Insomnia (sleeplessness) means that, despite an adequate opportunity to sleep, you cannot fall asleep or stay asleep and as a result feel impaired during the day. Occasional bad nights are normal. It becomes a problem when the sleep disorder persists over weeks or months and noticeably burdens everyday life.¹
Insomnia is among the most common complaints in general practice. Women are affected more often than men, and the frequency tends to increase with age. Many of those affected accept sleep disorders as inevitable, although effective treatments are available.¹,²
Insomnia is not a trifle
According to current knowledge, chronic sleep disorders increase the risk of depression, cardiovascular disease and other secondary conditions.¹
2. Forms of sleep disorders
Trouble falling asleep: falling asleep regularly takes excessively long — often due to rumination, tension or being overly alert at bedtime.
Trouble staying asleep: repeated waking during the night with difficulty getting back to sleep. Often the most distressing form.
Early waking: waking up considerably earlier than wanted, without being able to fall asleep again. Can also be a symptom of depression.
Acute vs. chronic insomnia: acute insomnia is often situational and usually fades on its own. Chronic insomnia persists for months and often becomes self-perpetuating.
Not every sleep disorder is insomniaSleep apnoea, restless legs syndrome and other sleep-medicine conditions have their own causes and treatments.
3. Symptoms and consequences
At night
Lying awake for a long time despite being tired
Frequent waking — often with difficulty falling asleep again
Sleep disorders usually do not have a single cause.¹
Psychological factors: stress, worries, a tendency to ruminate, depression, anxiety disorders. Mental illness and insomnia frequently reinforce one another.
Unfavourable sleep habits: irregular bedtimes, too much time in bed, screen use before sleep, caffeine in the evening.
Other sleep disorders:sleep apnoea, restless legs syndrome — should be ruled out.
Medications and substances: many medications can disturb sleep — including certain antidepressants, beta blockers, corticosteroids, thyroid hormones. Caffeine, alcohol and nicotine are common sleep disruptors.¹
Life phases: menopause, shift work and jet lag can trigger or worsen sleep disorders.
5. Diagnosis
The diagnosis is usually based on the history.¹
Sleep history: time to fall asleep, frequency of waking, sleep duration, daytime well-being. A sleep diary over one to two weeks is very helpful.
Questionnaire: standardized instruments (e.g. the Insomnia Severity Index) can objectify the severity.
Ruling out other causes: physical and mental conditions, other sleep disorders and sleep-disrupting medications should be evaluated.
Sleep laboratory: usually only when sleep apnoea or restless legs syndrome is suspected — not routinely for insomnia.
The current S3 guideline of the DGSM (2025 update, AWMF 063-003) is clear: cognitive behavioural therapy for insomnia (CBT-I) should be recommended as the first treatment option for everyone affected — including with co-existing physical or mental conditions.¹,³
First lineCBT-I — cognitive behavioural therapy for insomnia
A specialized, brief psychotherapy (usually a few sessions over a few weeks) that specifically addresses the causes of the insomnia.¹
Sleep restriction
Time in bed is temporarily limited to the actual sleep time, in order to increase sleep pressure. One of the most effective single measures.
Stimulus control
The bed is used only for sleeping. Anyone who cannot fall asleep gets up and only returns when tired.
Cognitive restructuring
Unhelpful thoughts about sleep are identified and changed (e.g. "I absolutely have to sleep tonight, or I won't get through tomorrow").
Relaxation techniques
E.g. progressive muscle relaxation, breathing exercises, mindfulness.
Sleep hygiene
Optimizing the sleep environment and habits.
CBT-I also available digitally
CBT-I is also available as a digital version (app/online) — but in-person therapy is preferred.¹
Sleep hygiene — the basics
Regular sleep and wake times — including at the weekend
Bedroom: dark, cool, quiet
Avoid caffeine for several hours before sleep
Alcohol is not a sleep aid — it fragments sleep
Reduce screen time before sleep
Regular exercise — but not right before bedtime
Sleep hygiene alone usually isn't enough
For chronic insomnia, sleep hygiene alone is usually not enough. The guideline recommends CBT-I as the first treatment option — not sleep hygiene alone.¹
7. Medications
Sleep medications can be useful in certain situations — usually short-term and in addition to CBT-I. The decision is always made by the treating practice.¹,³
Second lineMedication options
Z-drugs (zolpidem, zopiclone)
Work quickly and relatively briefly. With longer use there is a risk of dependence. They should usually not be stopped abruptly.
Benzodiazepines
For insomnia they are usually no longer recommended as a first choice. High potential for dependence.
Sedating antidepressants
E.g. mirtazapine, trazodone, doxepin at a low dose. Can be useful for insomnia with accompanying depression.
Antihistamines (diphenhydramine, doxylamine)
Available over the counter. Can help short-term, but in the guideline they are usually not recommended as a first choice.
Herbal remedies
Valerian, hops, passionflower — the evidence is limited. They may be experienced individually as well tolerated for mild sleep disorders.
Do not stop sleep medications abruptly
Z-drugs and benzodiazepines should not be stopped on your own or abruptly — rebound insomnia and withdrawal symptoms are possible. Gradual tapering is done together with the treating practice. More: Stopping medications.
8. Melatonin
Melatonin is a hormone produced by the body that controls the sleep-wake rhythm.¹
Can be useful for jet lag, shift work or a disturbed sleep-wake rhythm
For classic insomnia, the efficacy is rather moderate according to studies
Prolonged-release melatonin is prescription-only in Germany; low-dose melatonin is freely available as a dietary supplement — quality and dosage vary
Sleep diary: helps to spot patterns. It is also very helpful for medical assessment.
Medication check: many medications can disturb sleep. A look at the medication plan is worthwhile. More: Drug interactions.
Exercise: regular physical activity can improve sleep quality.
Alcohol: worsens sleep quality (fragmented sleep, less deep sleep). More: Medications and alcohol.
How brite helps you with sleep disorders
CBT-I as first line, sleep medications only short-term — the biggest challenge with insomnia is often not starting therapy, but the controlled discontinuation of sleep medications. brite helps you manage both steps cleanly.
Medication reminder — mirtazapine or trazodone at the right time in the evening, prolonged-release melatonin one to two hours before sleep, Z-drugs only short-term: brite reminds you on time and helps you not extend the use uncontrollably. Set up a reminder
Interaction check — sleep medications + antidepressants, + painkillers, + alcohol can dangerously amplify respiratory depression. In older people, sedating substances increase the risk of falls. brite shows the critical combinations right away. Check now
Health history — document sleep quality, time to fall asleep, night-time waking and daytime well-being over time — essentially a digital sleep diary that makes diagnosis and treatment adjustment easier at the sleep-medicine or family-doctor practice. Track your history
Digital medication plan — all your medications clearly laid out for your family doctor and sleep medicine. Sleep-disrupting medications (beta blockers, corticosteroids, thyroid hormones, some antidepressants) recognizable at a glance — the most common overlooked cause of insomnia. Go to medication plan
The optimal sleep duration is individual. For most adults, seven to eight hours is usually given as a guide value — but what matters is how rested you feel, not the exact number of hours.
CBT-I is a specialized short-term therapy that specifically addresses the causes of sleep disorders. It is offered by psychotherapists, sleep physicians and as a digital version. Access is usually via your family doctor.¹
Usually not as a sole therapy. Z-drugs and benzodiazepines are designed for short-term use. The guideline recommends CBT-I as the first treatment option.¹,³
Melatonin can be helpful for jet lag or a disturbed sleep-wake rhythm. For classic insomnia, the efficacy is rather moderate according to studies.
No. Alcohol shortens the time to fall asleep but worsens overall sleep quality: fragmented sleep, less deep sleep, earlier waking.
When sleep disorders persist for several weeks and impair everyday life, or when there are signs of another cause (snoring, pauses in breathing, restless legs, depression).
Yes — including certain antidepressants, beta blockers, corticosteroids, thyroid hormones. If you suspect this, speak to your doctor — there are often alternatives.
According to current knowledge, the evidence for herbal remedies is limited. They may be experienced individually as well tolerated for mild sleep disorders, but they usually do not replace guideline-based therapy.
Spiegelhalder K, Riemann D et al. S3-Leitlinie Insomnie. Somnologie 2025. awmf.org
Deutsche Gesellschaft für Schlafforschung und Schlafmedizin (DGSM). dgsm.de
Medical disclaimer: This article is for general information and does not replace medical advice, diagnosis or treatment. Sleep medications should not be stopped on your own. If there are signs of sleep apnoea (snoring, pauses in breathing, pronounced daytime sleepiness), a sleep-medicine evaluation should be carried out. The choice of medication and the dosage are always determined individually by the treating practice. Last updated: April 2026.
