Insomnia warning signs and when you should see a doctor about your poor sleep

Everyone experiences a restless night occasionally, but when does persistent difficulty sleeping signal something more profound, such as insomnia? We consulted Jason Ellis, a professor in psychology at Northumbria University and director of the Northumbria Centre for Sleep Research, who outlined crucial warning signs and potential underlying causes.

Professor Ellis defines insomnia broadly as "problems getting off to sleep, staying asleep or waking up too early in the morning that exists despite having adequate opportunity for sleep." Clinically, this becomes chronic insomnia when it occurs "at least three nights a week for at least three months."

Initially, insomnia often emerges as "a response to a stressor," Ellis explains. This could stem from a physical or psychological illness, or significant life events like job loss or the death of a partner. However, a critical challenge arises when individuals attempt to manage their sleep issues, inadvertently exacerbating the problem.

"The main challenge we have with insomnia is what we try to do to compensate for it is a thing that actually can actually keep it alive and give it its own energy," he notes. Common strategies, such as going to bed early, napping, or having a lie-in, can disrupt the natural sleep cycle. Similarly, relying on coffee to stay awake or alcohol to induce sleep can further impair the process. "Therefore, what becomes a normal adaptive response to stress becomes a sleep problem in its own right," Ellis cautions.

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Key indicators of insomnia include a "racing mind" and persistent rumination, thinking, and worrying upon getting into bed, according to Ellis. The NHS website further lists feeling tired after waking, waking early and being unable to return to sleep, frequent night awakenings, and daytime fatigue and irritability as common signs. A distinctive feature, Ellis adds, is the development of an aversion to the bedroom. "What we find with many patients with insomnia is they’ll have no issues in the early evening, but as soon as they go to the bedroom and all the lights have come off they begin to struggle," he observes, describing this as "a hyper-arousal, because they’ve learnt to associate the bedroom with a negative space."

The impact of poor sleep extends beyond immediate discomfort. "We all know that after a bad night’s sleep we’re certainly not on top form the next day. We’re a little bit more moody, a little bit more irritable, a little bit more sad and our performance doesn’t tend to do very well after a poor night of sleep," Ellis states. Over time, this can lead to "associations with long-term mood problems, particularly depression," and can also worsen existing illnesses.

Certain factors can heighten the risk of developing insomnia. Personality traits such as being "more anxious and worry-prone, and people who are more perfectionistic" are linked to the condition. A history of insomnia also significantly increases the likelihood of recurrence "unless it’s properly treated." Age is another factor, as "our sleep system becomes more vulnerable to insomnia" as we get older, due to the degeneration of sleep-regulating mechanisms and increased prevalence of chronic illness and medication use. Menopause also presents a prominent risk, with hormonal fluctuations contributing to "a higher level of insomnia in menopausal populations compared to non-menopausal populations."

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Professor Ellis advises seeking medical help if symptoms persist. "Insomnia becomes pathological or abnormal after about two weeks, so I would recommend talking to your GP after you have experienced these symptoms for longer than two weeks," he states, emphasising that "it’s always better to seek help sooner rather than later."

For treatment, "CBT-I (cognitive behavioural therapy for insomnia) is the first line treatment for insomnia," Ellis confirms. This talking therapy, typically delivered over six to eight weeks, addresses "dysfunctional attitudes and worries as well as managing that sleep regularity." It comprises two main aspects: the cognitive component helps individuals "identify their worries, anxieties, concerns and maybe some inflated, dysfunctional beliefs around sleep," employing techniques like constructive worry time. The behavioural component focuses on regulating the sleep process, maximising the drive to sleep, and mitigating pre-bed anxieties.