Insomnia
Also called: sleeplessness, trouble sleeping, sleep problems, chronic insomnia, short-term insomnia, neend na aana (not being able to sleep)
Insomnia means you regularly find it hard to fall asleep, stay asleep or feel rested, and it affects your day. Better sleep habits and a talking therapy called CBT-I work best. Sleeping tablets are only for short use under a doctor.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Insomnia is when you often have trouble sleeping even though you have the time and a chance to sleep. You may take a long time to fall asleep, wake up many times in the night, wake too early and not get back to sleep, or wake up feeling tired. To count as insomnia, it has to cause distress or make daytime life harder, for example through tiredness, low mood or poor concentration.
Insomnia that lasts less than 3 months is called short-term insomnia. It is often set off by stress, illness, a change of routine or a poor sleeping place. Insomnia that lasts 3 months or longer is called long-term (chronic) insomnia. It is very common: about a third of adults have some sleep problems, and around 1 in 10 have insomnia that affects their day. Women and older people are affected more often.
The good news is that most people sleep better by changing their sleep habits. The most effective treatment for long-term insomnia is cognitive behavioural therapy for insomnia (CBT-I, a structured talking therapy that changes the thoughts and habits that keep you awake). Sleeping tablets can help for a few days or weeks when insomnia is severe, but they can cause dependence (your body comes to rely on them), so doctors use them only for a short time.
In Pakistan
A house-to-house survey of adults in Karachi found that about 1 in 3 reported insomnia, and about a third of them used sleep medicines, mostly prescribed by family doctors; psychological distress, health problems and money worries were linked to insomnia.
Symptoms
- Finding it hard to fall asleep most nights
- Waking up several times during the night
- Waking up too early and not being able to get back to sleep
- Waking up feeling tired or not refreshed
- Feeling tired, low in energy or sleepy during the day
- Being irritable, moody or short-tempered
- Finding it hard to concentrate or remember things
- Worrying about sleep and dreading bedtime
- Making more mistakes at work or school, or having near-accidents
Causes and risk factors
Causes
- Stress, worry, anxiety or depression
- Poor sleep habits, such as irregular bedtimes, daytime naps, long periods awake in bed or using a phone or screen in bed
- A noisy, bright, hot, cold or uncomfortable bedroom
- Tea, coffee or other caffeine late in the day, alcohol, smoking or illegal drugs
- Shift work, night work or jet lag
- Health problems such as long-term pain, sleep apnoea (breathing stops and starts in sleep), restless legs, an over-active thyroid, needing to pass urine at night, menopause or pregnancy, and some medicines
What makes it more likely
- Being a woman, especially around menopause
- Being middle-aged or older
- Having a mental health condition such as depression or anxiety
- Having a long-term or painful physical illness
- Taking medicines that can disturb sleep
- Working evening or night shifts
- Stressful life events, money worries or other psychological distress
Complications
Poor sleep over a long time can make it hard to think, concentrate and remember, and can lower your performance at work or school. It raises the risk of mistakes and accidents, including falling asleep while driving. Long-term insomnia is linked with anxiety and depression, and with physical problems such as high blood pressure, heart disease and type 2 diabetes. Using sleeping tablets for a long time can itself become a problem, because the body gets used to them, they stop working as well, and stopping them suddenly can bring back worse sleeplessness. In older people, sleeping tablets raise the risk of confusion and falls.
When to see a doctor
- Falling asleep or feeling very drowsy while driving or operating machinery: stop driving and see a doctor
- Loud snoring with pauses in breathing, choking or gasping at night, or severe daytime sleepiness: see a doctor, as this may be sleep apnoea
- Very low mood, hopelessness or thoughts of harming yourself: get urgent help now at the nearest hospital emergency department or tell someone you trust
- Insomnia that has lasted for months, or makes daily life hard to manage, even after changing your sleep habits
- Needing sleeping tablets for more than a few weeks, or feeling unwell, anxious or unable to sleep when you try to stop them
- Sleeplessness together with signs of another illness, such as night-time pain, breathing problems or passing urine often at night
Diagnosis
Insomnia is diagnosed by talking with a doctor. The doctor asks how long the problem has lasted, how you sleep, what your bedtime routine is like and how it affects your day. They also ask about stress, mood, medicines, caffeine, alcohol, smoking and other health problems that may be causing it. A physical examination is usually enough, and in most cases no special test is needed.
Your doctor may ask you to keep a sleep diary for 2 to 4 weeks, writing down when you go to bed, how long it takes to fall asleep, how often you wake and how you feel in the morning. Short questionnaires can show how severe the insomnia is. An overnight sleep study (polysomnography, which records breathing, brain waves and movements during sleep) is not a routine test for insomnia. It is used when the doctor suspects another sleep disorder, such as sleep apnoea, and you may be referred to a sleep clinic.
Treatment
- Find and treat the cause: your doctor looks for stress, anxiety, depression, pain, breathing problems at night or medicines that may be keeping you awake
- Improve sleep habits: keep a regular sleep and wake time, keep the bedroom dark, quiet and comfortable, and avoid caffeine, alcohol, smoking, large late meals and screens before bed
- For long-term insomnia, try cognitive behavioural therapy for insomnia (CBT-I), face-to-face or through an approved digital (online or app) programme; it is the most effective treatment and its benefits last after it ends
- CBT-I uses stimulus control (go to bed only when sleepy and get up if you cannot sleep), sleep restriction (limit time in bed to the time you actually sleep, then slowly increase it), relaxation and changing unhelpful worries about sleep
- Only if insomnia is severe, is badly affecting daily life and other measures have not worked, a doctor may prescribe a sleeping tablet for a short time; your doctor decides the medicine and the dose
- Do not use sleeping tablets for long periods and never stop them suddenly after regular use; your doctor will reduce them slowly
- If another sleep disorder is suspected or insomnia does not improve, your doctor may refer you to a sleep clinic or a psychologist
Medicines in Pakistan
Medicines a doctor may use, by group. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Z-drugs (non-benzodiazepine sleeping tablets) | may be prescribed for short-term relief of severe insomnia after other measures have not worked; they can cause tolerance and dependence, so they are used only for a short time under a doctor | Chosen by your specialist |
| Benzodiazepines | only for short-term use under a doctor, for example when insomnia comes with severe anxiety; they can cause dependence, withdrawal and rebound sleeplessness, and raise the risk of confusion and falls in older people | Diazepam (68 brands) |
| Sedating antihistamines (pharmacy sleep aids) | may help for 1 to 2 weeks at most; the body gets used to them quickly, they can cause next-day drowsiness and they are best avoided in older people, so ask a doctor or pharmacist first | Chosen by your specialist |
Also used (not yet in our price list): zopiclone (a Z-drug), zolpidem (a Z-drug)
Self-care and prevention
Self-care
- Go to bed and get up at the same time every day, including weekends
- Relax for at least an hour before bed, and keep phones and screens out of bed
- Keep your bedroom dark, quiet, comfortable and not too hot or cold
- Avoid tea, coffee, cola, smoking and alcohol for at least 6 hours before bed
- Avoid daytime naps and large meals late at night
- Exercise regularly during the day, but not within 4 hours of bedtime
- If you cannot sleep after about 15 minutes, get up, do something calm in another room and go back to bed when you feel sleepy
- Do not drive or use machinery when you feel sleepy
Prevention
- Keep a regular sleep routine and a calm, comfortable bedroom
- Limit caffeine, especially late in the day, and avoid alcohol and smoking
- Stay physically active during the day
- Deal with stress early, and seek help for worry, anxiety or low mood before it disturbs your sleep
- Ask your doctor or pharmacist whether any of your medicines might affect sleep
Common questions
Do pharmacy sleep aids work?
Many sleep aids sold in pharmacies contain a sedating antihistamine. They may help for a week or two, but the body gets used to them quickly and they can leave you drowsy the next day. Do not use them for longer than that, and check with a doctor or pharmacist first, especially if you are older or take other medicines.
Are sleeping tablets safe?
Sleeping tablets can help for a few days or weeks when insomnia is severe, but they do not fix the cause. Many of them are habit-forming, stop working as well over time and can cause dependence. They should only be used for a short time, exactly as prescribed by a doctor.
What is CBT-I?
CBT-I (cognitive behavioural therapy for insomnia) is a short, structured talking therapy. It teaches you new sleep habits and helps you change worries and beliefs about sleep that keep you awake. It is the most effective treatment for long-term insomnia, and its benefits last after treatment ends. It can be done with a therapist or through an approved online programme.
Can stress cause insomnia?
Yes. Stress, worry, anxiety and depression are some of the most common causes of poor sleep. Treating the stress or mood problem, and learning ways to relax, often improves sleep too.
When should I see a doctor about insomnia?
See a doctor if changing your sleep habits has not helped, if the problem has lasted for months, or if it makes daily life hard. See a doctor sooner if you snore loudly with pauses in breathing, feel very sleepy during the day or have very low mood.
Sources
- NICE. Zaleplon, zolpidem and zopiclone for insomnia: Understanding NICE guidance (TA77) - information for people with insomnia, their families and carers, and the public (2004).
- NICE. Sleepio to treat insomnia and insomnia symptoms: information for the public (NICE medical technologies guidance MTG70) (2022).
- StatPearls (NCBI Bookshelf). Short-Term Insomnia - StatPearls - NCBI Bookshelf (2025).
- NHS 111 Wales. NHS 111 Wales - Health A-Z : Insomnia (2025).
- MedlinePlus. Insomnia: MedlinePlus Medical Encyclopedia (2026).
- electronic medicines compendium (emc). Diazepam 2 mg Tablet - Summary of Product Characteristics (SmPC) (2025).
- Journal of the Pakistan Medical Association (Kidwai and Ahmed). Prevalence of insomnia and use of sleep medicines in urban communities of Karachi, Pakistan (2013).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.
Related conditions
Anxiety disordersDepressionOveractive thyroid (hyperthyroidism)