Insomnia

Insomnia means regularly having trouble sleeping — finding it hard to fall asleep, waking up several times during the night, lying awake, waking early and being unable to get back to sleep, or feeling tired and irritable during the day despite this. Insomnia lasting less than 3 months is short-term; lasting 3 months or longer is long-term. On average, adults need 7 to 9 hours of sleep a night, children 9 to 13 hours, and toddlers and babies 12 to 17 hours.

Common causes include stress, anxiety or depression, an uncomfortable or noisy room, alcohol, caffeine or nicotine, illegal drugs, jet lag, or shift work. It can also be caused by certain conditions and medicines, including mental health conditions, Alzheimer's or Parkinson's disease, restless legs syndrome, an overactive thyroid, or menopause, as well as things that disturb sleep such as long-term pain, sleepwalking, sleep apnoea, narcolepsy, or nightmares.

Insomnia usually improves with better sleep habits — going to bed only when sleepy, waking at the same time each day, relaxing for an hour before bed, keeping the bedroom dark and quiet, exercising regularly, and having a comfortable bed. It's best to avoid smoking or drinking alcohol, tea or coffee within 6 hours of bed, large late meals, exercising within 4 hours of bed, screens before bed, daytime napping, or driving while sleepy. A pharmacist can suggest short-term sleep aids, though these aren't a cure and shouldn't be used for more than 1 to 2 weeks.

See a GP if changing your habits hasn't helped, you've had trouble sleeping for months, or it's seriously affecting your daily life. A GP will try to identify the cause, and may offer cognitive behavioural therapy (CBT), delivered face-to-face or through an online programme, to help change the thoughts and behaviours keeping you awake. Sleeping pills are now rarely prescribed, and only for a few days or weeks at most, given the risk of side effects and dependency.

Sleep Apnoea

Sleep apnoea is when your breathing repeatedly stops and starts while you sleep — the most common type is obstructive sleep apnoea (OSA). Symptoms mainly happen during sleep, including breathing that stops and starts, gasping, snorting or choking noises, frequent waking, and loud snoring, alongside daytime tiredness, poor concentration, mood swings, or morning headaches. It can be hard to notice yourself, so it may help to ask someone to observe you sleeping.

See a GP if you have these symptoms, ideally bringing someone who's witnessed them. Left untreated, sleep apnoea can lead to high blood pressure, a higher stroke risk, type 2 diabetes, heart disease, low mood, and a higher accident risk from daytime tiredness — you may also need to tell the DVLA if you're diagnosed. If a GP suspects sleep apnoea, they may refer you to a sleep clinic for tests measuring your breathing and heart rate overnight, giving an AHI score reflecting how severe it is (mild, moderate or severe).

Treatment can include losing weight, stopping smoking, and cutting back on alcohol, though many people need a CPAP machine — a device that gently pumps air through a mask to keep the airway open overnight, available free on the NHS. Other options include a mandibular advancement device (a gum shield-like device), surgery such as removing large tonsils, facial muscle exercises, or a nerve-stimulation device, depending on the individual case.

About Iron Deficiency Anaemia

Iron deficiency anaemia happens when a lack of iron leads to fewer red blood cells, meaning tissues and organs get less oxygen than they need. It's the most common type of anaemia, often caused by blood loss or pregnancy, and is treated with iron tablets and dietary changes.

Symptoms

Common symptoms include tiredness and lack of energy, shortness of breath, noticeable heartbeats (palpitations), paler than usual skin, and headaches. Less common symptoms — not usually linked to pregnancy — include tinnitus, food tasting different, itching, a sore tongue, hair loss, unusual cravings for non-food items (pica), difficulty swallowing, mouth ulcers, spoon-shaped nails, or restless legs syndrome.

Diagnosis and Treatment

See a GP if you think you might have iron deficiency anaemia — they'll ask about your lifestyle and medical history, and arrange a full blood count blood test. If the cause isn't clear, further tests may follow, such as a stool test to check for hidden blood, or referral to a specialist. Once a cause is identified — such as an ulcer or heavy periods — treatment can be targeted, and iron tablets are usually prescribed for around 6 months if your red blood cell count is low, alongside eating more iron-rich foods like dark leafy greens, fortified cereals, meat, dried fruit and pulses, while cutting back on tea, coffee, dairy, and high-phytic-acid foods that can block iron absorption.

Common causes include heavy periods, pregnancy, and bleeding in the stomach or intestines — from NSAIDs, ulcers, bowel inflammation, piles, or occasionally cancer. Left untreated, iron deficiency anaemia can increase infection risk, and raise the risk of heart or lung complications, or pregnancy complications.

About Overactive Thyroid

An overactive thyroid, or hyperthyroidism, is when the thyroid gland — a small, butterfly-shaped gland in the neck — produces too much thyroid hormone, affecting things like heart rate and body temperature. It can affect anyone, but is around 10 times more common in women, typically appearing between ages 20 and 40.

Symptoms

Symptoms can include nervousness, anxiety and irritability, mood swings, difficulty sleeping, persistent tiredness and weakness, heat sensitivity, a swollen neck (goitre), an irregular or unusually fast heartbeat, trembling, and unintentional weight loss.

Diagnosis and Causes

See a GP if you have these symptoms — they can arrange a blood test to check thyroid function, and refer you for further tests to identify the cause if needed. The most common cause is Graves' disease, an autoimmune condition (behind around 4 in 5 cases), alongside thyroid nodules producing excess hormone, or certain medicines such as amiodarone.

Treatment

An overactive thyroid is usually treatable. Main options include medicine to reduce hormone production, radioiodine treatment (a form of radiotherapy that reduces the thyroid's activity), or surgery to remove part or all of the thyroid. You'll usually see an endocrinologist to discuss which option suits you best, since each has its own benefits and drawbacks.

Left untreated or poorly controlled, an overactive thyroid can lead to eye problems, pregnancy complications such as pre-eclampsia or premature birth, or rarely a thyroid storm — a sudden, life-threatening flare-up of symptoms.

About ME/CFS

Myalgic encephalomyelitis, also known as chronic fatigue syndrome (ME/CFS), is a long-term condition causing extreme, disabling fatigue that doesn't improve with rest and is often out of proportion to any activity done. The main feature is fatigue lasting at least 3 to 4 months, alongside a worsening of symptoms after physical, mental or emotional exertion, sometimes delayed by a day or more — known as post-exertional malaise.

Symptoms

Alongside persistent fatigue, people with ME/CFS often experience unrefreshing sleep, problems with memory and concentration (sometimes called "brain fog"), and muscle or joint pain. Other possible symptoms include headaches, sore throat or tender glands, dizziness, sensitivity to light, sound or temperature, and flu-like feelings. Symptoms vary considerably between individuals and can fluctuate over time, with periods of relative stability interrupted by flare-ups or relapses.

Getting Diagnosed

There's no single test for ME/CFS — a GP will assess your symptoms and their pattern over time, and usually arrange blood tests to rule out other possible causes of fatigue, such as anaemia, an underactive or overactive thyroid, or other underlying conditions. Diagnosis can take time, since it depends on ruling out other explanations rather than a specific confirmatory test.

Management and Support

There's currently no cure for ME/CFS, but various approaches can help manage symptoms and improve quality of life. This can include support from a specialist ME/CFS team where available, careful activity and energy management (sometimes called pacing) to avoid triggering post-exertional malaise, support with sleep, and treatment for any related symptoms such as pain or low mood. Many people find that learning to understand their own individual triggers and limits is a central part of managing the condition day to day. Recovery and improvement vary considerably between individuals — some people improve significantly over time, while others continue to live with fluctuating symptoms long-term.

Self-Care

When to See a GP

See a GP if you've felt tired for a few weeks and aren't sure why, if tiredness is affecting your daily life, or if you're tired alongside other symptoms such as weight loss or mood changes, or you've been told you make gasping, snorting or choking noises while asleep.

Treatment

Treatment for tiredness or fatigue depends on the underlying cause. Possible approaches include talking therapies such as cognitive behavioural therapy (CBT), advice on improving your sleep, or guidance on relaxation and lifestyle changes. If a GP isn't sure what's causing your tiredness, they may refer you to a specialist, and you may need tests such as blood tests to check for anaemia, diabetes, or an overactive thyroid.