In the film Fight Club, the main character says, “when you have insomnia, you’re never really asleep, and you’re never really awake.” This will be a familiar sentiment to anyone who has wrangled with the same problem.
Insomnia makes you feel dreadful. Night times become tortured. Sleep can feel shallow and fragmented. Waking hours feel like wading through treacle.
Good sleep is essential for our health and emotional wellbeing, so for the one in ten adults who suffer from insomnia, the condition is a real cause for concern.
Poor sleep has been linked to higher levels of inflammation, impaired immune system functioning and accelerated ageing of the brain.
Insomnia also doubles the risk of developing depression, and makes high blood pressure, heart disease and diabetes more likely.
If that wasn’t bad enough, a study of more than 15,000 people published in journal Sleep in 2022 found that adults with insomnia symptoms had a higher risk of dying from any cause over a 14-year follow-up period than those without symptoms.
When memory and concentration flag, many are forced to take time off work. So, the effects of insomnia aren’t just personal – they’re also economic.
In the UK, more than 200,000 working days are lost each year to insufficient sleep, at a cost to the economy of around £34bn (approx. $46bn), according to a 2023 report from the research organisation RAND.
In the US, the equivalent figure is more than $100bn according to 2025 estimates.
Meanwhile, insomnia is becoming more common – so much so that an entire industry has grown around it, promoting everything from apps and digital sleep trackers to pillows, supplements, and teas.
Many of these have no proven evidence base, leaving already-exhausted people vulnerable to misinformation and snake oil ‘solutions’.
Yet in recent years, there has been a quiet breakthrough in our understanding of insomnia. Researchers now have a far better grasp of what drives it, and crucially, which treatments actually work.
From proven behavioural therapies to more surprising lines of enquiry – think yawning and gut microbes – science is uncovering new ways not just to ease insomnia, but to help all of us sleep better.
What is insomnia?
Insomnia is more than just having a few bad nights’ sleep. The condition is diagnosed when the issues occur for at least three nights per week, for three months or more, and make daytime waking miserable.
It can involve problems falling asleep, staying asleep and waking up early.
For a long time, insomnia was misunderstood. Sleeplessness was seen as a pharmacological problem to be treated with drugs. Opiates, barbiturates and benzodiazepines have all been used as treatments.
But while they helped to knock people out, they were also highly addictive. Even the better medications available today, like zopiclone (also known as Z drugs), have their own set of possible side effects, such as feeling sleepy the next day and an increased risk of falls.
Another (rather sizeable) issue was that until 2013, insomnia didn’t formally exist. People slept badly and went to their doctors for help, but insomnia had yet to be recognised as a distinct clinical entity.
Doctors presumed that sleeplessness was a secondary symptom of other disorders, such as depression or pain. Treatment focused on the ‘primary’ condition, and insomnia was expected to resolve on its own. Only often, it didn’t.
The paradigm shift occurred in the 1980s. Clinicians started to realise that sleeplessness is a problem in its own right, and studies emerged showing that behavioural interventions work.
Prof Colin Espie from the University of Oxford was at the forefront of this research.
In one of his studies, for example, Espie showed that when insomniacs who had been referred by their doctors were coaxed to change their patterns of thought and behaviour around going to sleep, sleep came more easily.
A group of methods, known as Cognitive Behavioural Therapy for Insomnia (CBT-I), began to emerge. More on the specifics later, but study after study using CBT-I arrived at the same conclusion: the treatments are successful.
“It was the start of a new era,” Espie says.
Slowly but surely, people began to realise that sleeplessness has less to do with pharmacology and more to do with behaviour.
Now CBT-I is the first line of treatment for anyone who suffers from insomnia, with clinical guidelines concluding that it is more effective than drugs.
Classically, the techniques are delivered by trained professionals, one-to-one over a period of months, but we can all learn from their techniques.
Try to stay awake
The first thing to learn from CBT-I is that you can’t make yourself go to sleep. “Sleep isn’t a performative thing,” Espie says.
Imagine a football stadium full of people. A sponsor offers a million pounds to the person who can fall asleep first. “Suddenly you have a group of people who are perfectly normal sleepers who can’t get to sleep,” says Espie.
In order to drop off, we need the rituals and habits that enable sleep to be put in place.
People with insomnia often spend many hours awake in bed, worrying, scrolling or trying to force sleep. Then, when they can’t sleep, they come to associate their bed and their bedroom as a place of anxious wakefulness.
This drives an unhelpful self-fulfilling prophecy, where the fear of not sleeping activates the fight or flight response. Levels of stress hormones, such as cortisol and noradrenaline, increase and the body responds by staying awake.
This leaks into the day, creating an ongoing state of chronic hyperarousal.
Often, one of the first things that people do when they can’t sleep is try to go to bed earlier and stay in bed longer. Big mistake. Although it may seem counterintuitive, in the early stages of treating insomnia, sleep restriction is your friend.
Adenosine is a signalling molecule that builds up in your brain as you stay awake, ultimately creating a drive to sleep.
During sleep, your brain clears this adenosine, allowing you to feel refreshed in the morning. (Caffeine binds to and blocks adenosine receptors, which is why it keeps you awake).
It takes most adults around 16 hours to build up enough adenosine to generate the drive to sleep, and around eight hours of sleep to clear it.
During CBT-I, insomniacs are often persuaded to stay up later and get up earlier. You might be advised, for example, to go to bed at 1am and get up at 7am.
“A few days later, when you get the first night of being so shattered – bam, you’re out in two seconds. Then you’re out like a light for six hours,” says sleep therapist and researcher Kirsty Vant from Royal Holloway, University of London.
Then gradually, bedtime gets brought forward, and people find that they fall asleep faster and spend more of the time that they are in bed asleep.
Sleep improves when people change their behaviour, and the unhelpful association linking ‘bed’ and ‘wakefulness’ starts to fade.
Another way to improve sleep is by using a CBT-I method called ‘stimulus control’. The rule here is to use your bed for sleep and intimacy only. If you’re doing anything else, get out of the bedroom.
In a large 2024 study, combining the outcomes from 11 different trials, stimulus control was found to increase total sleep time and decrease the time taken to fall asleep.
“I also advise the quarter-of-an-hour rule,” Vant says. “If you spend more than 15 minutes trying to get to sleep, get up and do something else until you feel sleepy.”
Up to 80 per cent of those who try CBT-I find their symptoms improve, and up to 50 per cent experience full remission. Due to a lack of therapists, however, the treatment can be hard to access.
“Even if we started training people in earnest tomorrow, we’d still never meet patient demand,” says Dr Ian Woods, UK medical director at Big Health, the digital mental health company co-founded by Espie.
When Espie realised the potential of CBT-I, he started to develop an app-based digital treatment called Sleepio and launched Big Health to help get it off the ground.
Now, Sleepio has been evaluated in over 16 published randomised controlled trials comprising more than 8,400 participants, where it outperformed sleeping pills and placebo treatments. It’s one of the few sleep apps that’s grounded in peer-reviewed science.
The studies led Sleepio to become the first digital insomnia treatment to be approved by NICE (the UK’s National Institute for Health and Care Excellence).
Since then, Sleepio has been available without the need for a prescription or referral in Scotland for over three years, where more than 70,000 patients have used it.
“It’s a real mental health success story,” Woods says. “There will always be a place for in-person CBT-I,” he adds, “but we believe in a stepped care model.”
For those struggling with sleep, the app could be the first port of call, with additional face-to-face treatment as needed. Plans are now afoot to roll out Sleepio to England too.
CBT-I demonstrates the benefits of modifying sleep-related behaviours, but Espie wonders if another, more unusual approach could help those with insomnia too…
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Yawning as therapy?
Yawning is both curious and ubiquitous. We often yawn when we feel sleepy and sometimes yawn when we wake up. No one knows exactly why we do it, but this suggests that yawning may play a role in regulating arousal.
Yawning is also self-perpetuating: once you start, it can be hard to stop. And, it turns out, it could help us with our sleep.
In 2025, Espie wrote a paper for the Journal of Sleep Research called ‘Yawning as Therapy?’ in which he suggested that deliberate yawning might help to treat insomnia.
Yawning is something that we naturally associate with sleep. “It’s a reassuring cue that you have a developing drive to sleep,” he says.
The idea is that if a person is struggling to sleep, they can learn to produce a yawn. Then another one. Then more yawns come all by themselves, and because the brain strongly associates yawning with snoozing, a descent into sleep soon follows.
Espie hopes to organise a citizen science study to test this idea, but in the meantime, he has already tried it out on himself.
“I don’t suffer from insomnia,” he prefixes, “but I have tried yawning when I wake in the night and want to get back to sleep. You only have to yawn once or twice, then you find it comes every minute, and then you just kind of want to abandon wakefulness.”
The hypothesis that deliberate yawning can be used to promote sleep in insomniacs can easily be tested in clinical trials, but in the meantime, there’s nothing to stop you from trying this at home.
The sleep-gut connection
Another interesting area of research concerns the gut microbiome – the vast community of trillions of bacteria, viruses and other microorganisms that live inside our digestive tract, mainly in the large intestine.
Gut bacteria help us by digesting dietary fibre, which releases energy that we can use, and by making nutrients, such as vitamin K and folate.
But an imbalance of the microbiome has been linked to many health conditions, including depression, obesity, inflammatory bowel disease, type 2 diabetes and heart disease. And – you guessed it – insomnia.
Studies of people who suffer from insomnia show that the makeup of their gut bacteria is different from that of regular sleepers.
In a recent review (including 53 previous observational studies and involving 7,497 people with sleep conditions and 9,165 healthy controls), researchers found that the gut microbiomes of people with sleep problems were less diverse, with fewer bacterial species overall.
In people with insomnia, there was also a reduction in the abundance of anti-inflammatory bacteria, such as Faecalibacterium, and an increase of pro-inflammatory bacteria, such as Collinsella.
This shows us there is a link between insomnia and the microbiome, but it doesn’t tell us in which direction the link goes. Does sleep disruption cause changes to the microbiome, or does a disordered microbiome lead to sleep disruption?
The answer is both. “Evidence suggests that this is a bidirectional relationship,” says Dr Katherine Maki, who studies sleep and the microbiome at the National Institutes of Health, in the US.
Maki has shown, for example, that when rats have fragmented sleep, their blood pressure goes up and they develop unhelpful changes in the microbiome. These are very similar to the changes that have been documented in sleep-deprived people.
Meanwhile, researchers in China have transplanted gut microbes taken from people with insomnia into mice and found that the rodents develop insomnia-like behaviours.
They also have lower levels of butyrate, a molecule produced by certain gut bacteria, which provides cells with energy and weakens inflammation.
Now, clinical trials are underway to see if deliberately altering gut bacteria can ease insomnia.
In one study at the Sleep Disorder Centre at Brisbane’s Prince Charles Hospital, in Australia, 50 patients with chronic insomnia were treated with a carefully chosen combination of live, beneficial bacteria strains.
According to preliminary results, this improved the quality and quantity of sleep for some patients.
So, if you’re struggling to nod off, one of the best things you can try – aside from following CBT-I-related advice – is to look after your gut. “There’s no downside to this,” Maki says. “When you think of risks versus benefits, it’s only ever helpful.”
Feed the good bacteria with the fibre that they need to thrive, and you may just find that sleep comes more easily.
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