Insomnia Treatment

What is Insomnia?

Insomnia is the most common sleep problem in adults. Everyone sleeps badly for a few nights during stressful times — this is short-term (acute) insomnia and usually settles once the trigger passes. When poor sleep occurs at least three nights a week, lasts for at least three months and affects daytime life, it is called chronic insomnia.

Chronic insomnia often becomes a vicious circle: after a few bad nights you start worrying about sleep, go to bed earlier, lie awake longer, and the bed becomes linked with wakefulness and anxiety instead of sleep. Daytime naps, evening caffeine and screens reinforce the cycle.

Insomnia can be a problem on its own or a symptom of something else. Depression and anxiety, chronic pain, reflux, an enlarged prostate, thyroid disease, the menopause, some medicines and other sleep disorders such as sleep apnea or restless legs can all cause it. Sleep structure also changes with age, and causes of broken sleep become more common in older people — so the causes need careful assessment before treatment.

Insomnia and brain health

Long-term poor sleep affects attention, memory and decision-making. During sleep the brain clears waste products and consolidates what has been learned. That is why protecting sleep quality is particularly important for cognitive health in older age, and why sleep is always assessed alongside memory complaints in geriatric neurology.

Symptoms of Insomnia

• Taking more than 30 minutes to fall asleep
• Waking frequently and struggling to get back to sleep
• Waking much earlier than intended
• Feeling unrefreshed despite sleeping
• Daytime tiredness and low energy
• Poor attention, concentration and memory
• Irritability and mood changes
• Reduced performance at work and in social life
• Constant worry about sleep

When should you see a neurologist?

• Insomnia lasting more than three months
• Being unable to sleep without sleeping pills, or needing higher doses
• Snoring, breathing pauses or restless legs alongside insomnia
• Excessive daytime sleepiness
• Insomnia with low mood or anxiety
• New sleep problems, memory loss or night-time confusion in older age

Do not use sleeping pills — especially sedatives with a risk of dependence — for long periods without medical advice, and do not stop them suddenly.

How is Insomnia diagnosed?

Insomnia is diagnosed with a detailed sleep history: bedtimes and wake times, how long it takes to fall asleep, night awakenings, naps, caffeine and alcohol, screen habits, work patterns, sources of stress, medicines and other health conditions.

• Sleep diary: bedtime, wake time, time to fall asleep and awakenings recorded for 1–2 weeks
• Standard questionnaires: insomnia severity, daytime sleepiness, mood and anxiety
• Blood tests: thyroid function, iron and ferritin, B12 when relevant
• Polysomnography: when sleep apnea, periodic limb movements or another sleep disorder is suspected, or when treatment does not work

How is Insomnia treated?

Cognitive behavioural therapy for insomnia (CBT-I)

International guidelines recommend CBT-I as the first-line treatment for chronic insomnia. It targets the habits and thoughts that keep insomnia going and its effect lasts longer than that of medication. Its main components are:

• Stimulus control: using the bed only for sleep; getting up if you cannot sleep and returning when sleepy
• Sleep restriction: matching time in bed to actual sleep time, then gradually extending it
• Cognitive therapy: addressing anxious thoughts about sleep
• Relaxation techniques: breathing exercises, muscle relaxation
• Sleep hygiene: regular sleep times, less evening caffeine, alcohol and screen time, a good sleep environment

Medication

In selected cases, and usually for short periods, medication may be used. The choice depends on the type of insomnia, your age, other conditions and the risk of dependence. In older people some sleeping pills are avoided because they increase the risk of falls and confusion. If you have taken sleeping pills for a long time, a supervised, gradual reduction is part of the plan.

Treating underlying causes

Sleep apnea, restless legs, depression, chronic pain or reflux are treated if found — insomnia rarely resolves fully until they are addressed.

Body-clock (circadian) disorders

Sometimes the problem is not insomnia but sleep shifted to the wrong time. In delayed sleep phase — common in young people — falling asleep before the early hours is impossible and getting up is very hard; older people may fall asleep very early and wake after midnight. Timed light therapy, correctly timed melatonin and gradual shifting of sleep times can help.

Treatment timeline and your stay in Istanbul

The first assessment takes about 45 minutes. CBT-I is usually delivered over 4–8 sessions across several weeks, and most people notice improvement within that time. If medication is used, the dose and duration are reviewed regularly.

For patients from abroad, the consultation and — if needed — polysomnography can be fitted into 1–2 days in Istanbul. Therapy sessions and follow-up can continue online, in English.

Follow-up after treatment

• Keep your sleep diary during treatment
• Get up at the same time every day, including weekends
• Limit daytime naps
• Avoid caffeine after midday and alcohol and heavy meals in the evening
• Stay away from screens in the hour before bed
• Exercise regularly, but avoid intense exercise close to bedtime

Risks and what to watch for

Untreated chronic insomnia increases the risk of depression, anxiety, high blood pressure and accidents and affects work and social life. Some sleeping pills can cause dependence, daytime grogginess, falls and memory problems, so they should be used under supervision and for as short a time as possible. During the first weeks of CBT-I — especially sleep restriction — daytime sleepiness may temporarily increase; take care when driving.

Frequently asked questions about Insomnia