If you are lying awake wondering why you can't sleep, you are far from alone. Insomnia, meaning difficulty falling asleep, staying asleep, or waking too early, is one of the most common health complaints in the UK. The reasons range from stress and lifestyle to underlying health conditions, and the good news is that effective treatments exist. This guide explains the causes and what actually helps. Where a short-term prescription is appropriate, options such as Circadin melatonin are considered only after a clinical assessment.
Table of Contents
2. Why Can't You Sleep? The Common Causes
3. The Most Effective Treatments
3.2. Cognitive Behavioural Therapy for Insomnia (CBT-I)
3.3. Medication
5. The Vicious Cycle of Worrying About Sleep
6.1. Why can't I sleep even when I'm tired?
6.2. What is the most effective treatment for insomnia?
6.3. Why do I keep waking up in the night?
What Counts as Insomnia?
Most people have the odd bad night, and that is normal. Insomnia is when poor sleep happens regularly, typically three or more nights a week, and starts to affect how you feel and function during the day. It is described as short-term when it lasts up to a few weeks, often tied to a clear trigger, and long-term, or chronic, when it persists for three months or more.
Why Can't You Sleep? The Common Causes
Insomnia usually has more than one cause, and identifying yours is the first step to fixing it. The most frequent culprits include:
- Stress, anxiety and a racing mind, one of the biggest causes of trouble falling asleep.
- Poor sleep habits, such as irregular bedtimes, screens late at night, or napping during the day.
- Caffeine, alcohol and nicotine, all of which disrupt sleep, especially later in the day.
- Your sleep environment, including light, noise, heat or an uncomfortable bed.
- Health conditions, such as pain, breathing problems, an overactive thyroid or restless legs.
- Hormonal changes, including the menopause, where night sweats disturb sleep.
- Shift work and jet lag, which knock your body clock out of sync.
- Some medications, which can interfere with sleep as a side effect.
If night sweats are waking you and you are around the menopause, treating that underlying cause often helps, which our HRT range addresses. Sleep and weight are also closely linked, as our article on sleep and weight loss explains.
The Most Effective Treatments
The treatments with the strongest evidence are not the ones most people reach for first. Here is what works, roughly in the order it is usually recommended:
Sleep Hygiene and Habits
Simple, consistent changes form the foundation: a regular sleep and wake time, a wind-down routine, a cool dark bedroom, limiting caffeine and alcohol, getting daylight and activity during the day, and keeping screens out of the bedroom. These sound basic, but for many people they make a real difference.
Cognitive Behavioural Therapy for Insomnia (CBT-I)
CBT-I is the recommended first-line treatment for long-term insomnia and is more effective in the long run than sleeping tablets. It tackles the thoughts and behaviours that keep insomnia going. It is available through some NHS services, self-help programmes and apps, and does not involve medication.
Medication
Sleeping tablets are generally a short-term option, used cautiously because of the risk of dependence and next-day drowsiness. For some adults, particularly those over 55, a prescriber may consider a prolonged-release melatonin such as Circadin for short-term use. Medication is not a long-term fix on its own and works best alongside the behavioural approaches above.
When to See a Doctor
See your GP if poor sleep has lasted for several weeks, is affecting your mood, work or safety, or is not improving despite better sleep habits. It is also worth seeking help if you suspect an underlying cause such as pain, breathing problems or low mood, since treating that often resolves the insomnia.
The Vicious Cycle of Worrying About Sleep
One of the cruellest things about insomnia is how worrying about not sleeping makes sleep even harder. If you have ever lain awake wondering why you can't sleep, watching the clock and calculating how few hours are left, you will recognise how that anxiety keeps the brain alert at exactly the moment you want it to switch off. This is why the problem so often becomes self-sustaining.
Breaking the cycle is a core part of CBT-I. Techniques such as getting out of bed if you are not sleeping, rather than lying there frustrated, and not trying to force sleep, help loosen the link between your bed and stress. It feels counterintuitive, but easing the pressure to sleep is frequently what allows it to return.
Important: This article is general information and does not replace medical advice. Persistent insomnia can have underlying causes that need assessment, and sleep medicines carry risks including dependence and daytime drowsiness. Any prescription is supplied only after a valid consultation. If you are struggling with your mood as well as your sleep, please speak to your GP. You can start a consultation where appropriate.
Frequently Asked Questions
Why can't I sleep even when I'm tired?
A common reason is a busy or anxious mind at bedtime, where the body is tired but the brain stays alert. Stress, caffeine, irregular routines and screen use late at night all contribute. Addressing these, and trying CBT-I, often helps.
What is the most effective treatment for insomnia?
For long-term insomnia, cognitive behavioural therapy for insomnia (CBT-I) is the recommended first-line treatment and is more effective over time than sleeping tablets. Good sleep habits underpin it, with medication reserved for short-term use.
Why do I keep waking up in the night?
Frequent waking can be caused by stress, alcohol, an uncomfortable environment, needing the toilet, pain, breathing problems, or hormonal changes such as menopausal night sweats. Identifying the cause guides the best treatment.
Are sleeping tablets safe?
They can help short term but are used cautiously because of the risk of dependence and next-day drowsiness. They are not a long-term solution on their own and work best alongside behavioural changes, under medical guidance.
