A bad night is nothing unusual. The problem starts when poor sleep becomes a habit: you dread bedtime, you count the hours you have left, and the next day's tiredness takes over everything. By that point insomnia has detached from its original cause and runs in a closed loop.

When is it really insomnia?

Three criteria have to be met:

  • trouble falling asleep, long night-time awakenings or waking far too early;
  • at least three nights a week;
  • with daytime consequences: fatigue, irritability, poor concentration, low mood.

Beyond three months it is called chronic insomnia. Below that it is acute, and it often resolves along with the situation that caused it.

The loop that keeps insomnia going

The trigger — a bereavement, work stress, pain — is almost never what maintains insomnia months later. What maintains it are the strategies adopted to compensate:

  • going to bed earlier "to catch up", which lengthens time spent awake in bed;
  • sleeping in or taking long naps, which reduces sleep pressure in the evening;
  • staying in bed waiting for sleep, which teaches the brain that bed is a place of wakefulness;
  • checking the clock, which produces a measurable stress response at every awakening.

The bed itself ends up triggering alertness. That is why many people fall asleep in front of the television and become wide awake the moment they move to the bedroom.

What actually works: CBT-I

Cognitive behavioural therapy for insomnia is the recommended first-line treatment, ahead of any medication, and its results hold after follow-up ends. It rests on a few rules that are easy to understand and demanding to apply.

Stimulus control

  1. Go to bed only when genuinely sleepy — not merely tired.
  2. The bed is for sleep and intimacy only: no screens, no work, no meals.
  3. If sleep has not come after about 20 minutes, get up, go to another room, do something calm in dim light, and return only when sleepiness comes back. Repeat as often as needed.
  4. Get up at the same time every day, weekends included, whatever the night was like.
  5. No naps, or 20 minutes maximum before 3 pm.

Sleep restriction

Counter-intuitive but highly effective: time in bed is temporarily cut back to match time actually asleep. Someone spending 9 hours in bed for 5 hours of sleep starts with 5.5 hours in bed, then extends by 15–20 minutes a week as sleep consolidates. The first days are hard; falling asleep becomes quick again within one to two weeks. This method should be run with a professional, and it is not advised in epilepsy or bipolar disorder.

Habits that help (and those that are not enough)

Sleep hygiene alone does not cure chronic insomnia, but it removes obstacles:

  • no caffeine after 2 pm — it stays active for 6 to 8 hours;
  • alcohol brings sleep on but fragments the second half of the night;
  • a cool, dark, quiet bedroom;
  • daylight in the morning: the strongest signal for resetting the body clock;
  • regular exercise, but nothing intense within two hours of bedtime;
  • turn the clock away so you cannot see the time at night.

What about sleeping pills?

Benzodiazepines and related drugs have a real but narrow place: a few days to a few weeks, in acute insomnia tied to a specific event. Beyond that, effectiveness fades, dependence sets in, and stopping causes rebound insomnia that makes the drug look indispensable. In older people they raise the risk of falls and memory problems.

If you have been taking them long term, do not stop abruptly — sudden withdrawal can be dangerous. A gradual, supervised taper combined with CBT-I is the right approach.

When to look for another cause

Some signs point to a specific disorder that sleep advice will not fix:

  • snoring with breathing pauses, marked daytime sleepiness, morning headaches: sleep apnoea;
  • an irresistible urge to move the legs in the evening, relieved by movement: restless legs syndrome;
  • very early waking with sadness, loss of interest and appetite: depression, which needs treating in its own right;
  • chronic pain, reflux, repeated night-time urination, hot flushes.

A first medical opinion sorts through these possibilities and points to the useful test. A remote consultation is generally enough for that step: you can book an appointment or see the available doctors. If persistent anxiety is what disturbs your sleep, our article on stress and anxiety is a useful companion to this one.