When insomnia needs seeing a doctor

Four groups of signs that warrant assessment

1. Duration and frequency

• Trouble sleeping on three nights a week or more, lasting more than two weeks.
• You have had episodes before that keep coming back.
• You have needed something to get to sleep, medication or herbal, for more than a month.

2. Your days are already affected

• Tired enough that your work is clearly suffering.
• Forgetful, unable to concentrate, making more mistakes than before.
• Irritable, with relationships around you deteriorating.
• Relying on coffee to get through the day.

3. Signs of another sleep disorder

• Loud snoring, or someone has witnessed you stop breathing.
• A restless urge to move the legs at night, relieved by walking.
• Excessive daytime sleepiness despite enough hours in bed.
• You sleep well but at entirely the wrong time.

4. Accompanied by a mood problem

Low mood, loss of interest or persistent anxiety alongside insomnia is the group that most needs seeing early. Not because it is more severe, but because treating one side while ignoring the other usually gives a half result followed by relapse.

Why earlier is easier

Short-term insomnia usually responds to two simple behavioural changes and does not yet need a full course. Once it has run for years, the coping responses have set and unpicking them takes more weeks. This is the most practical reason not to wait.

What to prepare so the consultation is worth it

1. A sleep diary, even three days of it. It gives the doctor what memory cannot.
2. A list of EVERYTHING you take: prescriptions, over-the-counter medicines, supplements, herbal teas. Many causes of insomnia sit in that list.
3. Recent test results, thyroid function and full blood count above all.
4. Information from whoever sleeps next to you: do you snore, do you stop breathing, do your legs move a lot. Patients almost never know these things themselves.
5. Three questions you want to ask, written down. It is very easy to forget once you are in the room.

What the consultation will ask about

Knowing in advance helps you prepare, and it also helps you recognise whether a consultation was thorough enough. A proper insomnia consultation reconstructs a typical night by the clock, asks about daytime consequences, rules out other sleep disorders, reviews other conditions and current medication, and then assesses mood and anxiety.

If a consultation ends after ten minutes with a prescription for sleeping pills and no questions about snoring, about your legs, about your mood or about what you are taking, then the ruling-out was skipped, and that is the most common reason insomnia treatment does not work.