Introduction

We all know what it’s like to toss and turn at night, wondering how we’re going to make it through the next day. Occasional sleep problems are completely normal and nothing to worry about. But if you regularly have trouble sleeping and feel so exhausted that you can't get on with everyday life, you probably have a sleep disorder. Doctors consider a sleep problem to be a sleep disorder if it has been going on for more than a month.

There are many things you can do to help improve your sleep. They include relaxation techniques and changing your sleeping habits. It is also important to find ways to relieve stress and cope better with anxiety and worries. Sleeping pills are usually not a good idea – they're only considered for people with severe insomnia, and are then only used temporarily.

A doctor can help you find out if your sleep problems are being caused by a physical or psychological condition, and let you know what the treatment options are.

At a glance

• Sleeping badly can make you feel exhausted during the day.
• Relaxation techniques, home remedies and different bedtime habits may help to improve mild sleep issues.
• A full-blown sleep disorder causes problems and stress in everyday life.
• Cognitive behavioral therapy is often recommended then.
• Prescription medications (sleeping pills and sedatives) have many side effects and can quickly lead to dependence.

Symptoms

People who have trouble sleeping don't get enough restful sleep, and then feel tired and groggy the next day. Reasons for not getting enough good sleep include the following:

• Needing a very long time to fall asleep
• Not sleeping soundly, and frequently waking up at night
• Waking up at night and taking a long time to fall back to sleep
• Waking up much too early and then not being able to fall asleep again

If you have more than three bad night’s sleep per week and this goes on for more than one month, and it's so bad that it reduces your quality of life, you have a sleep disorder known as insomnia. Insomnia can affect everything in your life. For instance, many people have trouble concentrating at work or when doing hobbies. They often think about their sleep problem and spend a lot of time worrying about its effects – especially at night.

It's not normal for healthy people of any age to regularly have a lot of trouble getting to sleep and staying asleep. Different people need different amounts of sleep. Various factors play a role, including age:

• Children over the age of six years usually sleep about nine hours each night.
• Adults sleep about seven hours.
• People over the age of 80 generally only sleep about six hours.

These are only averages, though. Some people will need a little more or less sleep to feel rested.

The sleep times given here refer to what is known as the "total sleep time." This starts when you fall asleep and ends when you are truly awake the next morning and get up. Any periods of being awake during the night are subtracted to arrive at the total sleep time. It’s perfectly normal to need about half an hour to fall asleep once you've turned off the lights, so there's no reason to worry if it takes that long.

Causes

Many things can make it difficult to sleep, including:

• Worries and stress
• Stressful life events, like a separation or serious illness
• Alcohol and drugs
• Pain, needing to pee at night, or hot flushes
• Sleepwalking
• Pauses in breathing at night (sleep apnea)
• Restless legs syndrome
• Grinding your teeth (bruxism)
• Certain medications such as SSRIs (used to treat depression)
• Shift work
• Noise

Some of these causes can be avoided. That is especially true for alcohol. Although some people can fall asleep faster after drinking alcohol, it also makes their sleep less restful.

Prevalence

If you sleep badly, you’re not alone: About a third of people have trouble either falling asleep or sleeping soundly through the night.

Roughly 6 out of 100 people in Germany have a sleep disorder. These disorders are more common in women than in men. They can affect people at any age, even in early childhood.

Diagnosis

A sleep diary or smartphone app can help to work out what might be causing the problem. They can be used to keep a record of when your sleep wasn't very restful and what happened on those days. This can help to identify possible causes or a particular pattern. Doctors sometimes use these records to assess how severe the problems are.

A trip to the doctor can help you find out why you're having trouble sleeping. In an in-depth talk (anamnesis), the doctor will ask about your symptoms, habits and anything that might be causing the problems. This may include questions about

• which medication you're taking, if any,
• whether (and when) you consume alcohol, drinks containing caffeine, or drugs,
• whether stress at home or work might play a role, including emotionally stressful events in your life, and
• whether you're in any pain, or have a physical or mental illness.

As well as having a physical examination, you will have a blood test to find out whether an illness might be causing the sleep problems. If an illness is the cause, the treatment will mainly focus on that. Illnesses that can affect your sleep include thyroid, heart, lung and chronic kidney disease. Mental illnesses such as anxiety or depression can also lead to trouble sleeping.

If there's reason to believe that other problems are affecting your sleep – like breathing problems or leg movements during the night – a sleep study might be useful.

Treatment

There is currently very little high-quality research on effective ways to treat sleep problems. Common approaches and home remedies include:

• Improved bedtime habits (sleep hygiene): For example, only eating light meals and not drinking alcohol or caffeine-containing drinks before bedtime, using your bed for sleep only, and not going to bed until you're actually tired.
• Relaxation techniques like progressive muscle relaxation or autogenic training.
• Breathing exercises and meditation.
• Gentle physical exercise like going for a walk in the evening, doing simple yoga exercises or tai chi.
• Herbal sleeping pills and sedatives like valerian.
• Dietary supplements containing melatonin.
• Home remedies like a cup of warm milk, or chamomile or valerian tea, a warm shower or bath, or a warm foot soak.

If you've been diagnosed with insomnia, possible treatments include:

• Cognitive behavioral therapy: This type of talking therapy can help to change thought patterns and behaviors that may be stopping you from sleeping well.
• Melatonin medication
• Prescription sleeping pills like benzodiazepines and Z-drugs (benzodiazepine receptor agonists, otherwise known as "BzRAs"): These should only be used for a limited period of time because they have a lot of side effects and can quickly lead to a dependence.

Further information

When people are ill or need medical advice, they usually go to see their family doctor first. In our "Health care in Germany" topic you can read about how to find the right doctor – and our list of questions can help you to prepare for your appointment.

Sources

• Alessi C, Vitiello MV. Insomnia (primary) in older people: non-drug treatments. BMJ Clin Evid 2015. [PMC free article: PMC4429264] [PubMed: 25968443]
• Bruni O, Novelli L. Sleep disorders in children. BMJ Clin Evid 2010: 2304. [PMC free article: PMC3217667] [PubMed: 21418676]
• Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). Insomnie bei Erwachsenen. DEGAM-Anwenderversion zur S3-Leitlinie „Nicht erholsamer Schlaf/Schlafstörungen“. AWMF-Register-Nr. 063-003. 2017.
• Galland BC, Taylor BJ, Elder DE et al. Normal sleep patterns in infants and children: a systematic review of observational studies. Sleep Med Rev 2012; 16(3): 213-222. [PubMed: 21784676]
• Ohayon MM, Carskadon MA, Guilleminault C et al. Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep 2004; 27(7): 1255-1273. [PubMed: 15586779]
• Riemann D, Baum A, Cohrs S et al. S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen. Kapitel „Insomnie bei Erwachsenen“ (AWMF-Registernummer 063-003), Update 2016. Somnologie 2017; 21(2): 2-44.
• Schlack R, Hapke U, Maske U et al. Häufigkeit und Verteilung von Schlafproblemen und Insomnie in der deutschen Erwachsenenbevölkerung. Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1). Bundesgesundheitsbl 2013; 56: 740-748. [PubMed: 23703493]
• Schwabe U, Ludwig WD. Arzneiverordnungs-Report 2020. Berlin: Springer; 2020.

• IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.