insomnia

Insomnia

Insomnia is a common sleep problem that can make it difficult to fall asleep, stay asleep or feel properly rested after sleeping.
Most people occasionally have a poor night's sleep, particularly during periods of stress or changes to their routine. Insomnia is when sleep problems happen regularly and begin to affect how you feel or function during the day.
Insomnia lasting less than 3 months is described as short-term insomnia. Sleep problems lasting 3 months or longer are described as long-term insomnia. ^[1]

What causes insomnia?

Insomnia can have many different causes. It may be linked to your lifestyle, sleeping environment, physical health, mental wellbeing or medicines you are taking.
Common causes include: ^[1]

Stress and mental wellbeing:

• Stress: Work, money, relationships, bereavement or major life events can make it difficult to switch off at night.
• Anxiety: Worrying about daily problems or becoming anxious about not sleeping can keep your mind active at bedtime.
• Depression: Depression may cause difficulty falling asleep, waking during the night or waking earlier than intended.
• Other mental health conditions: Conditions such as bipolar disorder and schizophrenia can affect sleep.

Lifestyle and routine:

• Caffeine: Coffee, tea, energy drinks and some fizzy drinks can make it harder to fall asleep, particularly when consumed later in the day.
• Nicotine: Nicotine is a stimulant and may make sleep more difficult or less restful.
• Alcohol: Alcohol may initially make you feel sleepy, but it can interrupt sleep later in the night and reduce sleep quality.
• Shift work: Working nights or frequently changing shifts can disrupt your natural sleep-wake cycle.
• Jet lag: Travelling across time zones can temporarily disturb your body clock.
• Irregular sleeping patterns: Frequent daytime naps, sleeping late at weekends or going to bed at different times can make it harder to establish a regular routine.
• Using screens before bed: Phones, tablets, computers and televisions can keep your brain stimulated and make it harder to wind down.

Sleeping environment:

• Noise: Traffic, neighbours, television or other household noise can make it difficult to fall asleep or stay asleep.
• Room temperature: A bedroom that is too hot or too cold may interrupt sleep.
• Light: Street lighting, electronic devices or daylight entering the room can affect sleep.
• Uncomfortable bed: An unsuitable mattress, pillows or bedding can make sleeping more difficult.

Medical causes:

• Long-term pain: Conditions that cause ongoing pain can make it difficult to become comfortable or remain asleep.
• Menopause: Hot flushes, night sweats and hormonal changes can interrupt sleep.
• Restless legs syndrome: An uncomfortable urge to move the legs can become worse when resting at night.
• Sleep apnoea: Repeated pauses in breathing may cause loud snoring, choking, gasping and frequent waking.
• Overactive thyroid: An overactive thyroid can cause restlessness, anxiety, sweating and difficulty sleeping.
• Neurological conditions: Conditions such as Parkinson's disease and Alzheimer's disease can affect normal sleep patterns.

Medicines and substances:

• Stimulant medicines: Some treatments for attention deficit hyperactivity disorder or excessive daytime sleepiness may affect sleep.
• Some antidepressants: Certain antidepressants can cause restlessness or difficulty sleeping, particularly when first started.
• Steroids: Medicines such as prednisolone can cause increased alertness and sleep disturbance.
• Decongestants: Some cold and flu treatments contain stimulants that may make it difficult to sleep.
• Recreational drugs: Substances such as cocaine, ecstasy and amphetamines can cause severe sleep disturbance.

Do not stop or change a prescribed medicine without first speaking to your doctor, pharmacist or prescriber.

How do I know if I have insomnia?

Insomnia affects more than the total number of hours you sleep. It can also affect how easily you fall asleep, how often you wake and how you feel the following day.
Signs of insomnia may include: ^[1]

• Difficulty falling asleep: Regularly lying awake for a long time after going to bed.
• Waking during the night: Waking several times and finding it difficult to return to sleep.
• Waking too early: Waking earlier than intended and being unable to fall asleep again.
• Unrefreshing sleep: Feeling that you have not rested properly even after spending enough time in bed.
• Daytime tiredness: Feeling sleepy, lacking energy or struggling to stay alert during the day.
• Irritability or low mood: Poor sleep can affect your mood and your ability to manage stress.
• Difficulty concentrating: You may find it harder to focus, remember information or complete normal tasks.
• Worrying about sleep: Becoming increasingly anxious as bedtime approaches or repeatedly checking the time during the night.

Speak to your GP if changing your sleeping habits has not helped, you have experienced sleep problems for several months or insomnia is making it difficult to cope with normal daily activities.
You should also seek medical advice if you experience loud snoring with choking or gasping, an uncontrollable urge to move your legs or unexpected episodes of falling asleep during the day. ^[1]

How can I improve my sleep?

Changes to your routine and sleeping environment are usually the first steps in managing insomnia. These changes may take time to work, so it is important to follow them consistently rather than only after a poor night's sleep. ^{[1] [2]}

Things that may help:

• Keep a regular waking time: Get up at approximately the same time every day, including after a poor night's sleep.
• Only go to bed when sleepy: Going to bed too early can result in spending more time awake and becoming frustrated.
• Create a wind-down routine: Spend at least an hour relaxing before bed by reading, listening to quiet music or taking a bath.
• Make your bedroom suitable for sleep: Keep it dark, quiet, comfortable and at a suitable temperature.
• Exercise regularly: Daytime physical activity can improve sleep, although strenuous exercise should be avoided close to bedtime.
• Use your bed for sleep: Avoid working, eating or watching television in bed where possible.
• Write down worries: Making a list of tasks or concerns before bed may help prevent you thinking about them during the night.

Things to avoid:

• Caffeine, nicotine and alcohol: Avoid these for at least 6 hours before going to bed.
• Large late-night meals: Eating a heavy meal shortly before bed can cause discomfort and interrupt sleep.
• Late-night exercise: Avoid strenuous exercise during the 4 hours before going to bed.
• Daytime naps: Napping can reduce your natural sleepiness at bedtime, particularly when naps are long or taken late in the day.
• Screens immediately before bed: Phones, tablets and televisions can make it harder to wind down.
• Sleeping late after a poor night: Keeping your usual waking time helps prevent further disruption to your routine.
• Watching the clock: Repeatedly checking the time can increase worry and make it more difficult to return to sleep.

Insomnia treatments

The most appropriate treatment depends on how long you have experienced sleep problems, the possible cause and how much they are affecting your daily life.
Pharmacy sleep aids may help with temporary sleeping difficulties, but they do not treat every cause of insomnia and are not intended for long-term use. ^[1]

Sleep habits and routine

1. What it involves: Making consistent changes to your bedtime, waking time, daily routine and sleeping environment
2. How it works: Helps strengthen your natural body clock and builds a clearer association between going to bed and sleeping
3. Best suited for: Most people experiencing short-term or occasional sleep problems
4. Use: Changes should be followed consistently, including at weekends and after a poor night's sleep

Cognitive behavioural therapy for insomnia

1. Also known as: CBT-I
2. What it involves: A structured treatment that addresses thoughts, worries and behaviours that may be maintaining insomnia
3. How it works: Helps you develop a healthier sleep routine, reduce anxiety about sleep and retrain your body to associate bed with sleeping
4. Best suited for: Persistent or long-term insomnia, particularly when general changes to sleeping habits have not been enough
5. Availability: May be provided face-to-face, through a therapist or through an approved online programme

CBT-I is generally considered the preferred treatment for persistent or long-term insomnia. ^[3]

Nytol One-A-Night

1. Active ingredient: Diphenhydramine hydrochloride 50mg
2. Form: Oral tablet
3. How it works: Diphenhydramine is a sedating antihistamine that causes drowsiness and may help relieve temporary sleeping difficulties
4. Who can use it: Adults and people aged 16 years and over, subject to suitability
5. Use: Take one tablet with water approximately 20 minutes before going to bed
6. Maximum dose: Do not take more than the recommended dose and do not take another tablet if you wake during the night
7. Treatment length: For short-term use only and should not be taken continuously for longer than 2 weeks without consulting a doctor

Always follow the directions on the packaging and read the patient information leaflet supplied with the medicine. ^{[4] [5] [6]}

Treating an underlying cause

Insomnia may improve when the condition causing it is identified and treated. This may involve reviewing pain, anxiety, depression, menopause symptoms, restless legs syndrome, sleep apnoea or medicines that may be affecting sleep.
Do not stop or change prescribed medication without speaking to your doctor or prescriber. ^{[1] [3]}

Prescription sleeping tablets

Prescription sleeping tablets are not usually the first treatment for insomnia. A GP may occasionally prescribe a short course when insomnia is severe, other approaches have not worked and the expected benefits outweigh the risks.
These medicines are usually limited to a few days or weeks because they can cause side effects, may become less effective with continued use and can lead to dependence. ^{[1] [3]}

Will insomnia treatments work?

Many cases of short-term insomnia improve when the trigger settles and a regular sleeping routine is re-established.
Nytol One-A-Night may help reduce temporary difficulty sleeping, but it does not cure insomnia or treat an underlying medical, psychological or lifestyle cause. Diphenhydramine can also become less effective when used continuously, which is why it should only be used for a short period.
For long-term insomnia, cognitive behavioural therapy for insomnia and treatment of any underlying cause are generally more appropriate than repeatedly using sleep aids.
Results vary between individuals, and improvements to sleep habits may take several days or weeks of consistent use before the full benefit becomes noticeable. ^{[1] [3] [6]}

Insomnia treatment side effects

Nytol One-A-Night and other diphenhydramine sleep aids can cause side effects. Some effects may continue into the following morning, particularly if you do not have enough time for a full night's sleep. ^{[4] [5] [6]}

Possible side effects include:

• Daytime drowsiness: You may feel sleepy, less alert or slower to react the following day.
• Dizziness or unsteadiness: This may increase the risk of falls, particularly in older adults.
• Difficulty concentrating: Diphenhydramine can affect attention, coordination, judgement and reaction time.
• Dry mouth: Drinking water or using sugar-free chewing gum may help.
• Blurred vision: Do not drive or operate machinery if your vision or concentration is affected.
• Difficulty passing urine: This is more likely in people with prostate enlargement or existing urinary problems.
• Palpitations: Some people may experience a fast, irregular or noticeable heartbeat.
• Confusion or restlessness: Older adults may be more sensitive to these effects.

Do not drink alcohol while taking Nytol One-A-Night, as alcohol can increase drowsiness and impair coordination.
Do not combine it with other sedating antihistamines, sleeping tablets, tranquillisers or medicines that make you drowsy unless a healthcare professional has confirmed that it is safe.
Do not drive, cycle or operate machinery after taking Nytol One-A-Night or while you feel sleepy, dizzy, less alert or unable to concentrate. ^{[4] [5]}

Speak to a pharmacist or doctor before taking diphenhydramine if you have glaucoma, prostate enlargement, difficulty passing urine, asthma, bronchitis, chronic obstructive pulmonary disease, epilepsy, myasthenia gravis or moderate to severe liver or kidney problems.
You should also seek advice before use if you are pregnant, trying to become pregnant or breastfeeding. Nytol One-A-Night should not be used by children under 16 years of age or by an older person experiencing confusion. ^{[5] [6]}

Stop taking the medicine and seek urgent medical advice if you experience difficulty breathing, swelling of your face, mouth or throat, a seizure or a fast or irregular heartbeat.
If your sleeping difficulties continue after 2 weeks, do not continue treating them yourself with Nytol One-A-Night. Speak to your GP or another appropriate healthcare professional so that the cause can be assessed. ^{[5] [6]}

Suspected medicine side effects can be reported through the MHRA Yellow Card Scheme. ^[7]

References and further information

1. NHS: Insomnia – Symptoms, causes, self-care advice, when to seek medical help and available treatments.
2. NHS Every Mind Matters: How to fall asleep faster and sleep better – Practical advice about bedtime routines, managing worries and improving sleep habits.
3. NICE Clinical Knowledge Summary: Managing insomnia – Clinical guidance on managing insomnia and the use of cognitive behavioural therapy for insomnia.
4. NHS: Diphenhydramine – Patient information about diphenhydramine, including its use for short-term insomnia, precautions and side effects.
5. Electronic Medicines Compendium: Diphenhydramine Hydrochloride 50mg Patient Information Leaflet – Official patient information covering dosage, warnings, interactions and possible side effects.
6. MHRA: Nytol One-A-Night 50mg Patient Information Leaflet – Product-specific information about Nytol One-A-Night 50mg tablets.
7. MHRA Yellow Card Scheme – Report a suspected side effect involving a medicine or medical device.

This information is intended to support, rather than replace, the advice provided by your doctor, pharmacist or another qualified healthcare professional. Always read the patient information leaflet supplied with your medicine, as product information may be updated.