Insomnia & Sleep Problems in Ireland — Practical Guide

Insomnia — when is sleep difficulty a clinical problem?

Insomnia is persistent difficulty falling asleep, staying asleep, or non-restorative sleep — with daytime functional impact. Chronic insomnia is defined as symptoms at least 3 nights a week for 3+ months per NICE CKS. It affects around 1 in 10 adults in Ireland chronically, with many more experiencing transient sleep problems. Importantly: brief sleep disruption during stressful periods is normal — it does not require treatment beyond patience.

Common causes and contributors

• Lifestyle: irregular sleep schedule, late screen use, caffeine, alcohol, evening exercise
• Stress and worry — particularly bedtime worry
• Mental health — anxiety and depression frequently coexist with insomnia
• Physical conditions — chronic pain, hot flushes (menopause), GORD, BPH, restless legs
• Medications — some antidepressants, decongestants, steroids, beta-agonists
• Underlying sleep disorder — sleep apnoea (snoring, witnessed apnoeas, daytime sleepiness), parasomnias

First-line treatment — CBT-I, not sleeping pills

Cognitive Behavioural Therapy for Insomnia is recommended as first-line treatment for chronic insomnia per NICE, the American Academy of Sleep Medicine, and the European Sleep Research Society. CBT-I is more effective than sleeping pills in the long term and has no side effects or dependency risk.

CBT-I is a structured 4–8 session intervention combining: sleep restriction (initially counter-intuitive — compressing time in bed to match actual sleep, then expanding — but very effective), stimulus control (the bed is for sleep only — get up if you cannot sleep), cognitive techniques for worry and unhelpful sleep-related thinking, and relaxation training. Access in Ireland:

• Online programmes (Sleepio, SHUTi) — effective and convenient; some available through workplace EAPs
• Private CBT-I therapists
• HSE Counselling in Primary Care (general CBT, which includes insomnia management)

Sleep hygiene — necessary but rarely sufficient on its own

Sleep hygiene is foundational but generally does not, on its own, fix established insomnia. Still — these are worth getting right:

• Regular wake-up time — the single most important sleep-hygiene principle; protect this even at weekends
• Use the bed only for sleep and intimacy — not work, scrolling, TV
• Avoid caffeine after midday — half-life around 5 hours
• Avoid alcohol within 3 hours of bed — sedates initially but worsens sleep quality
• Wind down 30–60 minutes before bed; avoid screens or use blue-light filters
• Keep the bedroom cool, dark, and quiet
• If you cannot sleep within 20 minutes, get up briefly and do something dull, then return to bed
• Get bright light early in the day — anchors your circadian rhythm

Sleeping tablets — when, and the cautions

"Z-drugs" (zopiclone, zolpidem) and benzodiazepines (diazepam, temazepam) are reserved for short-term use during specific situations per NICE and HPRA. Risks of chronic use include tolerance (decreasing effect), dependence (physical and psychological), rebound insomnia on stopping, daytime sedation, falls (especially in older adults), and cognitive impairment.

For chronic insomnia, the right answer is almost never long-term sleeping pills — it is CBT-I and addressing the underlying drivers. Short courses (typically up to 2 weeks) during acute crises (bereavement, severe illness) can be appropriate. Melatonin has a modest role and is licensed for adults 55+ as Circadin (slow-release).

When in-person review is appropriate

• Snoring with daytime sleepiness or witnessed pauses in breathing — suspect sleep apnoea (needs sleep-clinic referral)
• Restless legs causing significant nighttime distress
• Significant depression with sleep disturbance
• Suspected narcolepsy (severe daytime sleepiness, sleep attacks)
• No improvement after 6–12 months of appropriate management

The Online Doctor consultation

An insomnia consultation covers: structured sleep history (using validated tools like the Insomnia Severity Index), assessment of contributing factors, screening for sleep apnoea, recommendations for CBT-I and lifestyle, and short-term medication where genuinely appropriate. The aim is sustained restoration of sleep — not just a few nights of relief.