Insomnia treatment

What is insomnia?

Insomnia is a sleep disorder that makes it hard to fall asleep, stay asleep, or wake feeling refreshed. It's common: more than 1 in 10 people have at least mild insomnia at any given time, and it's more common in women and older people ^[1].

Most people have short bursts of poor sleep when they're stressed or worried. That's short-term insomnia, and it often settles once the stress passes ^[1]. Insomnia becomes chronic when you have trouble falling or staying asleep at least three nights a week, for at least three months, and it affects how you function during the day ^[1].

What are the symptoms of insomnia?

Night-time symptoms include ^[1]:

• taking a long time to fall asleep
• waking often during the night
• waking too early and not being able to get back to sleep
• not feeling refreshed when you wake up.

Daytime symptoms include low energy, poor memory or concentration, irritability, low mood and tension headaches ^[1].

One useful distinction: people with insomnia usually feel tired and wired, but they don't often fall asleep unintentionally during the day. If you keep nodding off when you sit still, that points to a possible problem with your breathing during sleep, such as sleep apnoea, and is worth checking ^[2].

What causes insomnia?

Sometimes there's no single clear cause. Common contributors include ^[1]:

• stress and mental health conditions, such as anxiety, depression and PTSD
• medical conditions, such as chronic pain, menopause symptoms, and breathing, bladder or digestive problems
• other sleep disorders, such as sleep apnoea and restless legs
• substances, including caffeine, alcohol, nicotine and some medicines
• body clock disruption from shift work or travel across time zones
• sleep habits, like irregular hours or long periods awake in bed.

Sleep and mental health are closely linked. In a national survey of 1,011 Australian adults, people with depression or anxiety had about 4.3 times the odds of insomnia symptoms ^[3]. If low mood or worry is part of the picture, see our pages on depression and anxiety.

Whatever starts it, insomnia often keeps going because of what happens next. Lying awake in bed night after night can train your brain to link the bed with being alert, and treatment is partly about undoing that link ^[2].

What's the first-line treatment for insomnia?

Cognitive behavioural therapy for insomnia, usually shortened to CBT-i, is the recommended first treatment for chronic insomnia. The 2023 European insomnia guideline recommends it for adults of any age, including people with other health conditions, whether it's delivered in person or online ^[4]. The American Academy of Sleep Medicine gives multicomponent CBT-i its strongest recommendation ^[5], and Australian sleep physicians recommend it as first-line therapy in general practice ^[2]. A July 2026 joint position statement from Australia's sleep, GP, psychology, pharmacy and nursing organisations agrees, and adds that it works in person, in groups, by telehealth and through self-guided digital programs ^[16].

healthdirect notes that sleeping pills are less effective than CBT and are not a cure for insomnia ^[1].

What happens in CBT-i?

CBT-i is a structured program, usually spread over several weeks, that combines a few techniques ^[2][6].

Sleep diary

You keep a simple record of when you go to bed, roughly when you fall asleep, when you wake and how you feel. It shows the real pattern and guides the rest of the program.

Stimulus control

This rebuilds the link between bed and sleep. It means keeping a regular wake-up time, going to bed only when you're sleepy, and getting up and leaving the bedroom if you can't sleep, returning when you feel sleepy again ^[2].

Sleep restriction

This sounds backwards, but it's a core part of CBT-i. You limit your time in bed to roughly match how much you're actually sleeping, which consolidates your sleep, then you gradually extend it ^[2]. In one small trial, 73% of people given sleep restriction plus sleep hygiene improved, compared with 35% given sleep hygiene alone ^[2]. It's usually done with support from a clinician or a structured program.

Cognitive work

Insomnia comes with its own thoughts: "If I don't sleep tonight, tomorrow will be a disaster." CBT-i helps you notice and challenge these worries, so they stop fuelling the problem ^[2].

Relaxation and sleep habits

Relaxation techniques, such as breathing exercises and muscle relaxation, can help settle a busy mind ^[1][5]. Sleep hygiene (caffeine, alcohol, screens, bedroom set-up) is part of the package, but the evidence says it isn't enough on its own for chronic insomnia ^[5].

A shorter version called brief behavioural therapy combines sleep restriction and stimulus control. It's suited to general practice and doesn't need specialist training ^[2].

How well does CBT-i work?

The evidence is strong. A meta-analysis of 20 randomised trials (1,162 adults with chronic insomnia) found that after face-to-face CBT-i, people fell asleep about 19 minutes faster, spent about 26 minutes less time awake during the night, and their sleep efficiency improved by about 10 percentage points ^[6]. Total sleep time changed only slightly, by about 8 minutes, which wasn't statistically significant ^[6]. The improvements seemed to last at later follow-up, and no adverse outcomes were reported ^[6].

Online CBT-i also works. A meta-analysis of 11 trials with 1,460 participants found internet-delivered CBT-i improved insomnia severity, sleep quality and time awake at night, with effects comparable to face-to-face CBT-i and generally maintained at follow-up ^[7]. Programs that ran longer and included more personal support from a clinician had bigger effects ^[7].

Can you do CBT-i online in Australia?

Yes. Two free, Australian-developed programs are available:

• THIS WAY UP Insomnia Program. Run by St Vincent's Hospital Sydney, it's free and has four online modules you work through over 90 days ^[8]. It's designed for adults whose insomnia has lasted more than three months. You can enrol yourself, or a clinician can prescribe it and monitor your progress ^[8].
• MindSpot Sleep Course. Developed by psychologists at Macquarie University and offered free through MindSpot. Clinical trials reported about a 40% improvement in sleep quality, including in people with long-term insomnia ^[9].

If you'd like more support, a psychologist can deliver CBT-i one-on-one. Medicare rebates may apply (see below).

Could it be sleep apnoea as well as insomnia?

Obstructive sleep apnoea (OSA) is when your airway repeatedly narrows or closes during sleep. It often travels with insomnia, a combination known as COMISA (co-morbid insomnia and sleep apnoea).

A meta-analysis of 37 studies found that 38% of people with OSA also had insomnia, and that 29 to 35% of people with insomnia had OSA, depending on the threshold used ^[10]. Australian sleep physicians note that up to half of people with OSA report insomnia symptoms ^[2].

Clues that it's worth checking for sleep apnoea include loud snoring, someone noticing you stop breathing, and feeling very sleepy during the day ^[2][3]. In Australia, a GP can refer you directly for a Medicare-funded sleep study if screening questionnaires show a high probability of OSA. That means an Epworth Sleepiness Scale score of 8 or more plus a positive result on a second tool such as STOP-Bang or OSA50 ^[11]. A sleep or respiratory physician reviews the results and confirms eligibility before the study goes ahead ^[11].

The good news is that CBT-i still helps. A meta-analysis of studies in people with COMISA found CBT-i produced a large improvement in insomnia severity overall, and it helped whether or not their sleep apnoea had been treated ^[12].

Where do sleeping tablets fit in insomnia treatment?

Medication has a role, but it's a supporting one. The European guideline says medication can be offered when CBT-i isn't effective enough ^[4]. It recommends ^[4]:

• benzodiazepines, z-drugs and some other options for short-term use only (4 weeks or less) in most cases
• orexin receptor antagonists for up to three months, or longer in some cases
• prolonged-release melatonin for up to three months in people 55 and over
• not using antihistamines, antipsychotics, fast-release melatonin or herbal products for insomnia.

Australia's 2026 joint position statement is similar. Medicines aren't first-line, but may be used alongside CBT-i, when CBT-i hasn't worked or isn't suitable, or for short-term insomnia with a clear trigger, such as a bereavement, that's causing significant distress or affecting day-to-day functioning. If they're used, specific benzodiazepines and z-drugs may suit up to 2 to 4 weeks, melatonin up to 13 weeks, and orexin blockers are generally for chronic insomnia. Sedating antihistamines, antidepressants, antipsychotics, cannabinoids and complementary medicines aren't recommended for insomnia ^[16].

For the full picture on over-the-counter and prescription options, including risks like dependence and falls, see our guide to sleeping tablets in Australia.

A consultation doesn't guarantee a prescription. Your GP decides what's clinically appropriate.

What Medicare-funded help is there for insomnia?

• GP care. Medicare rebates apply to GP consultations.
• Psychology sessions. Under Better Access, a mental health treatment plan gives you Medicare rebates for up to 10 individual and 10 group sessions per calendar year ^[13]. In 2021, Medicare confirmed that chronic insomnia can be treated as a mental health issue in its own right under a GP mental health treatment plan ^[14]. Since 1 November 2025, a GP plan and referral need to come from the practice where you're enrolled in MyMedicare, or from your usual GP ^[15]. Read more about the mental health care plan and Medicare psychology rebates.
• Sleep studies. Medicare covers an unattended sleep study when the referral criteria are met, once in any 12-month period ^[11].
• Free online CBT-i. THIS WAY UP and MindSpot programs cost nothing ^[8][9].

How can a GP help with insomnia?

A GP can help you work out what kind of sleep problem you have and what's driving it. That usually means:

• going through your sleep pattern, ideally with a sleep diary
• checking for sleep apnoea, restless legs, pain, menopause symptoms and other medical causes ^[1]
• looking at mood, anxiety, stress, alcohol, caffeine and medicines that may be affecting sleep ^[1]
• starting behavioural strategies, referring you to a psychologist, or pointing you to an online CBT-i program
• discussing whether short-term medication makes sense for you, and reviewing it.

If you'd like to talk to a GP about your sleep, you can request an appointment. Our GPs can refer you to a psychologist when needed. Visit our sleep page to learn more.

If you're in crisis or thinking about suicide, call Lifeline on 13 11 14 or 000 in an emergency.

This page is general information, not medical advice.