Sleep Problems and Insomnia - Finding the Cause Before Reaching for a Sleeping Pill

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The Wellness is the best place in London to have persistent sleep problems assessed properly, because insomnia is very often a symptom of something else rather than a standalone problem, and treating it as one leads straight to sleeping tablets that mask the issue without ever fixing it. Roughly a third of UK adults report symptoms of insomnia at any given time, and a large share of chronic poor sleep has an identifiable driver, obstructive sleep apnoea, restless legs from iron deficiency, an overactive thyroid, menopause, chronic pain, anxiety or depression, or simply a sleep pattern that has drifted out of sync with a natural circadian rhythm. Sleeping tablets, where they are used at all, are for short-term crisis use, because tolerance builds within weeks and dependence becomes a real problem well before most people expect it, while the treatment with the strongest and most durable evidence, cognitive behavioural therapy for insomnia, is rarely offered because it takes longer to arrange than a prescription. A proper assessment takes a structured sleep history, tests for the physical causes that are often missed, and builds a plan around the driver that is actually present rather than reaching for a tablet as the first move. Consultations from £150 by video and £220 in person, comprehensive blood panel from £495. Fees appear further down this page.

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Reviewed by the medical team at The Wellness. Last updated August 2026.

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Get your sleep assessed on WhatsApp or email team@thewellnesslondon.com or call 020 3951 3429.

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What kind of sleep problem do you actually have

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Insomnia, difficulty falling asleep, staying asleep or waking too early, is the one most people mean when they describe a sleep problem, and it becomes chronic when it happens on 3 or more nights a week for 3 months or more. But several other patterns get mistaken for it. Obstructive sleep apnoea causes repeated pauses in breathing through the night, and the person is often unaware anything is happening beyond loud snoring, waking unrefreshed and profound daytime sleepiness, which is a very different problem from difficulty falling asleep and needs an entirely different test.

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Restless legs syndrome, an irresistible urge to move the legs, worse in the evening and at rest, disrupts sleep onset and is frequently driven by low iron stores rather than being a condition in its own right. Circadian rhythm problems, where the internal clock has genuinely shifted later or earlier than the schedule a person is trying to keep, look like insomnia but respond to completely different treatment, light exposure and timing rather than medication. And non-restorative sleep, where total sleep time looks adequate but the person wakes unrefreshed, points toward sleep apnoea, chronic pain or an underlying medical cause more often than toward classic insomnia. Working out which of these is actually happening is the first and most important step, because the treatment for each is different.

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What causes chronic insomnia

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The physical causes are the ones most often missed, because a sleep problem is assumed to be psychological until proven otherwise, when the reverse approach usually serves people better. Iron deficiency drives restless legs and disrupted sleep, and is confirmed or excluded with ferritin rather than haemoglobin alone. An overactive thyroid produces insomnia alongside palpitations, weight loss and anxiety, and an underactive one disrupts sleep architecture in its own way. Menopause disrupts sleep directly through hot flushes and night sweats and independently through the hormonal changes affecting sleep architecture itself, which is why sleep problems are one of the most under-recognised perimenopausal symptoms. Chronic pain, an overactive bladder, reflux, and medications including some antidepressants, steroids and stimulants all fragment sleep.

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Obstructive sleep apnoea deserves particular attention because it is common, serious if left untreated, and routinely missed in people who do not fit the stereotype, since it is not confined to overweight, heavily snoring men and is significantly under-diagnosed in women, who present with fatigue and insomnia symptoms rather than the classic picture. Left untreated it raises the risk of high blood pressure, heart disease, stroke and type 2 diabetes, which is why identifying it matters well beyond the sleep problem itself. Anxiety and depression are genuine and common causes of insomnia and should be diagnosed and treated on their own terms rather than assumed by default, particularly once the physical causes above have been considered.

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Ask what might be causing your sleep problem on WhatsApp or email team@thewellnesslondon.com.

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What actually treats insomnia

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Cognitive behavioural therapy for insomnia is the treatment with the strongest and most durable evidence available, more effective in the long term than sleeping tablets and without the tolerance or dependence risk, and it works by addressing the thoughts and habits that sustain poor sleep, including sleep restriction therapy, stimulus control and correcting the beliefs about sleep that often make the problem worse. It is chronically underused simply because it takes more than a single appointment to arrange, and we consider it before medication rather than after it has already failed.

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Sleep hygiene measures help as a foundation rather than a complete treatment on their own, a consistent wake time every day regardless of how the night went, since wake time anchors the body clock more powerfully than bedtime, limiting caffeine from the early afternoon onward, reducing alcohol, which fragments sleep even though it can help people fall asleep initially, keeping the bedroom cool, dark and used only for sleep, and getting daylight exposure, particularly in the morning, to support the circadian rhythm. Medication has a place for short-term, defined periods, days to a couple of weeks, during acute crisis or severe short-term disruption, prescribed with a clear plan for stopping rather than an open-ended repeat.

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Where a specific cause is identified, treatment addresses that directly. CPAP or another device for confirmed sleep apnoea, iron replacement for restless legs driven by low ferritin, thyroid treatment where relevant, targeted treatment for menopausal symptoms, and treating the anxiety, depression or pain that is genuinely driving the sleep disruption. Fixing the driver resolves the sleep problem far more reliably than treating the symptom in isolation.

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When does a sleep problem need urgent or specialist assessment

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Most insomnia is investigated and managed over a matter of weeks, but a few patterns warrant more prompt attention. Witnessed pauses in breathing during sleep, particularly with loud snoring, gasping or choking, and marked daytime sleepiness that affects driving or safety at work, should be assessed for sleep apnoea without delay, because untreated moderate to severe sleep apnoea carries a real cardiovascular and safety risk. Sudden, severe insomnia in someone previously sleeping well, particularly alongside low mood, anxiety or a major life event, deserves assessment for the underlying trigger rather than simply being treated as a sleep problem.

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Excessive daytime sleepiness that persists despite adequate time in bed, or sudden muscle weakness triggered by strong emotion, raises rarer sleep disorders that need specialist assessment. And anyone already using sleeping tablets regularly for more than a few weeks, or finding they need an escalating dose to get the same effect, should be reviewed, because that pattern signals tolerance developing and is the point at which a proper plan, rather than a repeat prescription, is needed.

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What does sleep assessment cost in London

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Consultant sleep medicine or respiratory specialists in the Harley Street district run £250 to £450 for a first appointment before any test, with a home sleep study commonly costing £300 to £600 and a full in-laboratory polysomnography considerably more. Private cognitive behavioural therapy for insomnia with a specialist psychologist runs £150 to £250 a session over a course of several sessions. Comprehensive imaging and executive programmes at the top of the London market exceed £32,000. Below all of it sits a tier defined by its conditions rather than its price, a brief remote consultation that ends in a sleeping tablet prescription with no history taken of the pattern, no test for the physical causes and no plan for stopping.

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At The Wellness the assessment, the testing and the plan are 1 fee, and all figures are from prices. The Executive Health Programme, the most comprehensive assessment with full biomarker profiling and coordinated imaging, is from £11,995. The Comprehensive Blood Panel, including ferritin and iron studies, thyroid function, glucose and the relevant hormones, with consultation and interpretation, is from £495, and a Targeted Blood Panel from £295. An extended 45-minute consultation for a full sleep history and structured plan is from £395. An in-person consultation with examination in Marylebone is from £220, a same-day video consultation from £150 and telephone follow-up from £59. A home, hotel or office visit is from £495 daytime and £695 evenings and weekends. A home sleep study for suspected sleep apnoea, cognitive behavioural therapy for insomnia and referral to a named sleep specialist are arranged at specialist centres with the appointment booked.

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Same-day appointments 7 days a week in Marylebone, 3 minutes from Baker Street.

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Why The Wellness is the best place in London for sleep problems

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Because the cause is investigated before a tablet is offered. Iron studies, thyroid function and the relevant hormones are tested in the same round, sleep apnoea is considered actively rather than assumed absent, particularly in the women it is so often missed in, and the pattern, insomnia, non-restorative sleep, a circadian shift or restless legs, is correctly identified before treatment starts.

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Because the treatment with the best evidence is offered rather than skipped for being slower to arrange. Cognitive behavioural therapy for insomnia is considered before medication, sleep hygiene measures are explained properly rather than handed over as a generic leaflet, and where a sleeping tablet is genuinely appropriate it comes with a defined course and a stopping plan rather than an open repeat.

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And because the driver, once found, is actually treated. Sleep apnoea referred and managed rather than left, iron deficiency corrected, menopausal symptoms addressed, and the anxiety or pain driving poor sleep treated on its own terms. Fixing what is actually wrong, rather than sedating the symptom, is what gets sleep back on track and keeps it there.

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Book a sleep assessment on WhatsApp or call 020 3951 3429.

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Frequently asked questions

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What causes chronic insomnia

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Physical causes including iron deficiency, thyroid disease, menopause, chronic pain and undiagnosed sleep apnoea are common and often missed. Anxiety and depression are genuine causes too. A circadian rhythm that has shifted out of sync with your schedule can also look like insomnia while needing entirely different treatment.

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Is cognitive behavioural therapy really better than sleeping tablets

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For chronic insomnia, yes. It has the strongest and most durable evidence of any treatment, more effective in the long term than medication and without the tolerance or dependence risk, and it addresses the habits and thoughts that sustain poor sleep rather than sedating the symptom.

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How do I know if I have sleep apnoea rather than insomnia

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Sleep apnoea typically causes loud snoring, witnessed pauses in breathing or gasping, and waking unrefreshed with marked daytime sleepiness, which is different from the difficulty falling or staying asleep that defines insomnia. It is significantly under-diagnosed in women, who often present with fatigue rather than the classic picture, and is confirmed with a sleep study.

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Can low iron really affect my sleep

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Yes. Iron deficiency is a common and often missed cause of restless legs syndrome, an irresistible urge to move the legs that disrupts falling asleep, and it is confirmed or excluded with ferritin rather than haemoglobin alone, since haemoglobin can be normal while iron stores are already low.

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Are sleeping tablets safe to take long term

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Not generally. Tolerance builds within weeks, meaning the same dose becomes less effective, and dependence becomes a real risk well before most people expect it. They have a place for short, defined periods during acute crisis, with a clear plan for stopping, rather than as an ongoing repeat prescription.

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Can menopause cause insomnia

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Yes, both directly through hot flushes and night sweats and independently through hormonal changes affecting sleep architecture itself. It is one of the most under-recognised perimenopausal symptoms, and treating the underlying menopausal change often improves sleep more reliably than treating insomnia in isolation.

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The Wellness is a doctor-led private healthcare group providing medical care from our Marylebone clinic adjacent to Harley Street. All doctors are GMC-registered. Blood analysis is performed by accredited laboratories, and sleep studies and specialist referral are arranged at specialist centres and reported by consultants. This article is general information and not a substitute for personal medical advice. If you are in crisis, call 999 or the Samaritans on 116 123.

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Enquire now on WhatsApp or email team@thewellnesslondon.com or call 020 3951 3429.

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References. NICE Clinical Knowledge Summaries on insomnia, including guidance on cognitive behavioural therapy and the short-term, time-limited role of hypnotic medication. NICE guideline NG202 on obstructive sleep apnoea, hypopnoea and obesity hypoventilation syndrome, diagnosis and management. British Association for Psychopharmacology guidance on the evidence-based treatment of insomnia. Published prevalence data on insomnia and sleep apnoea in UK adults, including under-diagnosis of sleep apnoea in women. Published evidence on iron deficiency and restless legs syndrome. Published 2026 London private sleep medicine and cognitive behavioural therapy market pricing.