Sleep Disorders and Insomnia:
Causes, Treatment & What Really Helps

1. What is insomnia?

Insomnia (sleeplessness) means that you cannot fall asleep or stay asleep despite adequate opportunity to sleep, and feel impaired during the day as a result. Occasional bad nights are normal. It becomes a problem when sleep difficulties persist over weeks or months and noticeably affect daily life.^¹

Insomnia is one of the most common complaints in primary care. Women are affected more often than men, and prevalence tends to increase with age. Many people accept sleep problems as inevitable, even though effective treatments are available.^¹,²

2. Forms of sleep disorders

• Difficulty falling asleep: falling asleep regularly takes excessively long — often due to rumination, tension or hyperarousal at bedtime.
• Difficulty staying asleep: repeated awakenings at night with difficulty returning to sleep. Often the most distressing form.
• Early morning awakening: waking much earlier than desired without being able to fall back asleep. Can also be a symptom of depression.
• Acute vs. chronic insomnia: acute insomnia is often situational and usually resolves on its own. Chronic insomnia persists for months and often becomes self-perpetuating.

3. Symptoms and consequences

At night

• Lying awake for long periods despite tiredness
• Frequent awakenings — often with difficulty falling back asleep
• Rumination and racing thoughts in bed

During the day

• Tiredness and exhaustion
• Concentration problems and reduced performance
• Irritability, mood swings
• Increased risk of errors and accidents

Long-term consequences

• Increased risk of depression and anxiety disorders
• Increased cardiovascular risk (high blood pressure)
• Increased risk of obesity and type 2 diabetes

4. Causes

Sleep problems typically do not have a single cause.^¹

• Psychological factors: stress, worry, ruminative tendency, depression, anxiety disorders. Mental health conditions and insomnia often reinforce each other.
• Unhelpful sleep habits: irregular sleep times, too much time in bed, screen use before bed, evening caffeine.
• Physical conditions: pain, heartburn, hyperthyroidism, heart failure, frequent urination at night.
• Other sleep disorders: sleep apnoea, restless legs syndrome — should be ruled out.
• Medications and substances: many medications can disrupt sleep — including some antidepressants, beta-blockers, corticosteroids, thyroid hormones. Caffeine, alcohol and nicotine are common sleep disruptors.^¹
• Life stages: menopause, shift work and jet lag can trigger or worsen sleep problems.

5. Diagnosis

Diagnosis is typically based on history.^¹

• Sleep history: sleep onset, awakenings, sleep duration, daytime functioning. A sleep diary over one to two weeks is very helpful.
• Questionnaires: standardised tools (e.g. Insomnia Severity Index) can quantify severity.
• Excluding other causes: physical and mental conditions, other sleep disorders and sleep-disrupting medications should be assessed.
• Sleep lab: typically only when sleep apnoea or restless legs syndrome is suspected — not routinely for insomnia.

6. Treatment: CBT-I & sleep hygiene

Current guidelines (NICE CKS Insomnia, AASM, German DGSM 2025) are clear: cognitive behavioural therapy for insomnia (CBT-I) should be offered to all affected adults as the first-line option — including those with comorbid physical or mental conditions.^¹,³

Sleep hygiene — the basics

• Regular sleep and wake times — also at weekends
• Bedroom: dark, cool, quiet
• Avoid caffeine for several hours before sleep
• Alcohol is not a sleep aid — it fragments sleep
• Reduce screen time before bed
• Regular exercise — but not directly before bedtime

7. Medications

Sleep medications can be useful in certain situations — typically short-term and as an adjunct to CBT-I. The decision is always made by the treating practice.^¹,³

8. Melatonin

Melatonin is an endogenous hormone that regulates the sleep-wake cycle.^¹

• Can be useful for jet lag, shift work or disrupted sleep-wake rhythm
• For classic insomnia, evidence of effectiveness is rather moderate
• Prolonged-release melatonin is prescription-only in many countries; low-dose melatonin is available as a supplement in some markets — quality and dosing vary

9. Daily life with sleep disorders

• Sleep diary: helps identify patterns and is also very helpful for medical assessment.
• Medication review: many medications can disrupt sleep. A look at the medication list is worthwhile.
• Exercise: regular physical activity can improve sleep quality.
• Alcohol: worsens sleep quality (fragmented sleep, less deep sleep).

How brite helps you with sleep disorders

CBT-I as first line, sleep medications only short-term — the biggest challenge in insomnia is often not starting treatment but controlled tapering of sleep medications. brite helps run both steps cleanly.

• Intake reminder — mirtazapine or trazodone in the evening at the right time, prolonged-release melatonin one to two hours before sleep, Z-drugs only short-term: brite reminds you on time and helps prevent uncontrolled extension of use.
• Drug interaction check — sleep medications + antidepressants, + opioid painkillers, + alcohol can dangerously increase respiratory depression. In older adults, sedating drugs raise fall risk. brite shows the critical combinations immediately.
• Health journal — track sleep quality, sleep onset, night-time awakenings and daytime functioning over time — essentially a digital sleep diary that supports diagnosis and treatment adjustment in the sleep medicine or GP practice.
• Digital medication plan — all medications clearly organised for GP and sleep medicine. Sleep-disrupting medications (beta-blockers, corticosteroids, thyroid hormones, some antidepressants) visible at a glance — the most commonly missed cause of insomnia.

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