It usually starts with one bad week. A deadline, an illness in the family or a row that never resolved, and sleep goes. The stress eases, but the nights do not come back with it. By week 6 the worry is no longer the deadline; it is the bed itself.
The question people bring is how to get sleep back without making things worse. This is the sort of insomnia private GP time is genuinely useful for: recent, tied to a cause, and not yet set hard into a habit. It deserves a plan built on causes, not a quick fix.
If you are at immediate risk of harming yourself or someone else, call 999 or go to A&E. For urgent mental health help, call NHS 111 and choose the mental health option, or call Samaritans free on 116 123, any hour.
What do I look at when stress has stopped you sleeping?
I start with the shape of the night, because different patterns point in different directions. Lying awake for an hour or two before sleep usually goes with a mind that will not switch off. Waking at 3 or 4am and being unable to drop back can go with low mood, and I ask about that more carefully. Broken sleep with several wakings sends me looking for something physical.
I usually ask people to keep a sleep diary for 2 weeks: bedtime, roughly how long it took to fall asleep, wakings, the time you got up, naps, caffeine and alcohol. The pattern matters more than any single night. A diary often shows what memory smooths over, such as weekend lie ins that quietly undo the week.
Then the stress itself. What started it, whether it is still going on, and what sits underneath. It is worth saying plainly that money is often behind the sleeplessness, or caring for someone, or a job that has crept into the evenings. I ask about these directly, because a plan that ignores the cause tends to work for a fortnight and then fade.
Mood and anxiety come next. Whether worry runs at night in particular, whether there are panic symptoms on waking, whether enjoyment has gone out of things, whether appetite has changed. I ask plainly about thoughts of self harm. Insomnia and low mood feed each other, and it matters which came first.
I check for physical causes alongside all of this. Pain that wakes you, needing to pass urine at night, heartburn when lying flat, night sweats or hot flushes around the menopause, an overactive thyroid, restless legs, and loud snoring with pauses in breathing that a partner has noticed. Some treatments for other conditions disturb sleep too, which is why I ask for a list of everything you take, including remedies bought over the counter.
I also ask about the day, not only the night: light, exercise, meal times, screens late in the evening, and shift patterns. Shift work deserves a mention of its own, because rotating shifts make a fixed wake time impossible, and the plan then has to be adapted rather than abandoned.
Then the habits that keep insomnia going once the original stress has passed. Lying in bed for hours trying harder, watching the clock, the phone in bed, going to bed early to make up for lost sleep, long naps, caffeine late in the day, and the glass of wine that helps you drop off and then wakes you at 3am. None of these is a failing. They are what anyone does when they are tired, and they happen to keep the problem alive.
The plan is built from what the assessment finds. For stress related insomnia it usually starts with a small number of rules kept every day, weekends included:
- the same wake time every morning, whatever the night was like
- bed only when sleepy, not simply because it is late
- if you are awake for what feels like 20 minutes, get up, do something dull in dim light, and go back when sleepy
- a wind down hour before bed, with worries written down earlier in the evening rather than rehearsed in bed
- daylight in the morning, caffeine finished by lunchtime, and alcohol cut back
These steps are the core of a structured approach often called cognitive behavioural therapy for insomnia, and it is usually where I start. The first week or two can feel harder before it feels better, and I say so in advance. If the plan is not enough on its own, there are treatment options, which we discuss in clinic, limits included. I usually suggest we look again in 2 to 3 weeks.
What I will not do is promise a full night's sleep by next week. Sleep that took 2 months to unravel usually takes a few weeks of steady effort to come back, and it comes back unevenly. A bad night in week 3 is not a sign the plan has failed.
When should sleeplessness be seen sooner?
Most stress related insomnia is not dangerous, but some patterns should not wait. See a doctor sooner, or use the crisis lines above, if:
- you have thoughts of harming yourself, or the nights have become a time of hopelessness
- you are sleeping far less than usual but feel unusually energetic, driven or full of ideas
- you have fallen asleep while driving, or nearly have, or a partner has seen you stop breathing in your sleep
- there are drenching night sweats, weight loss, or breathlessness when you lie flat
- you are relying on alcohol to get to sleep
- nightmares or flashbacks began after a frightening event
If you are sleepy enough during the day to worry about driving, please do not drive until you have been assessed.
For the appointment, bring the sleep diary, a list of everything you take, and if possible a partner's description of your nights. It is surprising how often the snoring or the restless legs are news to the person who has them.
How do we approach insomnia at Clinique Alpa?
A clinic appointment at 466 Green Lanes is 30 minutes for £100. You can see me there, and that time is the point. Insomnia needs a proper history, and a proper history takes longer than a few minutes. If you would rather talk from home and nothing needs examining, a video consultation is 30 minutes for £79.99, currently with Dr Alpa J. Morawala.
With your consent, a summary goes to your NHS GP. This is private care alongside the NHS, never a replacement for it. If anxiety turns out to be the larger problem, my piece on private anxiety treatment explains how we approach it, and if work is at the root of it, the piece on burnout or depression may be worth reading next.
Written by Dr Mitesh Parmar, MBBS MRCGP, Principal GP and Clinical Director at Clinique Alpa, 466 Green Lanes, Palmers Green, London N13 5PA. This article is general information, not personal medical advice. In an emergency call 999. For NHS advice call 111 or visit nhs.uk.