Non-hormonal causes

For information on non-hormonal causes of insomnia see NICE CKS guidance. Some examples include:

NATURAL AGEING:

• The circadian system and sleep homeostatic mechanisms become less robust with normal ageing.
• Total sleep time, sleep efficiency, and deep sleep decrease with ageing and the number of nocturnal awakenings and time spent awake during the night increase.

HEALTH CONDITIONS AND MEDICATIONS:

• Medical disorders such as COPD, heart failure, neurodegenerative diseases, malignancy, musculoskeletal conditions and chronic pain.
• Psychiatric conditions such as PTSD, depression and anxiety.
• Primary sleep disorders, this includes insomnia disorder, obstructive sleep apnoea, sleep-disordered breathing and restless legs syndrome.
• Prescribable medications such as corticosteroids and SSRIs.
• Polypharmacy.
• Over the counter medications, including analgesics that contain caffeine.

PSYCHOSOCIAL AND LIFESTYLE:

• Stressful events such as work concerns, exams, bereavement, loneliness, worries about children or elderly relatives, changes in employment, financial difficulties.
• Jet lag and shift work.
• Caring for young children that wake at night.
• Caffeine intake. Caffeine is an adenosine antagonist with a highly variable half-life between 2 to 10 hours. Adenosine is a substance that promotes sleepiness.
• Alcohol. While alcohol is initially sedating, this effect disappears after a few hours, resulting in a fragmented and disturbed sleep in the second half of the night.
• Substance misuse.
• Poor sleep hygiene (temperature, noise and light exposure). A cooler room makes it easier to fall and stay asleep.

For a list of medications associated with insomnia, download below:

MEDICATIONS THAT CAN DISTURB SLEEP (1).docx

Note: less common causes exist outside of this list.