Insomnia: causes, what helps and when to see a doctor
Trouble falling asleep, waking at night and daytime fatigue: understand insomnia, practical sleep changes, assessment and treatment options including CBT-I.
You feel tired in the evening, but once you lie down, sleep does not come. Or you fall asleep easily and then spend part of the night awake. Insomnia can take either form. Finding a way forward means looking at how often it happens, what accompanies it and how it affects the following day.
What helps with insomnia? A regular routine and changes to sleep habits are a useful starting point. If the problem persists or significantly affects your life, discuss it with a doctor. For chronic insomnia, the recommended first treatment is cognitive behavioural therapy for insomnia, or CBT-I. General sleep tips alone do not replace this treatment.
How to recognise insomnia
Insomnia means difficulty sleeping even when you have enough time and suitable conditions for sleep. You may struggle to fall asleep, wake repeatedly and find it hard to get back to sleep, or wake too early in the morning. Daytime effects can include fatigue, irritability and difficulty concentrating.
One bad night does not mean you have a chronic disorder. Key criteria include difficulties at least three nights a week for at least three months, together with an impact on daytime functioning. A doctor considers these alongside the wider picture. Three months is not a waiting period before you can seek help.
Sleeping too little because your schedule leaves too little time for sleep is a different situation. It also deserves attention, but the solution may differ from treatment for insomnia.
Causes of insomnia: what can disturb sleep?
Sometimes the problem starts after a stressful event. In other cases, several factors contribute. Looking for patterns is more useful than assuming there must be one explanation.
| Possible contributor | What to notice |
|---|---|
| Stress, anxiety or low mood | Whether worries return at bedtime and whether emotional difficulties also affect the day. |
| Shifts, travel and an irregular schedule | How bedtime and waking time differ between workdays and days off. |
| Caffeine, nicotine and alcohol | What you use and when, including energy drinks or alcohol taken to help you sleep. |
| Pain, hormonal changes and other health problems | Whether a particular symptom wakes you, such as pain or hot flushes. |
| Medicines and other sleep disorders | Whether the problem followed a change in treatment or comes with snoring or restless legs. |
This table cannot establish a diagnosis. Use it to prepare specific information for your doctor; do not change prescribed treatment yourself if you suspect a side effect.
Waking up at night: when another sleep disorder may be involved
Night waking can be part of insomnia, but accompanying symptoms matter. Loud snoring, witnessed pauses in breathing or waking up gasping can suggest sleep apnoea. Discuss these with a doctor, especially if you are very sleepy during the day. Snoring alone does not establish the diagnosis.
If you wake repeatedly, record what accompanies the waking. A description such as “pain wakes me” or “my partner noticed pauses in my breathing” is more useful for assessment than the time on the clock alone.
How to fall asleep: changes to your everyday routine
Choose changes you can keep up over the coming days. Your evening does not need to become a test of whether you have followed every rule perfectly.
- Keep a regular getting-up time. Where your schedule allows, get up at a similar time on weekends too. Go to bed when you feel sleepy.
- Move caffeine earlier in the day. Its effects can last for many hours. Remember tea, cola and energy drinks as well as coffee.
- Avoid using alcohol as a sleep aid. It can make falling asleep easier but disrupt sleep later in the night. Nicotine can also affect sleep.
- Make time to wind down. Dim the lights, put work aside and reduce phone use before bed. Keep your bedroom quiet, dark and comfortably cool.
- Include daylight and movement in your day. Long or late naps can make it harder to fall asleep at night. If you nap, notice how it affects the night that follows.
If you work nights or rotating shifts, “get up at the same time every day” may not be realistic. Discuss your actual work pattern with a doctor if sleep problems persist.
What if you are already in bed and cannot sleep?
If you have been awake for a while and are becoming tense, you can get out of bed and do something quiet in dim light. Return when you feel sleepy. Avoid working or repeatedly checking the time; there is no need to measure every minute you spend awake.
These habits may support sleep, but limited improvement does not mean you are not trying hard enough. Persistent insomnia may need targeted treatment.
When to see a doctor about insomnia
Book an appointment if poor sleep lasts for several weeks, keeps recurring or makes work, concentration or daily life difficult. Seek help sooner if the impact is substantial. You do not need to try every supplement or reach the three-month threshold for chronic insomnia first.
Tell the doctor about significant anxiety, mood changes, pain and any pauses in breathing during sleep. Do not drive when you feel sleepy. If you are falling asleep unintentionally during the day, discuss what to do next with a doctor promptly.
What happens at an insomnia assessment?
In Czechia, a general practitioner is a practical starting point. The consultation focuses on sleep, your health and the products you take. The findings guide further tests or referral to specialist care.
A sleep diary covering one to two weeks can help. Simple notes are enough:
- when you go to bed and get up;
- roughly how long falling asleep takes and how long you are awake overnight;
- naps and daytime sleepiness;
- the timing of caffeine, alcohol and any medicines or supplements.
Bring a medicines and supplements list too. For other practical arrangements, see our doctor's appointment checklist.
Do I need a sleep laboratory test?
Not everyone does. Insomnia is usually assessed mainly through the clinical interview and sleep diary. An overnight sleep study may be appropriate when another sleep disorder is suspected or difficulties have not responded to treatment. Blood tests are also selected according to the clinical concern rather than ordered as a standard package for everyone.
Treating chronic insomnia: what is CBT-I?
Cognitive behavioural therapy for insomnia addresses habits and thoughts that keep the problem going. With a trained professional, you work on issues such as worrying about another sleepless night, time spent in bed and the association between bed and prolonged wakefulness. Treatment may include relaxation methods and adjustments to your sleep schedule informed by your diary.
Therapy takes place over several sessions; clinically validated digital programmes also exist. When arranging care, ask specifically about CBT-I. An ordinary relaxation-music app is not the same treatment.
One component may involve a guided adjustment of time spent in bed. Do not use this as a reason to prescribe yourself a drastic reduction in sleep. The suitability of the approach also depends on other health conditions and risks associated with sleepiness.
Sleeping pills and melatonin: what to expect
A doctor may recommend medicine depending on the severity of the problem, previous treatment and your health. Treatment duration depends on the product; some carry a risk of dependence and next-morning drowsiness. Agree how long to take it, when it will be reviewed and how treatment will end.
If you regularly take a prescribed sleeping medicine, do not change the dose or stop it suddenly without discussing it with the prescriber. Do not combine it with alcohol.
Does melatonin help with insomnia?
Melatonin influences sleep timing, but it is not a universal answer to waking at night. The type of problem, timing of use and formulation matter. European guidance distinguishes ordinary fast-release melatonin from prolonged-release preparations, which may be appropriate for some patients aged 55 and over.
Discuss the choice with a doctor or pharmacist. Supplements can also cause side effects and interact with medicines; there is insufficient safety information on melatonin supplements during pregnancy and breastfeeding.
Need help arranging an appointment in Prague?
If you are unsure where to start, you can contact OpenMedical. We help you navigate care and coordinate an appointment with a partner provider. Briefly explain how long the problem has lasted and your preferred consultation language. The treating professional decides on assessment and treatment; availability of specific care needs to be confirmed.
This article concerns adults and provides general information. It does not replace an individual assessment or treatment plan.
Sources and editorial references
Sources checked on 2026-09-21.
- Czech National Health Information Portal (NZIP): nzip.cz
- Czech Psychiatric Association: psychiatrie.cz
- The European Insomnia Guideline (2023), Journal of Sleep Research: onlinelibrary.wiley.com
- National Health Service (NHS): nhs.uk
- National Heart, Lung, and Blood Institute (NHLBI): nhlbi.nih.gov
- National Center for Complementary and Integrative Health (NCCIH): nccih.nih.gov
