Insomnia: what may lie behind it, and what can help

Insomnia means you regularly have trouble sleeping: falling asleep, staying asleep, or waking too early and not getting back to sleep [1]. It often eases when sleep habits change, and for long-term insomnia, cognitive behavioral therapy (CBT-I) is the first choice in Swedish guidance and is also suggested by the NHS [1][2]. If it has gone on for months, talk to your vårdcentral (local primary care clinic) or 1177.

I’m a US-trained naturopath and acupuncturist in Östermalm, and sleep comes up in many first visits. Here’s what I’d like you to know before we meet, or before you see your doctor.

What insomnia looks like

You may have insomnia if you regularly [1]:

• find it hard to fall asleep
• wake several times during the night
• lie awake at night
• wake early and can’t get back to sleep
• still feel tired after a night’s sleep
• feel irritable or find it hard to concentrate during the day

1177 gives a concrete marker: if it takes you at least 45 minutes to fall asleep, that’s one sign [2]. Waking often, waking too early and feeling tired during the day are others.

Insomnia that lasts less than 3 months is called short-term insomnia. If it lasts 3 months or longer, it’s called long-term insomnia [1].

What may lie behind it

There’s rarely one cause. The NHS lists these common ones [1]:

• stress, anxiety or depression
• noise, or a bedroom that’s too hot or too cold
• an uncomfortable bed
• alcohol, caffeine or nicotine
• jet lag or shift work
• long-term pain, sleep apnea or nightmares
• health conditions such as an overactive thyroid, restless legs or menopause
• some medicines

When I go through a client’s week, it’s usually a mix: a stressful stretch at work, coffee late in the afternoon, a glass of wine to wind down, and then a 3 a.m. wake-up. If you’re in your 40s, hormones can be part of it too. I’ve written more about that in perimenopause insomnia.

Sleep habits worth trying first

None of these is new, I know. But they’re where both the NHS and 1177 start [1][2]:

• get up at the same time every day, even after a bad night
• go to bed when you feel sleepy
• wind down for an hour before bed
• keep the bedroom dark, quiet and cool, around 14–18°C [2]
• if you haven’t fallen asleep after about 15 minutes, get up and do something calm until you feel drowsy [2]
• avoid caffeine, alcohol and nicotine for 6 hours before bed [1]
• exercise during the day, but not within 4 hours of bedtime [1]
• skip daytime naps, or keep them before 15:00 and no longer than 15 minutes [2]

One tip I often give: write down for a week or two when you go to bed, when you wake, and what you ate and drank in the evening. Patterns show up quickly, and the notes are useful for your doctor too.

Insomnia treatment: what your doctor may offer

CBT-I

Cognitive behavioral therapy for insomnia (CBT-I) is the first-line recommendation for long-term sleep problems in Sweden [2]. It’s a structured program that works on the thoughts and habits that keep you awake, and it can be done face-to-face or online [1][2]. Ask your vårdcentral what they offer. Internet-based CBT is available in many regions.

The research behind it is solid. A 2015 meta-analysis of 20 randomized trials with 1,162 adults found that face-to-face CBT-I shortened the time to fall asleep by about 19 minutes and cut time awake at night by about 26 minutes [3]. The gains seemed to last, and no harms were reported. A 2019 meta-analysis of 30 trials found that the effects get smaller over time, but are still clinically meaningful up to a year after the program ends [4].

Sleeping pills

Sleeping pills are rarely the first step. 1177 says they’re meant for short periods at the lowest possible dose, and some can cause dependence [2]. The NHS says the same: they’re usually used for a few days or weeks at most, when insomnia is severe and other approaches haven’t helped [1]. Any question about starting, changing or stopping sleep medication goes to your doctor or pharmacist.

What the research says about acupuncture

I want to be honest here. A Cochrane review looked at 33 randomized trials with 2,293 people [5]. Some results pointed toward better sleep quality, and acupuncture added to other care might give a small extra benefit. But the effects were small, all the trials had a high risk of bias, and publication bias was likely. The authors concluded that the evidence is not rigorous enough to support or refute acupuncture for insomnia [5]. Side effects were rarely reported and were minor.

So the picture is uncertain. Many people tell me they feel calm and drowsy during a session, and some fall asleep on the table. I use acupuncture as one part of a plan, next to sleep habits, food and stress.

How I work with insomnia in Stockholm

I work in parallel with your doctor. If you’re doing CBT-I or taking sleep medication, the plan we make together runs in parallel.

At a first visit, I ask what a typical night looks like: when you go to bed, when you fall asleep, what wakes you, and how you feel the next morning. Then we go through the day: stress, meals, caffeine, alcohol, digestion, your cycle, and what you’ve already tried. Bring your sleep notes if you have them.

After the visit, you get a written plan. It can include:

• small changes to evenings, meals and stress
• Chinese and Western herbs
• homeopathy and supplements
• Japanese acupuncture, my main style, with thin, single-use needles and a gentle technique
• lab tests through a private lab when they add something, for example thyroid or iron

Tell me what medicines you take, and I’ll factor them in when we choose herbs and supplements.

A first visit is 60 minutes and 3,500 SEK, in person at Kommendörsgatan 9 or online, in English or Swedish. If you’d like to start with acupuncture, a first acupuncture visit is 50 minutes and 1,750 SEK. You’ll find every option on the prices page, and how a first visit works. For the wider picture, see my page on sleep and fatigue.

When to see a doctor

Contact your vårdcentral or call 1177 (Sweden’s healthcare advice line) if:

• you’ve had trouble sleeping for months [1]
• changing your sleep habits hasn’t helped [1][2]
• poor sleep makes it hard to cope with daily life [1]
• you or your partner suspect another sleep disorder, such as sleep apnea
• your low mood or anxiety doesn’t lift
• you have new, severe or unclear symptoms

Avoid driving when you feel drowsy [1]. If you have thoughts of not wanting to live, or in an emergency, call 112.

Not sure where to start? Book a free 15-minute call with me on a Tuesday between 13:00 and 14:00, or send me a message.

Sources

1. NHS. Insomnia. Page last reviewed 19 March 2024. Accessed 2026-11-09. https://www.nhs.uk/conditions/insomnia/
2. 1177. Sömnsvårigheter (in Swedish). Updated 2023-06-01. Accessed 2026-11-09. https://www.1177.se/Stockholm/liv--halsa/stresshantering-och-somn/somnsvarigheter/
3. Trauer JM, Qian MY, Doyle JS, Rajaratnam SMW, Cunnington D. Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Annals of Internal Medicine, 2015;163(3):191–204. Accessed 2026-11-09. https://europepmc.org/abstract/MED/26054060
4. van der Zweerde T, Bisdounis L, Kyle SD, Lancee J, van Straten A. Cognitive behavioral therapy for insomnia: a meta-analysis of long-term effects in controlled studies. Sleep Medicine Reviews, 2019;48:101208. Accessed 2026-11-09. https://europepmc.org/abstract/MED/31491656
5. Cheuk DKL, Yeung W-F, Chung K, Wong V. Acupuncture for insomnia. Cochrane Database of Systematic Reviews, 2022. Accessed 2026-11-09. https://www.cochrane.org/evidence/CD005472