Ajax Harwood Clinic
Trouble sleeping
Insomnia is difficulty falling asleep, staying asleep, or waking too early — often enough, and for long enough, that it wears on your days as well as your nights.
What usually happens
The first-line treatment is not a sleeping pill. It is a structured programme called CBT-I, which retrains the association between your bed and being awake. It works better than medication over the long run, and unlike medication its benefit lasts after it stops.
That is not a brush-off, and it is not us withholding something. Sleeping medicines have a role, mostly short-term and in specific situations, but they lose effect and become hard to stop — which is exactly the trap we are trying to keep you out of.
Something else is often driving it. Pain, mood, breathing that stops and starts overnight, alcohol, shift work, an overactive thyroid, or another medicine you take — insomnia that will not budge usually has a reason worth finding.
Sleep need is not eight hours for everyone. Lying in bed longer trying to reach a number tends to make sleep worse, not better.
At your appointment
We will ask about the shape of your nights — when you go to bed, how long to fall asleep, what wakes you, when you finally get up — and about your days, since daytime effect is what makes it worth treating.
We will ask what else might be involved: mood, pain, alcohol, caffeine, other medicines, snoring or witnessed pauses in breathing.
You may be asked to keep a sleep diary for a week or two. It sounds tedious and it is genuinely the most useful thing you can bring — memory for sleep is unreliable in exactly the ways that matter.
Most people leave with a behavioural plan and a follow-up, not a prescription.
Worth asking
- Is there something underneath this that we should be looking for?
- How would I get started with CBT-I, and what does it involve?
- If I am already taking something to sleep, how would we go about coming off it?
- How long before I should expect a difference?
Alcohol and sleep
A drink can help you fall asleep, but it breaks up sleep later in the night and can make insomnia worse over time. If a drink has become part of getting to sleep, it's worth talking about.
If you’d like to drink less, or stop, there’s help that doesn’t ask you to call yourself anything.
If you drink every day, please don’t stop suddenly on your own — stopping all at once can be dangerous. Talk to us first.
Curious what your doctor is weighing up? The clinical tool we use for insomnia is open to anyone — it is detailed and written for clinicians, and you are welcome to read it.
Open the clinician reference →General health information for Ajax Harwood Clinic patients and the public — not medical advice, and not a substitute for seeing your own doctor. In an emergency call 911.