The tips with the strongest evidence for long-term insomnia come from CBT for insomnia, which you can get through your GP. For long-term insomnia, familiar sleep habits help but aren't enough on their own.
Tips that work, in brief
For long-term insomnia the strongest evidence is for CBT for insomnia, and the NHS says a GP may offer it face to face or through an online self-help programme. The one to start on your own tonight is getting up when you can't sleep and going back when you're sleepy. Relaxation is worth a go, and sleep restriction therapy is one to do with a professional. Keep the familiar sleep habits, but the US guideline suggests not relying on them alone. If it's been months, see your GP.
CBT for insomnia has the strongest evidence
Edinger and colleagues wrote the American Academy of Sleep Medicine's 2021 guideline after a task force reviewed the evidence. Its only strong recommendation for chronic insomnia in adults is multicomponent CBT for insomnia, which the NHS describes as working on the thoughts and behaviours that keep you awake. It's a US guideline for clinicians treating long-term insomnia, not a list of tips for one bad night.1
| Approach | US guideline rating | How you'd do it in the UK |
|---|
| CBT for insomnia | Strong recommendation | Through your GP, face to face or online |
|---|
| Brief versions of CBT for insomnia | Suggested | Ask your GP |
|---|
| Stimulus control (getting up when you can't sleep) | Suggested | On your own, tonight |
|---|
| Sleep restriction therapy | Suggested | With a professional, as part of CBT |
|---|
| Relaxation therapy | Suggested | On your own or with guidance |
|---|
| Sleep hygiene on its own | Suggested against, as the only treatment | Keep the habits, but don't stop there |
|---|
Get up when you can't sleep, and go back when you're sleepy
This is the part you can start tonight. The guideline suggests stimulus control on its own. NHS Every Mind Matters gives the practical version: if you're still awake after around 20 minutes, get up, sit somewhere comfortable, do something relaxing and go back to bed when you feel sleepy.2 I wouldn't turn it into a stopwatch exercise. For more help, try our guide to what to do when you can't sleep.
Relaxation and sleep restriction are worth trying, the second with help
The guideline also suggests relaxation therapy. Breathing exercises are a perfectly good excuse to put the phone down, to my mind. Try our guide to box breathing if you'd like something simple to follow while you wind down. Sleep restriction therapy is suggested too, but it's done with a professional as part of CBT. Don't try to invent your own version: this is something to work through with support.
Which approach got the US sleep guideline's only strong recommendation for long-term insomnia?
- Sleep hygiene tips
- CBT for insomnia
- Relaxation therapy on its own
CBT for insomnia was the only strong recommendation. Relaxation was suggested, and sleep hygiene was suggested against as the only treatment.
Sleep habits help, but for long-term insomnia they aren't enough on their own
The guideline suggests not using sleep hygiene alone for chronic insomnia. That doesn't make the habits useless: the NHS says insomnia usually gets better by changing your sleeping habits.3 "Sleep hygiene" sounds like homework to me, but I'd follow NHS Every Mind Matters' advice: keep a regular routine and keep screens out of the hour before bed. For more on poor sleep, try our guide to junk sleep.
If it's been months, ask your GP about CBT
The NHS says a GP will try to find out what's causing your insomnia.
See a GP if:
- changing your sleeping habits has not helped your insomnia
- you've had trouble sleeping for months
- your insomnia is affecting your daily life in a way that makes it hard for you to cope
You may be offered CBT face to face with a therapist or through an online self-help programme to change the thoughts and behaviours keeping you awake. CBT has the real evidence, and I'm glad it's free through your GP. The NHS also says GPs now rarely prescribe sleeping pills. Take a sleep diary along to help explain your nights, and use our guide to keeping a sleep diary to set one up.
Face to face or online, ask your GP about CBT for insomnia once habits alone haven't helped.
Questions people ask about sleep tips that work
For long-term insomnia, CBT for insomnia has the strongest evidence. It's the US sleep medicine guideline's only strong recommendation, and relaxation and the other approaches get weaker ones. CBT addresses the thoughts and behaviours that keep you awake. In the UK, ask your GP about it: they may offer sessions face to face or an online self-help programme.
Sleep habits help, and the NHS says changing them usually improves insomnia. The US guideline nevertheless suggests not relying on sleep hygiene alone for chronic insomnia. Keep the useful habits, but don't treat persistent insomnia as a reason to keep adding bedtime rules. If good habits haven't helped after months, ask your GP about CBT.
You can get CBT for insomnia through an online self-help programme if your GP offers it. Ask your GP which option would suit you, because face to face therapy is another route. You can start stimulus control yourself: NHS advice is to get up after around 20 minutes awake and return when sleepy. Sleep restriction therapy needs professional support as part of CBT.
