What is insomnia?
Insomnia is a difficulty in getting to sleep, staying asleep or not feeling refreshed after sleeping.
What are the principles of managing insomnia?
1. Spending less time awake in bed – so that you associate bed with sleep.
2. Making sure you have been awake long enough before trying to get to sleep – to increase your chance of sleeping.
3. Keeping a fixed routine to regulate your internal clock – to increase your chance of sleeping at night.
We would advise you to try and avoid talking about your sleep with anyone other than professionals. Try to distract yourself from trying to solve your sleep problems with anything other than following advice below.
How can my time awake in bed be reduced?
The information below gives advice on working out how much you actually sleep on a night and how to make the time in bed for sleep only. Average hours of sleep in 24 hours: Work out how many hours of sleep per 24 hours you get, on average, over a 2-week period (choose a ‘normal’ week, not holiday or night shift week).
- Wake time: Choose a time to wake up each morning that works every day of the week. For example, if you have to be up for work at 6:00am on a Monday to Friday then choose 6am as your wake time for the whole week, including weekends.
Get out of bed after an estimated 15 minutes awake if you wake-up before your alarm goes off.
Always get out of bed when your alarm goes off.
- Bedtime: Use your average sleep time to work backwards from your chosen wake-up time to calculate your bedtime. For example, your average sleep time over 2 weeks is 5 hours a night. Your chosen wake-up time is 5:00am. This means you should go to bed no earlier than midnight each night.
- Lying awake in bed: Go to bed when you feel sleepy at or after your calculated bedtime – not before. If you ESTIMATE that 15 minutes has passed and you are still not asleep, then get out of the bed and go to your pre-prepared night ‘nest’, see later in the leaflet for more information around a night nest. When you feel sleepy then go back to bed. Repeat this as much as necessary and never sleep in the night ‘nest’- see Important Notes further on in the leaflet.
- Discipline and consistency: Agree with yourself that you will always get out of bed either before or at your chosen wake-up time and no later. Agree with yourself that you will never get into bed before your calculated bedtime.
- Clocks: Before getting into bed at your calculated bedtime, set an alarm for your chosen wake-up time. NEVER CHECK THE TIME BETWEEN YOUR BEDTIME AND WAKE-UP TIME.
How can I stay awake long enough before trying to get to sleep?
- Naps and wakeful time: Your wakeful time is the time between your chosen wake-up time in the morning and your calculated bedtime. Do not have any planned or unplanned naps in the time that you are supposed to be awake, this is called wakeful time.
Keep yourself awake!
How can I keep a fixed routine to stabilise my internal body clock?
- Keep your waking time fixed for at least 4 to 6 weeks. This is due to your internal clock being slow to respond.
- Go outdoors in the morning before 10:00am.
- Eat your lunch as your main meal at the same time each day.
- Create a 2-hour pre-sleep routine starting with a warm bath or shower followed by writing a journal/diary and then doing some neutral but engaging activities. For example, if your calculated bedtime is midnight, then start this routine at 10:00pm.
Important notes
Bedtime
If your calculated sleep duration is less than 5 hours on average, then still give yourself 5 hours in bed. For example, if you have calculated your average sleeping time as 4 hours and fixed wake-up time is 6am.
Do not get into bed at 2:00am (6:00am take away 4 hours = 2:00am). You should use 5 hours as your minimum time in bed so your calculated bedtime would be 1am (6:00am take away 5 hours = 1:00am).
Naps
Napping during the ‘wakeful’ time decreases your brain’s ability to sleep through the night. However, if you have to drive or do something risky and feel very sleepy in the day then drink a caffeinated drink and have a 20-minute nap. This may derail your programme for a day or so but you must still keep to your fixed wake time and follow the rules about the night ‘nest’ etc.
Body clock
Light exposure, eating, sports, all affect your body clock. Your sleep is part of your body clock cycle. The better your cycles are for eating, sports and other daily activities the stronger your sleep cycle will become at night as well.
Night nest
Create a safe, warm space to go to if you cannot sleep, ideally out of the bedroom. Choose some engaging neutral activities, for example a nature documentary, crossword, dot to dot, audio book, colouring in. This is where you will go in the night if you cannot get to sleep after about 15 minutes.
Writing a night journal
Two hours before bedtime get a notebook, write down one thing in the day that you are grateful for, one thing that makes you sad and 4 things you will achieve the next day.
Mental health
Stop the programme if you have any deterioration in mental health and seek help. You may feel sleepier for the first few days or even weeks of the new programme.
Duration
Stick to the new schedule for at least 4 weeks unless your mental health deteriorates.
Medication for sleep
Medication for insomnia will be more effective after you have adjusted your sleep schedule. Most insomnia medication stops working in the long run. Unless you have followed the right sleep schedule and stopped lying in bed awake and looking at the clock in the night.
Difficult nights
Even when you follow the rules above you will have nights when you get very little sleep. You must still get up at the chosen wake-up time. Your internal clock will help you to feel more alert as the days goes on. Keep following the programme and you will have better nights again.
Alcohol
Find alternative ways to relax and unwind. Alcohol will make your quality of sleep worse.
Online resource
This leaflet can be made available in other formats including large print, CD and braille and in languages other than English, upon request.
Patient Experience Team (PET)
South Tees Hospitals NHS Foundation Trust would like your feedback. If you would like to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Team who will help you to do this.
This service is based at The James Cook University Hospital but also the Friarage Hospital in Northallerton, our community hospitals and community health services.
South Tees Hospitals NHS Foundation Trust
- Telephone: 01642 854807
- Freephone: 0800 0282451
Email: [email protected]
Monday to Friday, 9am to 4pm
Out of hours if you wish to speak to a senior member of trust staff, please contact the hospital switchboard (numbers below).
James Cook University Hospital
Marton Road
Middlesbrough
TS4 3BW
Telephone: 01642 850850
The Friarage Hospital
Northallerton
North Yorkshire
DL6 1JG
Telephone: 01609 779911
Leaflet ID: PI057 version 1
Review due: 18 May 2029