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Chronic insomnia

Insomnia chronica · Chronická nespavost

What it is

Trouble sleeping three nights a week for three months with daytime harm.

Symptoms & signs

  • Trouble falling or staying asleep
  • early waking
  • daytime fatigue
  • irritability
  • poor concentration

🚩 Get help if…

  • call 112 / 911 now Thoughts of suicide or self-harm
  • see a doctor soon Falling asleep while driving
  • see a doctor soon Loud snoring with pauses in breathing
  • see a doctor soon Low mood, panic or racing thoughts most days

Where it strikes

Medical treatment

  • CBT for insomnia first, not tablets — as good in the short run and better after it stops trials support
  • Dual orexin antagonists mixed evidence
  • Z-drugs beyond a few weeks — tolerance, night falls and rebound insomnia not confirmed in trials
  • Treating the apnoea, pain or depression underneath trials support
  • Digital CBT-I apps (Somryst, SleepioRx) — FDA-cleared 2020 and 2023

Natural & lifestyle

  • Fixed wake time
  • no screens or alcohol before bed
  • cool dark room
  • caffeine cut-off 8 h before bed
  • morning daylight
  • exercise
  • stimulus control

Emerging & experimental

  • Temperature-controlled mattresses
  • closed-loop acoustic stimulation of deep sleep

Alternative, off-label & anecdotal

Approaches used outside the guidelines, with what their supporters report and what testing has found so far.

  • Melatonin — small benefit for falling asleep mixed evidence
  • Valerian — trials disagree mixed evidence
  • Acupuncture — trials disagree mixed evidence
  • Magnesium and tart cherry juice — small trials early / small studies
  • Homeopathic sleep remedies — no plausible mechanism; untested in good trials anecdotal / traditional

ICD codes