Introduction

"Doctor, I'm exhausted."

Many people spend night after night lying awake wondering why sleep no longer comes easily. Some cannot fall asleep, while others wake in the early hours and cannot return to sleep. The answer is often more complex than people expect.

Sleep is more than closing your eyes

Insomnia is not simply getting too little sleep. It is difficulty obtaining sleep that is refreshing and restorative. Quality often matters just as much as quantity.

Sometimes insomnia is the problem. Sometimes it is the symptom.

A psychiatrist asks not only how many hours you sleep, but why your sleep has changed. Common causes include anxiety, depression, chronic stress, grief, chronic pain, sleep apnea, restless legs syndrome, caffeine, alcohol, certain medications, and irregular work schedules.

The vicious cycle of worrying about sleep

The harder people try to sleep, the more anxious they become — and the less likely sleep is to come. Breaking that cycle is an important part of treatment.

Sleeping tablets are not always the first answer

Medication can help some people, but improving sleep habits, treating any underlying condition, and Cognitive Behavioural Therapy for Insomnia (CBT-I) often provide longer-lasting benefits.

Small habits can make a big difference

Keep a regular sleep schedule, including on weekends
Avoid caffeine late in the day
Reduce screen time before bed
Keep the bedroom cool, quiet and dark
Exercise regularly, but not too close to bedtime

When should you seek help?

Seek medical advice if insomnia persists for several weeks, affects daily life, is associated with anxiety or depression, or causes severe daytime fatigue.

A final thought

Sleep is one of the foundations of physical and emotional health. Treating insomnia is rarely about forcing sleep — it is about understanding and removing the obstacles that prevent it.