Insomnia and poor sleep

What it is

Sleep needs two things to line up: a sufficient drive to sleep, built up across the waking day, and a nervous system quiet enough to let go. Most insomnia is a failure of the second rather than the first, which is why lying there exhausted and wide awake is such a common experience.

Pain is the other major thread and it runs both ways. Pain fragments sleep, and short sleep measurably lowers pain thresholds the next day, so a sore back and a bad night reinforce each other until something interrupts the loop.

What it feels like

• Lying awake for a long time at the start of the night, with a mind that will not slow
• Waking at three or four in the morning and not getting back off
• Sleeping the hours but waking unrefreshed
• Dreading bedtime, and clock-watching once in bed
• Daytime fogginess, irritability and a shorter fuse than usual

What causes it

Most people have more than one of these at once, and they feed each other. Read the list looking for the two or three that sound like your week rather than for the one true answer — the ones that describe you are the ones worth acting on.

High evening arousal

Sympathetic tone stays up - from work, from screens, from worry, from a late intense workout - and sleep onset needs it to come down. This is the mechanism behind most tired-but-wired nights.

An irregular body clock

Wake times that vary by hours, late lie-ins at weekends, and little morning daylight all leave the circadian signal weak and poorly timed, so the sleep window drifts.

Pain waking you

Musculoskeletal pain is one of the commonest causes of fragmented sleep, and reduced sleep then lowers the pain threshold the following day. The loop is well documented and it is where exercise makes a double difference.

Caffeine, later than you think

Caffeine has a half life of around five hours in most people and much longer in some. An afternoon coffee is still measurably present at bedtime for a great many people who believe it does not affect them.

Alcohol as a sleep aid

Alcohol shortens sleep onset and then wrecks the second half of the night - suppressed REM, fragmented sleep and early waking as it is metabolised. It is the most commonly self-prescribed and most counterproductive sleep drug.

Time in bed not spent asleep

Long stretches lying awake teach the brain that bed is a place for being awake in. This conditioning is the core of chronic insomnia and it is precisely what sleep restriction therapy unpicks.

Screens and light at night

Evening light delays melatonin, and the content is usually arousing as well as bright. The effect is real though smaller than commonly claimed - the stimulation often matters more than the wavelength.

Menopause, and hormonal change generally

Night sweats and falling oestrogen disrupt sleep substantially. It is one of the most common reasons for new insomnia in midlife women and it is frequently treated as unrelated stress.

Sleep apnoea and restless legs

Both fragment sleep without the person knowing why. Snoring plus daytime sleepiness, or an irresistible urge to move the legs in the evening, are specific enough to be worth investigating rather than managing at home.

Worry about sleep itself

Once sleep becomes the thing being monitored, the monitoring itself is arousing. This is why the harder someone tries to sleep, the worse it gets - the effort is the opposite of the state required.

Who tends to get it

• Anyone in a stressful or high-workload period
• People with chronic pain of any kind
• Women in the perimenopausal transition
• Shift workers and anyone with a highly irregular schedule
• Older adults, in whom sleep becomes lighter and more fragmented with age

What makes it worse, and what settles it

The qFIT routine for this

Ready-made routineSleep & Wind-Down

qFIT already has this one built. It runs massage first, then stretching, then strength — the order that works on a body that is already sore — and every activity in it carries the reason it is there.

The button below opens your Checklist with this routine already selected, so instead of your whole list you land on just its Categories, Targets and Exercises, each with its checkbox, ready to tick as you work through them.

Have more than one problem? Tick yours under My Problems on My Profile and your Checklist's Routine list gains Recommended for my problems — every routine for the problems you picked, merged into one. Your picks stay private; that filter is the only thing they feed.

Get it checked if…

Loud snoring with witnessed pauses points at sleep apnea - see the Snoring and obstructive sleep apnea entry

And whatever the body part: chest pain or unusual breathlessness on exertion; a fever alongside the pain; unexplained weight loss; pain that is constant and unrelated to how you move; new numbness, weakness or loss of bladder or bowel control; or one calf that is swollen, warm and painful. Any of those, stop and get assessed.

How it usually goes

Exercise-driven improvement is real but gradual - most trials show meaningful change over four to twelve weeks rather than in the first week, which is worth knowing so you do not conclude it failed after two nights. Chronic insomnia responds best to cognitive behavioural therapy for insomnia, which outperforms sleeping tablets in the long run and is worth asking about. Loud snoring with daytime sleepiness, or unrefreshing sleep despite adequate hours, should be assessed rather than self-managed.

Prevalence basis: Population sleep surveys across high-income countries

Others the same routine covers

These share the Sleep & Wind-Down routine, so the work is the same. If one of them also sounds like you, that is a reason to expect more from it, not less.

This is general information, not a diagnosis, and it cannot examine you. If it matches you, use it to ask better questions of a clinician rather than to replace one.