What insomnia is
Insomnia means difficulty falling asleep, staying asleep, or waking too early and being unable to fall back asleep — with consequences during the day: fatigue, irritability, difficulty concentrating or remembering.
It is considered chronic when it happens at least three nights a week for three months or more. Below that, it is short-term insomnia, often linked to an identifiable event.
One important point: chronic insomnia stops depending on what triggered it. It starts with a divorce, an illness or a stressful period at work, but it persists because of the behaviours and thoughts that build up around sleep — the effort to sleep, the hours staring at the ceiling, the anticipatory anxiety in the late afternoon.
How it shows up
- Regularly taking more than 30 minutes to fall asleep
- Waking several times a night and struggling to fall back asleep
- Waking well before the alarm and being unable to sleep again
- Non-restorative sleep, even after hours in bed
- Fatigue, sleepiness or lack of energy during the day
- Irritability, anxiety or low mood
- Difficulty with attention, memory and performance at work
- Constant worry about sleep and about the consequences of not sleeping
Causes and risk factors
Insomnia rarely has a single cause. There is usually a predisposition, a trigger and factors that perpetuate it.
- Stress, anxiety and mood disorders
- Irregular schedules, shift work and jet lag
- Caffeine, alcohol or nicotine, especially late in the day
- Screens and bright light exposure before bed
- Chronic pain, reflux, urinary problems and other conditions that interrupt sleep
- Medication: corticosteroids, some antidepressants, bronchodilators, among others
- Other sleep disorders, such as apnea or restless legs syndrome
- Spending too long in bed trying to make up for lost nights
How it is assessed
Insomnia is diagnosed mainly through clinical history. In a first consultation we go through your schedules, routines, bedroom environment, medication, consumption habits and what goes through your mind when you cannot sleep.
We usually ask for a sleep diary over one to two weeks — it is the most useful tool to understand the real pattern, because memory of sleep is notoriously unreliable.
Not all insomnia requires tests. We run a sleep study when another disorder is suspected underneath, such as sleep apnea or periodic limb movements, or when insomnia does not respond to treatment.
Treatment options
Cognitive behavioural therapy (CBT-I)
This is the internationally recommended first-line treatment for chronic insomnia — ahead of medication. It usually runs over a handful of sessions and works on the behaviours and thoughts that keep insomnia going. Unlike pills, the results persist after treatment ends.
Sleep restriction
It sounds counter-intuitive, but temporarily reducing time spent in bed consolidates sleep and is one of the most effective components of CBT-I. It is always done with supervision.
Stimulus control
Rebuilding the association between bed and sleep: using the bed only for sleeping, getting up when sleep does not come, keeping a fixed wake-up time every day.
Pharmacological approach
When needed, it is used judiciously, for the shortest possible time and integrated into the plan — never as a standalone, long-running solution. We also support people who want to taper sleep medication they have taken for a long time.
When to seek help
If you sleep badly three or more nights a week for over three months, if you already organise your day around the fear of not sleeping, or if you rely on medication to fall asleep, it is time to seek an assessment.
Do not wait for it to pass on its own. Chronic insomnia tends to settle in, and the sooner the cycle is broken, the simpler the treatment.
Frequently asked questions
Yes, and that is the recommendation. Cognitive behavioural therapy for insomnia (CBT-I) is the first-line treatment and delivers lasting results, without the side effects and tolerance associated with sleeping medication.
It depends on the person, but CBT-I is a short, structured treatment — not open-ended psychotherapy. Most people notice changes within the first weeks.
In most cases yes, with a gradual, supervised tapering plan carried out alongside CBT-I. You should never stop sleep medication on your own initiative.
Educational information reviewed by our clinical team. It does not replace an individual medical consultation.