Sleeping tablets are the most common first response to insomnia and the least likely to fix it on their own. Persistent sleep problems usually have drivers — stress, anxiety, low mood, or habits that have quietly formed around the bad nights — and treating those is what produces durable change.
What is a sleep disorder?
Sleep disorders affect sleep quality, timing, or duration — such as insomnia — and are frequently connected to underlying stress, anxiety, or depression.
Occasional poor sleep is universal and not a disorder. Insomnia is diagnosed when difficulty falling asleep, staying asleep, or waking too early occurs regularly over weeks or months and causes daytime consequences — fatigue, poor concentration, irritability or low mood.
Sleep problems are frequently both a symptom and a cause. Depression, anxiety, ADHD and trauma all disrupt sleep; poor sleep in turn worsens mood, concentration and anxiety. This two-way relationship is why treating sleep in isolation, without asking what else is going on, often fails.
A great deal of persistent insomnia is maintained not by the original trigger but by what develops in response to it — spending longer in bed to catch up, irregular sleep timing, daytime napping, and anxiety about sleep itself. These are the factors treatment targets.
What causes a sleep disorder?
Sleep difficulties usually begin with an identifiable trigger and then persist through habits and associations formed in response. Identifying both parts matters, because the original cause and what is currently maintaining the problem are often different.
Common contributors include:
- Stress, anxiety, or a period of significant worry
- Depression, which characteristically causes early morning waking
- Irregular sleep timing, shift work, or frequent travel
- Caffeine, nicotine, and alcohol — alcohol fragments sleep even when it speeds onset
- Screen use and stimulating activity close to bedtime
- Pain, breathing problems, or other medical conditions
- Some prescribed medications
- Anxiety about sleep itself, which becomes self-perpetuating
Common symptoms
Symptoms vary between people, and you do not need to recognise all of these to benefit from an assessment.
- Difficulty falling or staying asleep
- Waking up too early or waking frequently
- Excessive daytime sleepiness
- Irritability or poor concentration
- Low energy through the day
- Racing thoughts at bedtime
When to seek help
If poor sleep lasts more than a few weeks and impairs daytime functioning, professional evaluation helps address root causes.
How a sleep disorder is diagnosed
Assessment establishes the pattern rather than just the complaint: what time you go to bed, how long it takes to fall asleep, how often you wake, when you finally get up, and what the daytime consequences are. You may be asked to keep a sleep diary for a week or two, which usually reveals more than recall alone.
Dr. Surana will ask about mood, anxiety and stress, since these are among the most common drivers of persistent insomnia, and about caffeine, alcohol, nicotine and medication use.
Some sleep problems are not primarily psychiatric. Loud snoring with pauses in breathing, excessive daytime sleepiness despite adequate time in bed, or unusual movements and behaviours during sleep may point to obstructive sleep apnoea or another sleep disorder, and warrant referral for sleep study rather than psychiatric treatment alone.
Treatment options
The first-line treatment for persistent insomnia is psychological, not pharmacological. This surprises many people who expect a prescription, but the evidence is clear that behavioural treatment produces better and more durable results than sleeping tablets.
CBT for insomnia (CBT-I). This is the recommended first-line treatment. It works on the factors maintaining poor sleep: regularising sleep and wake times, restricting time in bed to rebuild the association between bed and sleep, breaking the cycle of lying awake frustrated, and addressing the anxious thinking about sleep that keeps people alert. It is structured and time-limited, and its effects generally persist after treatment ends.
Treating what underlies it. Where depression, anxiety, ADHD or trauma is driving the sleep disturbance, treating that condition is part of treating the sleep. Sleep frequently improves as the underlying condition is addressed.
Medication. Sleeping tablets can be useful for short periods in acute situations, but they are not a solution for chronic insomnia: tolerance develops, the underlying pattern is unaddressed, and stopping often produces a rebound worsening. Where medication is used it is generally short-term and alongside behavioural work, and this reasoning is explained rather than the request simply declined.
Practical sleep habits. Consistent wake time, light exposure in the morning, limiting caffeine after midday, and keeping the bed for sleep are discussed as specific changes fitted to your circumstances.
What recovery looks like
Sleep improves gradually rather than immediately, and the first phase of behavioural treatment can feel harder — restricting time in bed initially increases tiredness before consolidating sleep. This is explained in advance so it is expected.
Most people see meaningful improvement within four to eight weeks of consistent CBT-I. The gains tend to last, because what changes is the underlying pattern rather than the symptom being suppressed.
Occasional bad nights continue for everyone and are not a relapse. An important part of treatment is reducing the anxiety that a single poor night provokes, since that anxiety is often what turns a bad night into a bad month.
How Trio Mindspace can help
Dr. Surana evaluates psychological and behavioural contributors, using targeted therapy (such as CBT-I), lifestyle strategies, and medication when necessary.
Every plan begins with a full assessment rather than an assumption. Dr. Surana will explain what she thinks is happening, set out the options, and agree the approach with you before anything starts. You can read more about her background and approach, or see all conditions treated at the clinic.
Frequently asked questions
Cognitive Behavioural Therapy for Insomnia is a structured, short-term programme that retrains the association between bed and sleep. It addresses sleep timing, the habits that maintain insomnia, and the anxious thinking that builds around bedtime. It is the recommended first-line treatment for chronic insomnia in most guidelines.
Not as a default. Sedatives can help briefly in specific situations, but they do not resolve the underlying cause and can create dependence. Where they are used, it is deliberately short-term and alongside behavioural treatment.
Bedtime is often the first quiet moment of the day, so unprocessed worry surfaces then. It is one of the most common features of stress-related insomnia, and it responds well to specific techniques rather than to trying harder to sleep.
Possibly. Sleep apnoea, thyroid problems and certain medications all disturb sleep. Assessment includes screening for these, with referral where a non-psychiatric cause looks likely.
Generally no. Sleeping tablets can help for short periods in acute situations, but tolerance develops with regular use, the underlying pattern remains unaddressed, and stopping frequently causes a temporary worsening of sleep. Behavioural treatment (CBT-I) is the recommended first-line approach for persistent insomnia and produces longer-lasting results.
Alcohol shortens the time it takes to fall asleep but worsens sleep quality. It suppresses restorative sleep stages, fragments the second half of the night, and often causes early waking. Using alcohol to sleep tends to worsen insomnia over time.
Most adults need somewhere between seven and nine hours, but there is genuine individual variation. The more useful measure is how you function during the day rather than the number itself. Chasing a target figure often increases anxiety about sleep, which makes sleep worse.
It depends on the pattern. Where insomnia is linked to stress, anxiety, low mood or an irregular routine, psychiatric assessment is appropriate. Where there is loud snoring with breathing pauses, marked daytime sleepiness despite adequate time in bed, or unusual behaviours during sleep, a sleep study may be needed — and Dr. Surana will advise on referral if the assessment points that way.