Insomnia: why it lasts and what actually helps, from CBT-I to sleeping pills

Insomnia means having trouble falling or staying asleep despite adequate time and conditions for sleep, being dissatisfied with sleep, and having daytime difficulties as a result, such as fatigue, low or irritable mood and poor concentration. The International Classification of Diseases (ICD-11) calls it chronic insomnia when this happens several times a week for at least 3 months, and short-term insomnia when it has lasted less than 3 months (WHO, 2025). The sleep medicine classification ICSD-3 uses at least 3 times a week for at least 3 months (Edinger et al., 2021).

Being unhappy with your sleep is not an insomnia disorder if it causes no daytime difficulties (WHO, 2025). Lighter, shorter sleep with more time awake at night is also a common change with age, even in healthy people (Ohayon et al., 2004). Still, if your days are suffering, do not put it down to age alone (National Mental Health Information Portal, 2020). Nor is 8 hours a must. The American Academy of Sleep Medicine and the Sleep Research Society recommend that adults aged 18 to 60 sleep 7 or more hours on a regular basis, while noting that sleep need varies from person to person (Watson et al., 2015).

mind.io does not offer a sleep test. This guide uses research and clinical guidelines to explain why insomnia lasts, which treatments have been shown to work, what you can try from today, and when to see a doctor.

An American Academy of Sleep Medicine systematic review summarised that 35% to 50% of adults have insomnia symptoms, while chronic insomnia disorder meeting diagnostic criteria affects 5% to 15% (Edinger et al., 2021). Another review put insomnia disorder at about 10% of adults, with a further 20% having occasional symptoms (Morin & Jarrin, 2022). Short spells are common too: among good sleepers in the UK, 31.2% to 36.6% had acute insomnia within a year (Ellis et al., 2012).

In Korea, a telephone survey of 3,719 people aged 15 and over, published in 2002, found that 17.0% had insomnia symptoms at least 3 nights a week and 5% met the criteria for insomnia disorder, but only 6.8% of those with symptoms had sought medical help for their sleep (Ohayon & Hong, 2002). The number of people treated under health insurance with insomnia (G47.0) as the main diagnosis, counted by claim-review year, rose from 309,793 in 2015 to 501,603 in 2025, 61.2% of them women in 2025 (Health Insurance Review and Assessment Service, 2026). These are people treated, not prevalence.

Insomnia often lasts. In a study that followed 388 Canadian adults with insomnia for 3 years, 74% had insomnia for at least 1 year and 46% throughout all 3 years (Morin et al., 2009).

The best-known framework for insomnia is the 3P model: predisposing factors such as personality, precipitating factors such as a stressful event, and perpetuating factors that keep insomnia going (Spielman et al., 1987; Ellis et al., 2021). Even after the effect of the original stressor fades, perpetuating factors such as habits that get in the way of sleep and worry about sleep can sustain it (Ellis et al., 2021). It is a model used to design treatment rather than a proven mechanism.

The Korean national mental health portal describes a vicious circle: insomnia that starts with stress brings anxiety and fear about not being able to sleep, and that tension in turn disrupts sleep (National Mental Health Information Portal, 2020). Researchers also describe people with insomnia as being in a state of hyperarousal, by day as well as at night (Riemann et al., 2010). The Korean Sleep Research Society advises that lying in bed for a long time when sleep will not come only builds tension and makes it harder to fall asleep (Korean Sleep Research Society).

Insomnia, depression and anxiety are intertwined. In a meta-analysis of 21 longitudinal studies, people with insomnia were about twice as likely to develop depression later (odds ratio 2.10 after excluding outliers; Baglioni et al., 2011). In another meta-analysis, the 6 studies on anxiety disorders found a higher chance of developing one as well (odds ratio 3.23; Hertenstein et al., 2019). These are observational studies, so they cannot show that insomnia causes depression, and depression and anxiety can also bring on insomnia (Alvaro et al., 2013).

Some trials suggest that treating insomnia can help mental health too. In a trial that randomly assigned 291 adults aged 60 and over with insomnia and no major depression in the past year, 12.2% of those who received 2 months of cognitive behavioural therapy for insomnia later had a new or recurrent episode of major depression, compared with 25.9% of those who received sleep education (Irwin et al., 2022). In a trial with 3,755 UK university students with insomnia, digital cognitive behavioural therapy for insomnia also reduced depression and anxiety, though symptoms of mania rose slightly (Freeman et al., 2017).

If low mood or worry comes with your sleep problems, check in with the depression check-in (PHQ-9) or the anxiety check-in (GAD-7), and read depression symptoms and anxiety symptoms. Neither check-in is a diagnosis. If you have thoughts of harming yourself, do not carry them alone: call or text 988 now in the US or Canada, call Samaritans on 116 123 in the UK or Ireland, or find a line at findahelpline.com elsewhere.

The American College of Physicians recommends cognitive behavioural therapy for insomnia (CBT-I) as the initial treatment for all adults with chronic insomnia (Qaseem et al., 2016). The European guideline likewise recommends CBT-I as first-line treatment, including for people with other conditions, whether in person or digital (Riemann et al., 2023). CBT-I usually runs over 4 to 8 sessions with a sleep diary and combines education about sleep, stimulus control, sleep restriction and changing unhelpful thoughts about sleep (Edinger et al., 2021).

In a meta-analysis of 20 studies (1,162 people), CBT-I shortened the time taken to fall asleep by about 19 minutes and time awake during the night by about 26 minutes, but total sleep time rose by only about 8 minutes, not a clear difference (Trauer et al., 2015). In other words, it mainly improves falling asleep and time awake at night rather than the amount of sleep. An analysis of 241 studies (31,452 people) found that cognitive restructuring, third-wave elements such as acceptance and mindfulness, sleep restriction and stimulus control mattered for the effect, while sleep hygiene education was not essential (Furukawa et al., 2024).

The effects shrink over time but last up to a year (van der Zweerde et al., 2019), and digital CBT-I also kept its effect a year later, although face-to-face treatment worked somewhat better (Soh et al., 2020). Early in treatment, though, people can feel sleepy or irritable during the day, and sleep restriction may not suit people who drive or operate dangerous machinery, people prone to mania, people with poorly controlled epilepsy, or people with excessive daytime sleepiness (Edinger et al., 2021). Rather than sharply cutting your time in bed on your own, do it with a professional.

Stimulus control is an evidence-based behavioural method. As set out in the American Academy of Sleep Medicine guideline, it means going to bed only when sleepy, getting out of bed when unable to sleep, using the bed only for sleep and sex (no reading or watching TV in bed), getting up at the same time every morning, and avoiding daytime naps (Edinger et al., 2021). Advice on how many minutes to wait differs (National Mental Health Information Portal, 2020; Korean Sleep Research Society), so rather than counting minutes, get out of bed when you have been tossing and turning for a while and go back when you feel sleepy. After a bad night, still get up at your usual time instead of sleeping in (National Mental Health Information Portal, 2020; NHS, 2024). If you are at risk of falls or take sleeping pills, stimulus control may need to be adapted to stay safe (Edinger et al., 2021). If you are a natural night owl, see also Morning people and night owls.

Caffeine and alcohol matter too. When 12 good sleepers took a large dose of caffeine (400 mg) 6 hours before bed, sleep time measured by a device still fell by more than an hour. In their own sleep diaries it fell by 41 minutes, not a statistically clear difference, which suggests the effect can be bigger than it feels (Drake et al., 2013). A meta-analysis of 24 studies found that caffeine cut total sleep time by 45 minutes on average and estimated that a cup of coffee (about 107 mg) is best drunk at least 8.8 hours before bed. This is an estimate from studies mostly of healthy people, and it can differ from person to person (Gardiner et al., 2023). Alcohol may seem to help you fall asleep at first, but it disrupts the second half of the night (Ebrahim et al., 2013).

Not spending long on your phone in bed fits stimulus control, which keeps the bed for sleep. Whether blue-light filtering glasses improve sleep, however, is uncertain (Singh et al., 2023). The European guideline says light therapy and exercise may be useful add-ons to CBT-I (Riemann et al., 2023). If work exhaustion is part of the picture, see also burnout recovery.

Sleeping pills sometimes have a place. Clinical guidelines, however, advise using them for short periods, after weighing benefits and harms with a doctor, when CBT-I is not possible or not enough (Qaseem et al., 2016; Sateia et al., 2017). The European guideline treats short-term use as 4 weeks or less (Riemann et al., 2023). While taken, sleeping pills work about as well as CBT-I, but their gains tend to fade after stopping, whereas the gains from CBT-I last after treatment ends (Sateia et al., 2017).

Sleeping pills carry risks such as dependence and withdrawal, cognitive impairment, falls and fractures, and impaired driving, observed most often in older people (Sateia et al., 2017). The American Geriatrics Society’s Beers criteria advise against prescribing benzodiazepines and similar sleeping pills, or sedating first-generation antihistamines, to people aged 65 and over (American Geriatrics Society, 2023). The American Academy of Sleep Medicine suggests not using melatonin, or an antihistamine used in over-the-counter sleep aids, to treat insomnia (Sateia et al., 2017), and the European guideline does not recommend antihistamines for insomnia (Riemann et al., 2023). Do not stop sleeping pills you already take suddenly; adjust them with your doctor, and do not combine sleeping pills with alcohol (FDA, 2020; Korean Sleep Research Society).

See a doctor if changing your habits has not helped, if you have had trouble sleeping for months, or if insomnia makes daily life hard to cope with (NHS, 2024). Loud snoring or being told you stop breathing in your sleep may point to sleep apnoea, and uncomfortable legs that will not keep still to restless legs syndrome; an overactive thyroid or medicines you take can also be the cause (NHS, 2024). The Korea Disease Control and Prevention Agency advises that severe daytime sleepiness should first raise the question of sleep apnoea, and that it raises the risk of accidents at the wheel (Korea Disease Control and Prevention Agency, 2026). If this sounds like you, get checked by a doctor, and do not drive when you feel sleepy.

Q. Do I really need 8 hours? A. No. Adults aged 18 to 60 are advised to get 7 or more hours regularly, but sleep need varies from person to person (Watson et al., 2015). “I must get 8 hours” is listed as one of the beliefs that feed worry about sleep (National Mental Health Information Portal, 2020).

Q. Doesn’t a drink help me sleep? A. It may seem to help you fall asleep, but it disrupts the second half of the night (Ebrahim et al., 2013). Alcohol cannot replace a sleeping pill (National Mental Health Information Portal, 2020).

Q. Is good sleep hygiene enough? A. Common sense such as cutting down caffeine and alcohol may help, but sleep hygiene on its own is not recommended as a treatment for chronic insomnia (Edinger et al., 2021). CBT-I, including stimulus control and work on thoughts about sleep, is the first-line treatment.

Q. Not sleeping is bringing my mood down. A. Insomnia and depression affect each other (Alvaro et al., 2013). Look back over the last two weeks with the depression check-in (PHQ-9), and if things stay hard, talk to a professional.

Q. It’s so hard I’m having thoughts of harming myself. A. Please do not carry them alone. Reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you are in immediate danger, contact your local emergency services.

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