping pills. The first meeting is an introductory conversation in which you describe what brought you, how the problems affect your sleep, work and relationships, and what you have tried so far.

To prepare, it helps to keep a sleep diary for two weeks: when you went to bed, roughly when you fell asleep, how many times you woke, when you got up and how you felt during the day. Also bring a list of medicines and supplements.

Treatment is self-pay, you do not need a referral, and booking is managed by the provider that runs the clinic. But if your insomnia comes with thoughts that you no longer want to live, do not wait for an appointment: call 112. For a conversation in times of distress, Klic v duševni stiski (01 520 99 00) and Zaupni telefon Samarijan in Sopotnik (116 123) are also available.