Chronic insomnia affects around 1 in 10 UK adults and significantly impacts work, mood, relationships, and physical health. NHS sleep services are limited and waiting lists are long. Our approach is structured: identify the cause, address contributing factors, and use evidence-based treatments — including CBT for insomnia where appropriate.
Educational information — not a substitute for clinical assessment
This page describes insomnia and sleep disorders in general terms to help you decide whether assessment may be helpful. It is not a diagnostic tool. If you recognise yourself in what follows, please book a consultation.
Insomnia is the persistent difficulty initiating sleep, maintaining sleep, or experiencing restorative sleep, despite adequate opportunity for sleep, causing daytime impairment.
Insomnia is considered:
Insomnia is not defined by hours slept — some people thrive on 6 hours, others need 9. The key is whether sleep is satisfying and whether the person functions adequately in the day.
of UK adults have chronic insomnia. Many have never had proper assessment beyond "try sleep hygiene." Most can be helped significantly.
Difficulty falling asleep at the start of the night. Often associated with anxiety, racing thoughts, or restless legs.
Waking during the night and difficulty returning to sleep. Often associated with stress, mood disorders, perimenopause, sleep apnoea, restless legs, or alcohol.
Waking 1–3 hours before intended and unable to return to sleep. Strongly associated with depression.
Adequate sleep duration but waking unrefreshed. Often associated with sleep apnoea, ME/CFS, fibromyalgia.
Insomnia usually has multiple contributing factors. Identifying yours is the first step.
Many chronic insomnia patients have developed habits that perpetuate the problem — spending excessive time in bed trying to sleep, daytime napping to compensate, anxiety about not sleeping. Breaking this cycle is central to CBT-I treatment.
Obstructive sleep apnoea (OSA) is one of the most under-diagnosed sleep conditions. Key features:
Risk factors: male sex, increasing age, obesity, large neck circumference, jaw structure, family history. Women, particularly post-menopausal, are commonly missed. We routinely screen for sleep apnoea in patients with relevant symptoms or risk factors — using validated questionnaires (STOP-BANG, Epworth) and referring for home sleep studies where indicated.
Treated sleep apnoea transforms daytime alertness, mood, blood pressure, and cardiovascular risk.
Sleep pattern, onset and pattern of difficulty, daytime impact, mood, stress, medications, substances, partner’s observations (snoring, pauses, restlessness), prior treatments tried, what worsens or improves things.
Where helpful, we ask for a 2-week sleep diary to understand patterns. This often reveals things the patient hasn’t noticed.
Including neck size, BMI, blood pressure, oropharyngeal anatomy (Mallampati score for sleep apnoea screening).
Written plan based on findings — specific treatment for any identified conditions, behavioural approaches, CBT-I where appropriate, medication discussion if needed.
The most important step. Treating perimenopause, thyroid disease, sleep apnoea, restless legs, depression, anxiety, or pain typically transforms sleep without specific insomnia treatment.
First-line treatment for chronic insomnia per NICE and international guidelines. More effective long-term than medication. See dedicated section below.
Foundational but not sufficient alone for chronic insomnia. See section below.
Medication may be appropriate for short-term use in acute insomnia or for chronic insomnia where CBT-I isn’t available, isn’t effective, or as an adjunct. Several classes exist with different evidence bases, side effects, and dependency risks. Specific choices are discussed in consultation, considering risk-benefit balance and your preferences. UK law prevents naming specific medications on this website.
CPAP (continuous positive airway pressure) is the gold standard treatment for moderate-severe sleep apnoea. Mandibular advancement devices, positional therapy, or surgery are alternatives in selected cases. We refer for sleep medicine specialist input.
Iron replacement (RLS is often associated with low ferritin), avoiding triggers, and specific medication where needed.
CBT-I is the most effective long-term treatment for chronic insomnia. Components typically include:
CBT-I is typically delivered over 4–8 sessions. Available through our psychology team. Digital CBT-I (NICE TA922) is also an option and can be effective for some.
Foundational measures — necessary but rarely sufficient on their own:
Consider booking if:
Reasonable for acute insomnia (e.g. bereavement, severe acute stress). Generally limited to 2–4 weeks because of tolerance and dependency. We discuss appropriate use.
Often yes, with a structured tapering plan and often alongside CBT-I. We can support this safely.
Melatonin is effective for some circadian rhythm issues (jet lag, shift work) and modestly helpful for some older adults. For typical adult insomnia, evidence is mixed. Available on prescription in the UK; over-the-counter melatonin imported from abroad is unregulated.
Digital CBT-I is NICE-recommended (TA922) and effective for many. Sleepio is one well-evidenced option. May be a starting point or full treatment depending on severity.
Many patients notice improvement within 2–4 weeks. Full benefit usually by 8 weeks. Outlasts medication effects long-term.
Many UK PMI policies cover therapy sessions; coverage varies. We provide procedure codes.
Some patients find CBD helpful; evidence is limited. THC (recreational cannabis) often worsens sleep quality despite easier onset. Discuss with us if you’re considering or using.
For women in their 40s and 50s, perimenopause is a very common cause of new sleep difficulty. We assess this and treatment of perimenopausal symptoms often transforms sleep (see perimenopause page).
Care at MHW Clinic is delivered by a small clinical team, with Dr Haydar Bolat as Clinical Director. The specific clinicians involved in your care depend on the plan agreed with you at consultation.
UK-registered GP and Clinical Director at MHW. Conducts insomnia assessments including history, examination, sleep apnoea screening, and treatment planning. Refers to sleep specialists for sleep studies and to MHW psychology team for CBT-I.
View profileLanguages spoken across the team: English, Turkish, Bulgarian, Bengali, Hindi, Albanian, Azerbaijani, German, Romanian. We can also arrange professional telephone interpreters in most other languages at no extra cost. More on languages and interpreters →
This page was reviewed by Dr Haydar Bolat, Clinical Director at MHW Clinic. Content is based on NICE Clinical Knowledge Summaries on insomnia, NICE TA922 (digital CBT-I), and current UK clinical practice and current UK clinical practice. It is updated when guidance changes. Educational information only — not a substitute for clinical assessment.
Poor sleep undermines almost everything else. Book a longer consultation to identify what would actually help you sleep better.