Skip to main content
HomeSpecialistsBusinessBlogContact us
العربيةFor care providersBook a session
Skip to article text

Insomnia: why sleep is difficult and how it’s treated

Fahad AlmalikMedical review: Tatmeen team11 min read
سرير ووسادة من نسيج أزرق وبيج، وفوقهما ساعات قماشية في دوائر حلزونية تتصل بخيوط متشابكة.
Article contents
  1. What can cause insomnia or too little sleep?
  2. What can you try to improve sleep?
  3. Sleep difficulties in women: what may be different?
  4. Is insomnia dangerous?
  5. When should you seek a medical assessment?
  6. How is chronic insomnia treated?
  7. Frequently Asked Questions
  8. Sources and references
  9. Writer and reviewer

You may reach the end of an exhausting day, get into bed, and still be unable to sleep. Or you may fall asleep quickly, then wake repeatedly or too early and struggle to get back to sleep.

Insomnia means difficulty sleeping despite having enough time1 and suitable conditions for sleep, with an effect during the day, such as tiredness, poor concentration or irritability. Too little sleep can also happen because work, late nights or caring for a child leave you too little time to sleep2.

If insomnia keeps recurring and affects your day, you may need assessment and targeted treatment10 rather than more sleep rules. Cognitive behavioural therapy for insomnia, or CBT-I, is usually the first treatment option for chronic insomnia11. It addresses what keeps the difficulty going, with a plan adapted to your health and circumstances.

In this article: first steps for better sleep · sleep difficulties in women · treatment for chronic insomnia.

What can cause insomnia or too little sleep?

Insomnia may begin with work pressure, a family problem or a change in your schedule. Sometimes worry about sleep remains after the original pressure has eased: you watch the clock and count the hours until morning, making bedtime another source of tension3.

Other factors are worth considering: late caffeine or nicotine3, changing sleep times, and uncomfortable light, noise or temperature in the bedroom. Pain, some medicines, and conditions such as anxiety, depression or an overactive thyroid can also make sleep difficult. If the problem began after starting a medicine or changing its dose, tell your doctor or pharmacist4 so they can review it with you.

If you go to bed late and get up early for work, or caregiving repeatedly wakes you, you may have too little opportunity to sleep2 in the first place. Making more time for sleep or getting help with care becomes part of the solution. Limited opportunity and insomnia can occur together1: sleep may remain difficult even on a night when you have time to rest.

A consistently late sleep pattern5, with difficulty waking at the required time, is another possibility. If you sleep more easily when you can go to sleep and wake later, your body clock may need assessment6. That observation alone does not establish a diagnosis, but it is a reason to describe your sleep times on workdays and days off when seeking help.

Before trying every sleep tip at once, start with what you notice. What changed before the problem began? What actually wakes you? Are there circumstances that make some nights better or worse?

What can you try to improve sleep?

If the difficulty is recent, start with changes that fit your circumstances:

  • Keep your waking time reasonably consistent where possible. Go to bed when you feel sleepy. Shift work or overnight care may require a plan that accommodates those commitments.
  • Review late caffeine. Coffee, tea and energy drinks contain caffeine. Try leaving at least six hours between your last caffeinated drink and your intended bedtime, and notice your response. Avoid nicotine close to bedtime too.
  • Reduce what keeps you alert before bed. This might be work or prolonged scrolling. Leave time for a quiet activity you enjoy, such as reading a few pages, and make the bedroom dark, quiet and a comfortable temperature as far as you can.
  • If you are awake in bed for a long time, take a quiet break. If getting up is safe for you, move somewhere comfortable with dim lighting4 and return when you feel sleepy. You do not need to keep checking the clock10.

These steps can help, but may not be enough to treat chronic insomnia. If you are already following them without improvement, the next step may be assessment and more targeted treatment11, rather than a longer list of sleep rules.

Sleep difficulties in women: what may be different?

Hormonal changes can affect sleep3 at some stages of life, but they do not explain every sleep problem. Stress, schedules, medicines and health conditions still matter. The appropriate response depends on what is disrupting sleep.

During pregnancy

You may wake often to use the toilet7 or find it difficult to get comfortable, especially later in pregnancy. If sleep difficulties are troubling you, discuss them with the doctor or midwife following your pregnancy. Mention any persistent sadness or loss of interest as well.

After giving birth

Caring for your baby may leave you without enough uninterrupted time to sleep. Specific help with baby care and household tasks can create time to rest, and may be more useful than tips that are difficult to follow at this stage.

If sleep remains difficult even when your baby is asleep or someone else is caring for them, mention it at a follow-up appointment, especially alongside persistent sadness, severe anxiety or loss of interest. These symptoms deserve assessment; sleep difficulty alone does not establish postpartum depression8.

If you develop sudden or severe confusion, or hear or see things that are not there after giving birth, seek medical help immediately at a hospital emergency department. Ask a trusted person to help if they are available and can do so safely, but do not wait to find someone to accompany you. Do not drive yourself. If you are alone or cannot get there safely, call the ambulance service in Saudi Arabia on 99725.

During perimenopause and after menopause

Hot flushes or night sweats9 may wake you, and you may find it difficult to fall asleep again. Tell your doctor what happens when you wake, so these symptoms can be assessed alongside insomnia. Sleep difficulties at this stage are not always due to menopause, and persistent insomnia may need treatment of its own.

Is insomnia dangerous?

Recurring insomnia can affect concentration, mood and your ability to carry out everyday tasks. Chronic insomnia is also associated with physical and mental health problems. This does not mean every bad night will lead to illness; the pattern and its effect on you matter more than the hours slept on one night. If too little sleep leaves you sleepy, the risk of an accident needs immediate attention: do not drive when you are sleepy12.

When should you seek a medical assessment?

Book an appointment if sleep is affecting your concentration1, work or mood, or the problem keeps recurring and suitable changes have not helped. A family doctor can review your sleep4, medicines and associated symptoms, and decide whether you need a sleep specialist or mental health care.

Insomnia is generally considered chronic when it occurs at least three nights a week for three months or longer, with an effect during the day. This is a diagnostic time threshold1, not a period you must wait before asking for help.

Tell the doctor particularly if you notice:

  • Loud snoring with pauses in breathing or choking during sleep, reported by you or someone sleeping nearby. This may require assessment for sleep apnoea13.
  • An uncomfortable feeling in your legs with an urge to move them, worse while resting in the evening14 or at night. This may indicate a different problem that is disrupting sleep.
  • Daytime sleepiness that is difficult to resist, particularly if it is severe or recurrent4.

If you start sleeping very little and feel that you do not need sleep, together with unusual energy or impulsivity15 and racing thoughts, seek an urgent medical assessment23. This differs from insomnia that leaves you exhausted and wanting to sleep. The number of hours alone cannot establish what is happening.

Contact your doctor or treatment team now and follow the help-seeking plan agreed with them, if you have one. If you have no treatment contact or cannot reach them, seek assessment through an urgent medical service. In Saudi Arabia, while you can remain safe, 937 can provide medical consultation and guidance24 on where to seek care. If you cannot arrange an urgent assessment, go to a hospital emergency department23.

If there is current danger, you cannot keep yourself or someone with you safe, or sudden confusion develops, seek emergency help immediately. Do not drive yourself. If you cannot get there safely, call the ambulance service on 997. Do not delay emergency help26 while waiting for a returned call or someone to accompany you.

What might help you prepare for the appointment?

You can keep brief notes for a week or two16 about approximate sleep and waking times, night-time waking, naps, caffeine and how you feel during the day. Bring the names of your medicines and supplements, and say when the problem began. Estimates are enough: you do not need a smartwatch or to measure every minute. Do not delay the appointment to finish a record.

How is chronic insomnia treated?

Treatment involves assessing what contributes to the problem and treating insomnia itself when it persists. Cognitive behavioural therapy for insomnia, or CBT-I, is usually the first treatment option for chronic insomnia. It uses a plan specifically for sleep11 that goes beyond general advice10.

With a trained provider, you work on reducing worry about sleep and changing habits that keep you awake in bed, so that bed becomes associated with sleep rather than waiting and tension. The plan may include adjusting the time you spend in bed while monitoring your sleep and response. This needs to take your health and circumstances into account: do not start reducing your time in bed17 on your own.

CBT-I can be delivered in person or remotely11 by someone trained in it. It involves practice between sessions and monitoring changes in sleep and daytime functioning. You should not expect one session to resolve the problem.

Will you need sleep medicine?

A doctor may suggest medicine based on your symptoms, health, other medicines and preferences. In some circumstances, they may combine it with behavioural treatment18.

Ask about the expected benefits, side effects, duration, and the plan for follow-up or stopping. Medicines differ: some are used for a short period10 and others may be used longer under supervision. Do not start a sleeping medicine, change its dose or stop it on your own.

What about melatonin?

Melatonin is not a general solution for every sleep difficulty. It may have a role in some sleep-timing problems, and recommendations for insomnia vary17 by age and formulation19. Discuss with a doctor whether it is appropriate for your particular problem, especially during pregnancy or breastfeeding, or if you take other medicines. The word “natural” is not enough to establish safety or benefit20.

How can you choose suitable help?

If insomnia persists, ask when arranging treatment: “Do you provide cognitive behavioural therapy specifically for insomnia? What does it involve?” Discuss how the plan will fit your work, responsibilities and health. These details help you understand what the treatment offers and what you will need to practise between sessions.

Frequently Asked Questions

What is insomnia, and what causes it?

Insomnia means difficulty sleeping despite having enough time and suitable conditions for sleep, with an effect during the day. It may begin with work pressure, a family problem or a schedule change, and worry about sleep sometimes remains after that pressure eases. Late caffeine or nicotine, pain, some medicines, and conditions such as anxiety or depression can play a part. Too little sleep can also happen because work, late nights or caring for a child leave too little time.

How can I sleep better with insomnia?

Keep your waking time reasonably consistent where possible, and go to bed when you feel sleepy. Try leaving at least six hours between your last caffeinated drink and bedtime, and avoid nicotine close to bedtime. If you are awake in bed for a long time and getting up is safe for you, move somewhere comfortable with dim lighting and return when you feel sleepy. If these steps do not help, you may need assessment and more targeted treatment.

When should I see a doctor about insomnia?

Book an appointment if sleep is affecting your concentration, work or mood, or the problem keeps recurring and suitable changes have not helped. You can start with a family doctor. Insomnia is generally considered chronic at least three nights a week for three months or longer, but this is a diagnostic threshold, not a period you must wait. Also mention loud snoring with pauses in breathing, an urge to move your legs, or daytime sleepiness that is difficult to resist.

How is chronic insomnia treated?

Cognitive behavioural therapy for insomnia, or CBT-I, is usually the first treatment option for chronic insomnia. With a trained provider, you work on reducing worry about sleep and changing habits that keep you awake in bed. It can be delivered in person or remotely. A doctor may suggest medicine based on your symptoms and health, and in some circumstances combine it with behavioural treatment. Do not start a sleeping medicine, change its dose or stop it on your own.

Does melatonin help with insomnia?

Melatonin is not a general solution for every sleep difficulty. It may have a role in some sleep-timing problems, and recommendations for insomnia vary by age and formulation. Discuss with a doctor whether it suits your particular problem, especially during pregnancy or breastfeeding, or if you take other medicines. The word “natural” is not enough to establish safety or benefit.

Writing and article review

Fahad AlmalikWritten byFahad Almalik

Content writer and researcher at Tatmeen, writing in Arabic and English about mental health and everyday life, from relationships and stress to work, habits, and family.

Tatmeen teamMedical reviewTatmeen team

Every Tatmeen article is reviewed by care providers licensed by the Saudi Commission for Health Specialties, so what you read is accurate and trustworthy.

How we write and reviewSpotted an error? Tell us

This article builds understanding and does not replace a licensed care provider.

Need someone to talk to?

Tatmeen's licensed care providers are available around the clock, and the app's urgent consultation connects you with one within minutes.

Talk to a care provider

In immediate danger?

If you or someone you know is in danger, call an ambulance on 997 or go to the nearest emergency department.

Emergency numbers

Was this article helpful?

Add us to Google
All articles

Talk to a care provider

Your session, remotely and your way: voice, video or text.

  • Licensed by the Saudi Commission for Health Specialties
  • Available around the clock
  • Complete privacy and confidentiality
All care providers

One step for you, start now

Download Tatmeen to explore care providers and booking options.

  • Smart matchingFour quick questions suggest the right care provider
  • Urgent consultationTalk to an available care provider within minutes
  • Free psychological measuresMore than 20 tests to understand how you are doing

Scan to download