Sleep Problems: Insomnia, Sleep Apnoea, Snoring and When to Get Help

A plain-English guide to the most common sleep problems in the UK, what causes them, and where each one is covered in more detail.

What normal sleep looks like

Sleep is not a single uniform state. It is a cycle of distinct stages that repeat roughly every 90 minutes, four to six times a night, and each stage does different work. Deep slow-wave sleep, concentrated in the first half of the night, is when physical restoration and memory consolidation happen. REM sleep, concentrated in the hours before waking, is when emotional processing happens.

How much sleep a person needs varies. The familiar seven-to-nine-hour figure for adults is an average, not a prescription. The practical test is how you feel and function: if you wake reasonably rested and perform well during the day, you are getting the right amount for you.

It is also normal for sleep to become lighter and more broken with age. Waking two or three times and settling again is a normal older pattern, not a disorder.

Insomnia

Insomnia is difficulty getting to sleep, staying asleep, or getting sleep that feels restorative, despite having adequate opportunity to sleep, with impaired daytime functioning. It is the most common sleep problem in the UK.

The dividing line that changes everything is three months. Short-term insomnia, usually triggered by a stressor, resolves when the trigger passes. Chronic insomnia — three months or more, three or more nights a week — becomes self-sustaining, kept going by learned behaviours and beliefs rather than the original stressor.

For chronic insomnia, the first-line treatment in UK guidance is not a tablet. It is cognitive behavioural therapy for insomnia (CBT-I), a structured programme that targets the behaviours and beliefs keeping the problem going.

Read the full guide: Insomnia: symptoms, causes and treatment.

Obstructive sleep apnoea

In obstructive sleep apnoea, the airway repeatedly narrows or closes during sleep. Breathing pauses, oxygen levels dip, and the brain briefly rouses to restart breathing. This can happen hundreds of times a night, and the person is usually unaware of it.

The cardinal symptoms are loud snoring, witnessed pauses in breathing, and heavy daytime sleepiness — nodding off at the wheel, in meetings, or in front of the television. That last symptom is what distinguishes apnoea from insomnia, where people are exhausted but paradoxically unable to nap.

Snoring

Around four in ten UK adults snore regularly. Most snoring is harmless, caused by vibration of the soft tissues at the back of the throat. But it can also be the first sign of something more significant.

Simple snoring is loud but continuous. Snoring that is loud, irregular, and accompanied by choking, gasping or witnessed pauses in breathing is different — that pattern points towards apnoea and warrants assessment.

Things that help: side sleeping, losing weight if overweight, avoiding alcohol within two hours of bed, and treating nasal congestion. Things that do not: over-the-counter nasal strips, which have weak evidence at best.

Restless legs syndrome

Restless legs syndrome produces an irresistible urge to move the legs, usually in the evening and at rest. It is often accompanied by unpleasant sensations — creeping, crawling, tingling — that are relieved briefly by movement. It is worse in the evening and when sitting still, and it can delay sleep onset and fragment the night.

It is more common than most people realise, and it is often missed. It is associated with iron deficiency, kidney disease, diabetes and pregnancy, and treating the underlying cause sometimes resolves it. Where it does not, specific medications can help.

Jet lag and shift work

Circadian rhythm problems are different from insomnia. The sleep itself is normal — it is happening at the wrong time relative to the body clock. The two main examples are jet lag, caused by rapid travel across time zones, and shift work, caused by working against the biological night.

These are not treated with sleeping tablets. They are treated by shifting the body clock: timed light exposure, timed melatonin, and careful scheduling. Melatonin for jet lag is a different product from prolonged-release melatonin for insomnia, and the two are not interchangeable.

Read the full guide: melatonin for jet lag.

Sleep hygiene that actually helps

Sleep hygiene is often oversold. On its own, it does not treat chronic insomnia. But it is genuinely useful for short-term sleep problems, and it heads off the coping strategies that turn a bad fortnight into a chronic problem.

• Fixed wake time. Get up at the same time every day, including after a bad night. This is the single most important rule, and the one people break most.
• Bed for sleep and intimacy only. No reading, television, phone or worrying in bed.
• Get up if you are awake. If you are still awake after 15 to 20 minutes, get up, do something quiet and dull in low light, and return when sleepy.
• No caffeine after midday. Its half-life means an afternoon coffee is still active at bedtime.
• Avoid alcohol within two hours of bed. It shortens sleep onset and then fragments the rest of the night.
• Get bright light in the morning. This anchors the body clock.
• Avoid daytime naps. They drain the sleep pressure you need at night.

When to seek help

Arrange an assessment if:

• Sleep problems have lasted three months or more
• There is loud snoring with choking, gasping or witnessed pauses in breathing
• You have excessive daytime sleepiness rather than fatigue — nodding off unintentionally
• There is unusual behaviour during sleep — sleepwalking, acting out dreams, night terrors
• You have been using sleeping tablets or alcohol to sleep for more than a couple of weeks
• Sleep problems are significantly affecting work, relationships, mood or safety