Middle insomnia: what it is and how to beat it

From saga.co.uk

By Patsy Westcott

Waking repeatedly in the night and being unable to sleep again is the form of insomnia most suffered by older people. But there are ways to boost your chance of a better night’s sleep 

It’s 3am and you’re awake. You turn over, plump up the pillow, adjust the duvet and try a different position. You take a sip of water, realise you need the loo, tell yourself it can wait, then decide it can’t, and drag yourself to the bathroom. By the time you get back into bed, you’re wide awake and thoroughly fed up. However hard you try, sleep won’t come. 

If this sounds familiar, you’re not alone. Doctors call it middle insomnia, or sleep-maintenance insomnia, and it’s especially common in older people.

How common is middle insomnia?

“Sleep efficiency is undoubtedly more challenging as we get older,” says consultant neurologist Professor Guy Leschziner, professor of neurology and sleep medicine at Guy’s and St Thomas’ Hospitals.

Around half of older people report difficulty dropping off or staying asleep. Of these, sleep-maintenance insomnia, defined as multiple awakenings or prolonged wakefulness in the middle of the night, affects 50 to 70%.

“Typically, people report waking at 2, 3 or 4am and being unable to fall asleep again for hours,” says psychologist and sleep expert Dr Lindsay Browning of Trouble Sleeping.

Why are older people more affected?

“There are several destabilising influences on sleep that come with age,” says Prof Leschziner, author of The Nocturnal Brain: Nightmares, Neuroscience and the Secret World of Sleep.

“They include weakening of the brain circuitry that controls when we fall asleep, when we wake up and how stable sleep is, together with changes in the secretion of the sleep hormone, melatonin.

“Melatonin is the main chemical signal to the brain that it’s time to go to sleep and stay asleep. With age, its nocturnal peak is much lower, making it harder to maintain sleep,” he explains.

What physical changes can cause middle insomnia?

Certain physical aspects of getting older play a role too. They include: 

• Bladder weakness or irritability
• Joint and back pain or stiffness
• Menopausal symptoms such as night sweats or anxiety
• Medications, such as blood pressure-lowering beta blockers and calcium channel blockers, antihistamines, steroids and some antidepressants  

Medical conditions can also be culprits according to Prof Leschziner. Common offenders include:

• Obstructive sleep apnoea (OSA), in which breathing repeatedly stops and starts during sleep
• Periodic limb movement disorder (PLMD), which causes repetitive, uncontrollable jerking or twitching of the limbs
• Restless legs syndrome (RLS) a neurological condition that creates an irresistible urge to move the legs

“People with these conditions often feel as though they haven’t had any sleep,” says Prof Leschziner. In fact, this can be a trick of the brain, making you feel as though you haven’t slept a wink when you may actually have been drifting in and out of sleep.

What should you do if you’re affected?

Both experts agree that it’s best to not to lie there tossing and turning as this strengthens the association between bed and wakefulness.

“If you feel like you have been awake for about 20 minutes or more, it can help to leave the bedroom and go somewhere else,” says Dr Browning.

Prof Leschziner suggests sitting in dim lighting and doing something fairly unstimulating until you feel sleepy again. Dr Browning, meanwhile, recommends doing something “pleasant and engaging” to take your mind off not sleeping.

As she explains: “The aim is not to make yourself sleepier. It’s to take your mind off the fact you’re awake. This can reduce the link between bed, wakefulness and frustration, so that when you return to bed, sleep is more likely to follow naturally.”

Getty

Distracting and/or calming activities could include:

• Reading
• Watching TV
• Listening to the radio
• Creative activities such as puzzles, word searches or colouring books
• Humming a favourite tune to calm the brain and vagus nerve  

And what shouldn’t you do?

One of the biggest mistakes is checking the time. “Calculating how much longer it is until morning, and how annoyed you are that you’ve woken up can increase anxiety, making it harder to go back to sleep,” says Dr Browning.

She recommends setting an alarm for the latest time you need to wake up. “If you wake in the middle of the night, ask yourself: ‘Has my alarm gone off yet?’ If it hasn’t, it’s not morning, and you can try to go back to sleep.’

Another thing to avoid is scrolling on your phone. This can make it harder to get back to sleep because it strengthens that connection between being in bed and being awake and mentally switched on, and secondly, because the content of what you scroll may leave you feeling alert, agitated or distracted.

Instead, she suggests trying a calming breathing exercise or what experts call cognitive shuffling: mentally listing random, unrelated words or objects to gently distract the brain.

Should you have a snack?

Having something to eat in the middle of the night is not a good idea either, as it can train your body to wake up expecting food at that time. Instead try a light snack before bed, such as a piece of wholemeal toast with nut butter or a glass of warm milk.

And while we’re on food and drink, bear in mind that eating late in the evening, as well as caffeine and alcohol, are well-known sleep disruptors.

Are there any treatments?

According to the British Geriatrics Society, it’s best to steer clear of sleeping pills if you can. Older people are more susceptible to their sedating effects, which can lead to daytime drowsiness and a higher risk of falls and serious injury.

The good news is there are plenty of non-pill options and, even if you have struggled with insomnia for decades, you can still improve your sleeping habits.

“Long-standing insomnia is often maintained by unhelpful behaviours and anxiety about sleep itself, and this can be changed,” says Dr Browning.

CBT-I (cognitive behavioural therapy for insomnia) uses a range of techniques to tackle the habits and thought patterns that keep insomnia going – such as going to bed earlier to compensate for sleep loss or worrying about how you will function the next day – as well as so-called sleep restriction or sleep compression.

These techniques involve working out how long you usually spend asleep then strictly limiting the time you spend in bed to that time. It sounds counter-intuitive to deliberately restrict your sleep to treat insomnia, but over time it creates mild sleep deprivation. “Eventually, the sleep pressure that builds up as a result stabilises your sleep pattern, enabling you to gradually increase the amount of time you spend asleep in bed,” explains Prof Leschziner.

The Sleepio app, which uses CBT-I, is recommended by NICE (National Institute for Health and Care Excellence) and is thought to be especially beneficial for over 65s.

What matters, both experts agree, is not to accept broken nights as something you have to put up with. Once you understand what lies behind them, small changes to your routine can make a real difference and help you back to more restful nights.

Types of insomnia

• Short-term (acute) insomnia: lasts for less than three months and is often triggered by stressful events, jet lag or changes in the environment, such as a heatwave or extreme cold.
• Long-term (chronic) insomnia: lasts for three months or more and is often linked to underlying medical, psychological or lifestyle factors.
• Sleep-onset insomnia: difficulty dropping off at the beginning of the night. This is the kind most common in younger adults
• Sleep-maintenance (middle) insomnia: frequent awakenings during the night, or waking in the middle of the night and struggling to drop off again. This is the one most commonly suffered by older people
• Insomnia with early morning awakening: when you wake up very early in the morning, e.g. 5am.

If poor sleep is causing anxiety, frustration or daytime fatigue, speak to your GP or a sleep professional. 

https://www.saga.co.uk/magazine/health-and-wellbeing/middle-insomnia-what-it-is-and-do-you-have-it

Doctor explains the key difference between having insomnia and struggling to sleep

From ladbible.com 

She also shared 'sleep hygiene' tips for the festive period

A doctor has explained how to know if you're just having a bad night's sleep or if you need to seek medical advice.

Sleep is a vital thing, people can generally only go for so long without it before dying, and getting enough sleep each night is critical for all sorts of aspects of health.

As such, insomnia is a terrible thing to live with and people struggling with their sleep might be worried wondering whether or not they've ended up developing it if they're having a horrid time getting some much-needed shut eye.

                                                                                        Image Credit: Getty Stock Images

Dr Clare Rooms, a GP and the Clinical Lead for Insomnia at Boots Online Doctor, laid out how you can tell the difference between 'the odd bad night's sleep' and the sleep disorder insomnia.

She said: "Most people will experience the odd bad night’s sleep - often triggered by everyday stress, changes to routine, or late nights over the festive period - but that in itself doesn’t mean you have insomnia.

"The key difference comes down to how long the sleep disturbances last and the impact they have on daily life.

"Short-term sleep struggles usually improve once the trigger passes, but insomnia is a recognised sleep disorder. It involves problems falling asleep, staying asleep, or waking too early at least three nights a week for three months or more, and it also affects daytime functioning.

"People with insomnia may feel exhausted during daytime, may struggle to concentrate, become irritable, or notice their performance at work or relationships being impacted."

                                     If the disturbance to your sleep is lasting a long time you may have insomnia (Getty Images)

If you're having disrupted sleep then she recommends trying to have a 'consistent wake-up time' as well as cutting down on your alcohol consumption and 'avoiding heavy meals before bedtime' if you can manage it.

The doctor's other health tips for getting a better night's sleep included keeping your bedroom dark and cool at night, while taking in some fresh air and engaging in physical activity during the day.

She urged people who have 'ongoing' sleep disturbances to look for the other signs that you might have insomnia rather than a short-term issue.

These include sleep disruption carrying on far beyond a two-week period and the tiredness from a lack of sleep 'having a noticeable impact on your daily life'.

Making lifestyle improvements and adopting 'sleep hygiene measures' without success were other warning signs, as was 'anxiety building around bedtime' over the worry of 'another sleepless night'.

The doctor said that people suffering from 'persistent sleep disturbances' should speak to their GP.

https://www.ladbible.com/news/health/difference-insomnia-sleep-struggling-advice-303492-20251218

Not all insomnia is the same: Study identifies five subtypes and paves the way for personalized treatment

From english.elpais.com

To better understand why some people develop the condition while others do not, researchers have worked together to identify distinct patient profiles 

Insomnia has become a major public health problem in Western societies. In countries like Spain, for example, around 43% of the population experiences some symptoms of insomnia. According to data from a study by the Spanish Sleep Society (SES), the prevalence of chronic insomnia has tripled in the last two decades and now affects 14% of the Spanish adult population (around 5.4 million people).

According to the latest 2023 European Guidelines on Insomnia Treatment, cognitive-behavioural therapy for insomnia (CBT-I) is recommended as the first-line treatment for chronic insomnia in adults. Only if this therapy is ineffective or unavailable is the short-term use (no more than four weeks) of certain medications advised, such as benzodiazepines, benzodiazepine receptor agonists, and some antidepressants. In practice, however, many patients spend years taking these medications or suffering from insomnia symptoms that impair their quality of life without finding a treatment that improves their condition.

Chronic insomnia is defined as trouble sleeping that affects daytime functioning at least three times a week, for at least three months, and not explained by other factors. To understand why some people develop it while others do not, researchers in recent years have joined efforts to identify different types of insomnia patients, with the goal of providing more personalized and effective treatments.

There isn’t just one type of insomnia, and therefore it shouldn’t have a single treatment either. “It’s a complex and heterogeneous condition in which different pathophysiological pathways lead to the common complaint of lack of sleep and impaired daytime functioning,” explains Francesca Cañellas, a psychiatrist specializing in sleep medicine and a researcher at the Balearic Islands Health Research Institute (IdISBa).

These efforts have led to two approaches for determining the subtype of insomnia. The first divides patients into those with a short sleep duration (less than six hours) and those with longer sleep duration (more than six hours, the most common), but with a distorted perception of their rest. The second approach focuses on patient characteristics and is led by Dutch researchers Tessa Blanken and Eus Van Someren, who in 2019 proposed five patient subtypes based on life history as well as affective and personality traits. This classification doesn’t require medical tests and is carried out using a 204-question survey completed by the patients themselves.

In a study conducted in the Netherlands, using data from 2,224 participants with insomnia, Blanken and Van Someren identified five patient subtypes, but the majority fell into groups 2, 4, and 5. Subtype 2 — the most common in the general population — includes individuals with moderate levels of anxiety, who experience insomnia in response to stress and exhibit high levels of pre-sleep arousal. These patients typically respond well to cognitive behavioral therapy for insomnia. Subtypes 4 and 5 — who have slightly lower levels of anxiety — suffer from long-term insomnia in response to life events (subtype 4 exhibiting more severe insomnia), and they also frequently experienced childhood trauma. Both subtypes also tend to respond well to relaxation therapies and stress management techniques.

“The results of the study left me with the impression that the patients arriving at our sleep units were the most complex,” explains Cañellas. For this reason, the psychiatrist launched a research project, which received a grant from the Spanish Sleep Society, and involved eight multidisciplinary sleep units across Spain. This study analysed sleep characteristics, levels of anxiety and depression, family and personal history, the presence of other coexisting illnesses, and the treatments the patients were taking.

Insomnia has become a major public health problem in Western societies.  Pormezz - stock.adobe.com

Seven years of insomnia

The study’s results support the existence of the five insomnia subtypes and also Dr. Cañellas’s hypothesis: 82% of patients who come to sleep clinics fall into subtypes 1 and 3, the most complex types that have not responded to treatment. As a rule, they seek help too late, after suffering from insomnia for more than seven years.

Patients with subtype 1, the lead author explains, are characterized by significant distress related to their sleep, severe insomnia, and very high levels of depression. “In these patients, insomnia can be the first and most significant symptom of depression, so if the depression is not treated, the insomnia will not improve. Furthermore, more frequently than the other subtypes, these patients have been diagnosed at some point in their lives with anxiety or depressive disorders,” she notes.

Patients with subtype 3 sleep disorder, on the other hand, are moderately distressed about their sleep but do not respond well to treatment. “They are people with a tendency towards negativity. They come to the units frequently because they are the most worried,” explains Cañellas.

She explains that both subtype 1 and 3 patients tend to use more sleep medications (almost 30% were taking two or more drugs) and are more likely to have a family history of insomnia or psychiatric disorders. “We need to continue researching type 3 patients, who represent almost half of the patients seen in sleep units and are the ones who have the worst response to different treatments,” she concludes.

The importance of subdividing patients

“The results of the study allow us to reorient the treatment paradigm somewhat. In other words, we can’t tailor the treatment to everyone with insomnia; instead, we’ll have to modify the treatment based on each of the insomnia subtypes,” reflects Javier Puertas, clinical neurophysiologist at the Hospital de la Ribera in the Spanish city of Valencia and vice president of the Spanish Federation of Sleep Medicine Societies (Fesmes).

Ainhoa Álvarez, president of the Spanish Sleep Society, shares this view, arguing that this classification is a first step toward “more effective and personalized” treatments that can also be implemented earlier, without so much trial and error. For the researcher at the Bioaraba Health Research Institute, the simplicity of the questionnaire used to identify the subtype (the ITQ) means it can be administered in primary care, allowing patients who need specialist attention to be referred more quickly to sleep clinics or psychiatric services.

“Primary care is the driving force behind the management of the healthcare system. If, thanks to this questionnaire, it is possible to effectively screen patients and quickly refer only those who truly need it, this will also have positive repercussions for both the economy and the health of the population,” she adds.

https://english.elpais.com/health/2025-12-16/not-all-insomnia-is-alike-study-identifies-five-subtypes-and-paves-the-way-for-personalized-treatment.html

Insomnia: The misunderstood sleep disorder you probably don’t have

From independent.co.uk

Just because you can’t sleep doesn’t mean you have insomnia. You might have another sleep disorder, or none at all 

Even a single night of sleep trouble can feel distressing and lonely. You toss and turn, stare at the ceiling, and wonder how you’ll cope tomorrow. No wonder many people start to worry they’ve developed insomnia.

Insomnia is one of the most talked-about sleep problems, but it’s also one of the most misunderstood.

But just because you can’t sleep, it doesn’t mean you have insomnia. You might have another sleep disorder, or none at all.

What is insomnia?

Let’s clear up some terms and separate short-term or intermittent sleep problems from what health professionals call “insomnia disorder”.

Sleep problems can involve being awake when you want to be asleep. This could be lying in bed for ages trying to fall asleep, waking in the middle of the night for hours, or waking up too early. Having a sleep problem is a subjective experience – you don’t need to tally up lost hours to prove it’s a problem.

But insomnia disorder is the official term to describe a more problematic and persistent pattern of sleep difficulties. And this long-term or chronic sleep disorder has clear diagnostic criteria.

These include at least three nights a week of poor sleep, lasting three months or more. These criteria help researchers and clinicians make sure they’re talking about the same thing, and not confusing it with another sleep problem.

So, what are some reasons why a sleep problem might not be insomnia?

1. It’s short-term, or comes and goes

About a third of adults will have a bout of “acute insomnia” in a given year. This short-term problem is typically triggered by stress, illness or big life changes.

The good news is that about 72% of people with acute insomnia return to normal sleep after a few weeks.

Insomnia disorder is a long-term, persistent problem.

2. It doesn’t affect you the next day

Some people lie awake at night but still function well during the day. More fragmented and less refreshing sleep is also a near-universal part of ageing.

So if your sleep problem doesn’t significantly affect you the next day, it usually isn’t considered to be insomnia.

For people with insomnia, the struggle with sleep spills into the day and affects their mood, energy, concentration and wellbeing. Worry and distress about not sleeping can then make the problem worse, which creates a frustrating cycle of worrying and not sleeping.

3. It’s more about work or caring

If you feel tired during the day, an important question is whether you’re giving yourself enough time to sleep. Sometimes sleep problems reflect a “sleep opportunity” that is too short or too irregular.

Work schedules, child care, or late-night commitments can cut sleep short, and sleep can slip down the priority list. In these cases, the problem is insufficient sleep, not insomnia.

                                                Work schedules, child care, or late-night commitments can cut sleep short (Getty/iStock)

You might have noisy neighbours or an annoying cat. These can also affect your sleep, and reduce your “sleep opportunity”.

The average healthy adult gets around seven hours sleep (though this varies widely). For someone who needs seven, it usually means setting aside about eight to allow for winding down, drifting off, and waking overnight.

4. It’s another sleep disorder

Other sleep disorders can look like insomnia, such as:

• obstructive sleep apnoea (when your breathing stops multiple times during sleep) can cause frequent awakenings through the night and daytime sleepiness
• restless legs syndrome creates an irresistible urge to move your legs in the evening that often interferes with falling asleep. It’s often described as jittery feelings or having “creepy crawlies”, and is often undiagnosed
• circadian rhythm problems, such as being a natural night owl in an early-bird world, can also lead to trouble falling asleep.

5. Medications and substances are interfering

Caffeine, alcohol and nicotine all create insomnia symptoms and worsen the quality of sleep.

Certain medications can also interfere with sleep, such as stimulants (for conditions such as attention-deficit hyperactivity disorder or ADHD) and beta-blockers (for various heart conditions).

These issues need to be considered before labelling the problem as insomnia. However, it’s important to keep taking your medication as prescribed and discuss any concerns with your doctor.

Getting the right help

If your sleep is worrying you, the best first step is to see your GP. They can help rule out other causes, review your medications, or refer you for a sleep study if needed.

However, once insomnia becomes frequent, chronic (long term) and distressing, you can worry too much about your sleep, constantly check or track your sleep, or try too hard to sleep, for instance by spending too much time in bed. These psychological and behavioural mechanisms can backfire, and make good sleep even less likely.

That’s why “cognitive behavioural therapy for insomnia” (or CBT-I) is recommended as the first-line treatment.

This is more effective, and longer-lasting than sleeping pills. This therapy is available via specially trained GPs, and sleep psychologists. You can take part in person or online.

In the meantime

If you’re in a rough patch of sleep:

• remind yourself that short runs of poor sleep usually settle on their own
• avoid lying in bed panicking if you wake at 3.30am. Instead, step out of bed or use the time in a way that feels restful
• keep a consistent wake-up time, even after a poor night. Try to get some morning sunlight to reset your body clock
• make sure you’re putting aside the right amount of time for sleep – not too little, not too much.

https://www.independent.co.uk/life-style/health-and-families/sleep-insomnia-meaning-symptoms-help-b2823747.html

Why insomnia is disrupting your life and how to fight back

From rollingout.com

Discover the latest solutions to overcome sleepless nights and reclaim your health

The landscape of sleep medicine has evolved significantly, with insomnia emerging as a critical focus in healthcare. Modern understanding of this sleep disorder has revealed its complex nature and far-reaching impacts on overall health, leading to innovative approaches in treatment and management.

The science of sleeplessness

Sleep disruption occurs through various mechanisms, affecting the body’s natural circadian rhythm and sleep-wake cycle. Modern research has identified multiple pathways through which insomnia develops, from neurological changes to behavioural patterns. This understanding has revolutionised treatment approaches, moving beyond traditional sleep medications to more comprehensive solutions. Sleep disturbances are now recognized not only as an issue of restlessness but also as an alarm for underlying conditions such as anxiety, depression, and other health disorders.

While insomnia has long been linked to occasional sleepless nights or stress, the recent emphasis on its scientific basis highlights the far-reaching consequences of inadequate sleep. Insomnia is no longer seen just as a symptom but as a medical condition that can severely impact one’s overall well-being.

Complex patterns of sleep disruption

Insomnia manifests in distinct patterns, each requiring specialized attention. Sleep initiation insomnia prevents individuals from falling asleep, while sleep maintenance insomnia disrupts continuous rest. These patterns can overlap, creating complex sleep challenges that require tailored interventions. For some individuals, falling asleep is not the problem; it’s staying asleep. For others, falling asleep may take hours, leading to frustration and anxiety. These patterns vary greatly, affecting how treatments are designed and implemented.

Understanding the different types of insomnia allows healthcare professionals to prescribe more personalized care, moving away from a one-size-fits-all model. Cognitive behavioural therapy for insomnia (CBT-I) has emerged as one of the most effective treatment options, addressing these varied patterns through a series of structured techniques and lifestyle adjustments.

 

Biological and environmental factors

Modern sleep science has identified numerous contributors to insomnia.

Neurological factors affecting sleep-wake cycles can be triggered by stress, depression, or even genetic predispositions, making it difficult for the body to regulate sleep properly. Hormonal fluctuations, particularly during menopause or pregnancy, impact sleep patterns, often making it harder to fall or stay asleep.

Environmental influences such as noise, light, temperature, or uncomfortable bedding can disrupt natural rhythms. Many people may not realize that factors like these significantly impact their sleep quality, leading them to unknowingly perpetuate the cycle of sleeplessness.

Psychological factors such as anxiety, trauma, and depression are also critical contributors. Insomnia often accompanies these conditions, making it harder for individuals to relax enough to fall asleep. Recognising these emotional factors is vital in treating insomnia, as addressing the root cause can result in more sustainable improvements.

Lastly, medical conditions such as asthma, arthritis, or sleep apnoea can interfere with rest, compounding the problem. Treating the underlying health issue often improves the sleep disturbance.

                                                                Photo credit: shutterstock.com/Prostock-studio

Impact on daily function

Sleep disruption creates cascading effects throughout daily life. Individuals with insomnia often face cognitive and emotional challenges that compromise their overall function. From forgetfulness and trouble concentrating to irritability and mood swings, insomnia can significantly diminish quality of life.

The cognitive performance and memory are severely impacted, leading to difficulty retaining information and performing everyday tasks. Professionals often struggle with productivity, unable to focus or complete their work effectively. Physical health and immunity also decline as the body doesn’t receive the restorative sleep it needs. Chronic insomnia has been linked to heart disease, diabetes, and hypertension, making it critical to address this condition as part of overall health care.

Personal relationships can suffer when sleep deprivation leads to mood swings, poor emotional regulation, and irritability. A lack of sleep not only affects the individual but also those around them, creating a ripple effect that can affect family, friends, and colleagues.

Advanced treatment approaches

Contemporary insomnia treatment embraces a multi-faceted approach incorporating various therapeutic strategies. Evidence-based interventions now include cognitive behavioural therapy, chronotherapy, and targeted lifestyle modifications. These approaches address both immediate symptoms and underlying causes.

Cognitive behavioural therapy for insomnia (CBT-I) has become the gold standard for treatment. It works by identifying and changing the negative thought patterns that contribute to insomnia. Unlike traditional medications, CBT-I targets the root causes of sleeplessness and provides long-term solutions that help individuals sleep better without relying on pharmaceutical drugs.

Chronotherapy, another advanced approach, adjusts an individual’s sleep-wake cycle gradually, realigning it with natural circadian rhythms. These treatments may include shifting sleep time incrementally or exposing the person to bright light at specific intervals. By resetting the body’s internal clock, chronotherapy helps individuals achieve better rest naturally.

Targeted lifestyle modifications involve improving sleep hygiene, including setting a consistent sleep schedule, optimizing the sleep environment, and reducing caffeine or alcohol intake. All these strategies are designed to promote healthy, sustainable sleep habits.

Prevention strategies

Modern sleep hygiene emphasises preventive measures alongside treatment. This comprehensive approach includes environmental optimisation, behavioural modifications, and lifestyle adjustments. Creating an ideal sleep environment proves crucial for maintaining healthy sleep patterns.

Minimising distractions—such as noise, light, or even electronic screens—can significantly improve sleep quality. Behavioural modifications focus on fostering relaxation techniques, such as deep breathing, meditation, and progressive muscle relaxation. These changes help to prepare the body for sleep, reducing the time it takes to fall asleep and increasing the likelihood of staying asleep.

Incorporating these practices into a daily routine can help prevent insomnia from taking hold in the first place, especially for individuals with high-stress lifestyles or those who travel frequently.

Long-term health considerations

Chronic insomnia’s relationship with other health conditions demands attention to long-term management strategies. Research continues to show the clear link between sleeplessness and conditions such as heart disease, obesity, and diabetes. Managing insomnia is not just about getting a good night’s sleep but also about maintaining long-term health.

By treating insomnia effectively, individuals can improve not only their sleep but also their overall well-being. This requires a comprehensive approach that includes proper treatment, lifestyle changes, and ongoing support.

Future developments

Emerging research continues to uncover new aspects of sleep medicine, promising more effective treatments for insomnia. These developments may revolutionise our approach to sleep disorders, offering hope for those struggling with chronic sleep disruption.

As sleep science continues to evolve, researchers are looking into more personalised treatments that incorporate genetic factors and advanced sleep technologies. This progress could lead to more tailored interventions and, ultimately, better outcomes for people with insomnia.

The evolution of insomnia treatment represents a significant advancement in sleep medicine, offering new hope for those affected by sleep disorders. As research continues, our understanding grows, leading to more effective and personalised treatment approaches.

https://rollingout.com/2025/01/05/insomnia-treatment-guide/

Why Do Some People Need More Sleep Than Others?

From time.com

By Jeffrey Kluger

My bed and I spend less time together than the experts say we should. Most nights, my head hits the pillow around 11:00 pm, and I’m up—without an alarm—at 5:30 am. That six and a half hours of shuteye puts me behind the seven to nine hours the American Academy of Sleep Medicine and Sleep Research Society recommend for adults. Does it hurt me? Not so I can tell.

I may be a bit of an outlier as far as the guidelines are concerned, but I am by no means alone. Our sleep needs change over the course of our lifetimes—from 17 hours a day as a newborn, to up to 12 hours as a schoolkid, to the seven- to nine-hour benchmark for adults. But those figures are just averages. Plenty of people, like me, get by on significantly less for their age, while others require a good bit more. What is it that makes some folks short sleepers, some folks long sleepers, and others smack-in-the-middle sleepers? A lot of things, as it turns out.

Your sex matters—a little

When it comes to the differing sleep needs of men and women, one of the most commonly cited statistics is that women require more—but only by a tiny bit, about 11 extra minutes a night. The finding comes from a 2013 study in the American Sociological Review that surveyed nearly 73,000 participants in the U.S. Bureau of Labor Statistics’ American Time Use Survey. The sample group included only people in the 18 to 64 age range—eliminating the youngest and oldest respondents, whose sleep needs often fall on the highest and lowest end of the scale—to arrive at the small but statistically significant difference.

The researchers cited a range of factors that might explain the small gap—including the round-the-clock responsibilities of unpaid housework, which women still perform more commonly than men—and few opportunities for catch-up naps during the day. 

The American Sleep Foundation reports additional possible explanations, including menstruation, menopause, and pregnancy, all of which can interrupt sleep and lead to women staying in bed a little bit longer to make up for the periodic awakenings. Other findings suggest that women fall asleep a bit faster than men, meaning that they enter their sleep cycle with an edge of a few minutes. And then, of course, there’s the burden of caring for children—especially small children—which falls more heavily on mothers than fathers.

“When you have kids, you’re always dealing with them,” says Dan Gartenberg, an adjunct professor in biobehavioural health at Penn State University and CEO of Sleepspace, a sleep-assistance app. “Women may report having to get more sleep simply because they’re being woken up all the time.” Still, while more studies have been conducted on male-female sleep differences since the one in 2013, they have not turned up anything dramatic. “Honestly, the effect for gender is small,” says Gartenberg.

The wages of insomnia

About one in three adults worldwide experiences insomnia—or the inability to fall asleep or stay asleep—at any given time, according to the Cleveland Clinic. About one in 10 suffer from the chronic form of the condition. known as insomnia disorder, which is defined as three or more nights of sleep problems per week lasting three or more months. Insomnia can occur at different phases of the sleep cycle. So-called initial insomnia involves difficulty falling asleep; maintenance insomnia occurs when you wake up in the middle of the night but are able to go back to sleep; and late insomnia is waking up too early and being unable to go back to sleep. A lot of things can cause insomnia, including anxiety, depression, chronic pain, acid reflux, a family history of sleep problems, and stressful life circumstances that make it difficult to unwind. 

By definition, people with insomnia get less rest, which increases their need to stay in bed longer fighting to sleep or finding the time to nap during the day. “If your sleep is very broken up, you’re going to need more of it,” says Gartenberg.

There are several treatments for insomnia. Benzodiazepines and sedative-hypnotics are options, but also dangerous ones, as they can lead to dependency and addiction. What’s more, they lead to poor quality of sleep. “Ambien, for example, is not meant to be used every day because it’s going to reduce your deep sleep,” says Gartenberg.

Other, safer options include such sleep-hygiene strategies as going to bed and getting up at the same time every day; avoiding over-the-counter stimulants like certain cold medicines; limiting TV time or other stimulating activities before bed; and taking a bath, listening to soothing music or meditating in the evening. The goal, says Gartenberg, is to achieve sleep that is “regenerative and consolidated”—restful without medications and, if possible, without interruption. The closer you get to those twin goals, the more your sleep needs will fall back into the recommendations for your age.

The role of sleep apnoea

Next to insomnia, apnoea - or the periodic cessation of breathing during sleep, leading to micro-awakenings or full awakenings throughout the night - is the most common sleep disorder. “About 20% of the U.S. population has sleep apnoea, which is technically defined as literally choking five times an hour or more,” says Gartenberg. “If you have a severe case, you’re choking 100 times per hour.” In addition, he adds, about half of the population who do not meet the technical definition of sleep apnoea have suboptimal breathing during sleep, choking two to four times per hour.

There are two types of sleep apnoea, each with its own cause. Obstructive sleep apnoea occurs when the muscles in the back of the throat relax and collapse during sleep, cutting off breathing. Central sleep apnoea occurs when the brain fails to send signals to the central nervous system instructing respiration to take place. Overall, men are two to three times more likely to suffer from apnoea than women. About 4% of women have a related condition known as upper airway resistance, that can also disrupt breathing and sleep, according to Gartenberg. That condition occurs in only 1.5% of men.

As with insomnia, apnoea can cause people to require more hours of sleep, as they try to make up for the disruptions and awakenings that occur over the course of the night. The worse the apnoea is, the more catch-up time may be required. There are multiple treatments for apnea, including weight loss, CPAP sleep masks, implantable devices, and surgery.

Screwy circadian rhythms

Your body is a walking clock, built to respond to the cycles of the day. We awaken as the sun rises, sleep after it sets, and go through peaks and valleys of high and low energy in between—with the greatest highs occurring two to four hours after we wake up and again before the dinner hour, according to Gartenberg. But as technology takes us further and further from the state of nature, our circadian clock is coming unsprung.

“Since the invention of the light bulb, we're getting the wrong signals based on our circadian rhythms, which is hindering our sleep quality and our ability to have a regenerative night’s sleep,” says Gartenberg.

If the problem began in the late 19th century, it’s being turbocharged in the early 21st. We cocoon ourselves in brightly lighted cities, where 56% of the world’s population lives; work remotely at all hours—no need to follow a nine-to-five schedule if you can wake up, log on, and put in your time whenever you want; and spend our days and nights in front of screens, which bathe us in blue light, a wavelength that suppresses the production of the sleep hormone melatonin. All of this leads to poor-quality sleep and the need for more than the baseline for your age.

It’s not necessary to move out of the city or ditch your electronics to recalibrate your internal clock. Instead, you can nudge it into alignment by imposing a regular structure on your day. Try to wake up at the same time every morning and go to bed at the same time every night, exercise during those morning or early evening peaks, have your meals at set hours, avoid eating dinner too close to bedtime, and power down your phone or tablet an hour or two before sleep. 

The role of the genes

It is the rare person who can get by on just four and a half hours of sleep—but those individuals exist. Not only do they need relatively little slumber, they also tend to score higher than average on tests of energy, optimism, and pain tolerance. Those people, known as short sleepers, have been found by researchers at the University of California, San Francisco to have a mutation in seven genes that play a role in regulating sleep and, the studies suggest, mood—though to date they have published papers only on four of them.

“There are many people who think everyone needs eight to eight and a half hours of sleep per night and there will be health consequences if they don’t get it,” Dr. Louis Ptacek, a neurology professor at UCSF and the co-discoverer of the short sleeper genes, told TIME in 2020. “But that’s as crazy as saying everybody has to be 5 ft. 10 in. tall. It’s just not true.” 

Still, no one suggests that it’s terribly common to have short sleep written in your DNA. So far, only about 50 families with the short-sleeper genes have been identified.

A few sleep hacks

Go easy on alcohol and cannabis: Even a little bit of drinking can scramble your sleep—helping you drift off more easily, perhaps, but causing you to awaken more during the night. Additionally, when you have alcohol in your system before bed, you get less rapid eye movement (REM) sleep, the deepest sleep phase. “Alcohol totally wrecks sleep quality,” Gartenberg says. Cannabis, similarly, has sleep-inducing benefits in the early part of the night, but sleep-disturbing effects later.

Get some variety in your day: One of the reasons babies sleep so much is because they spend their waking hours vacuuming up information about the world. Consolidation of this information happens during sleep, so babies need to conk out early and often to preserve what they’ve learned. That doesn’t change in adulthood—meaning that the more novel experiences you have, the better you might sleep at night. “If you’re riding your bike and follow the same route again and again, maybe instead go a different route,” says Gartenberg. “When we learn and expose ourselves to more information, there’s actually an effect where you get more deep sleep.”

Figure out your natural sleep cycle. The next time you’re on vacation, take the time to learn about yourself. Rather than setting an alarm every day and dashing off to an activity, try going to bed at the same time for at least three nights running and not setting an alarm at all. Ideally, you will sleep until your body determines it has had enough. “This is a close estimation of what your unique sleep needs are,” says Gartenberg. If you’re sleeping, say, eight and a half hours, you can make sure you get to bed early enough when you get back home so that you can log that much time each night.

https://time.com/7064982/how-much-sleep-do-you-need-health/