Insomnia (Sleeplessness): Good Night and Sweet Dream?

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asian woman having insomnia

Insomnia is the most common sleep disorder describing the situation in which one suffers from sleeplessness. Patients with insomnia can’t fall asleep or sleep as well as they would like to. Poor sleeping and lack of rest may lead to poor energy levels and even serious complications. Want to stay away from sleeplessness and have a good night? Read our ultimate guide to learn more about insomnia!

Insomnia Meaning: What is Insomnia?

Insomnia is a sleep disorder in which the patients cannot obtain adequate quality sleep as they cannot fall asleep readily, cannot stay asleep for enough periods, or cannot get deep sleep. The body fails to recover from daily workload, causing a lower energy level, defected work performance and poor quality of life. As a result, insomnia may undermine one’s mental, physical and social health at the same time. Insomnia can be transient, acute and chronic.

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Causes of Insomnia

Insomnia is caused when one is excessively aroused physically or mentally, leading to the inability to fall asleep, stay asleep, or enter deep sleep for an adequate period. The following causes may lead to such hyperarousal:

  • Concomitant diseases or conditions: Several conditions may lead to insomnia, for example, sleep apnea, mental disorders, hyperthyroidism, brain lesions, severe acute pain and chronic pain, heart failure, asthma, chronic obstructive pulmonary diseases (COPD), overactive bladder, nocturnal polyuria, depression, anxiety, etc.
  • Medications or substance abuse: Caffeine, medications like amphetamines, bronchodilators, nicotine, diet pills or addictive substances like ethanol and ketamines may also block us from adequate quality sleep.
  • Hormone shift: For example, there is a higher chance for women to suffer from insomnia due to premenstrual syndrome or perimenopause.
  • Conditions that disrupt circadian rhythm: For example, jet lags and shift duty may cause one to have a disrupted circadian rhythm, disturbing the natural internal clock and sleep-wake cycle, resulting in the inability to sleep well.
  • Other causes include traumas, genetic factors, poor sleep hygiene, life crisis events, environmental changes, temperature, sleep partner’s causing arousal, excessive LED/blue wave from electronic devices usage before sleep.

Risk Factors of Insomnia

Other than the above causes, numerous risk factors may indirectly give rise to a higher risk of insomnia, including:

  • Sex: Females are more likely to suffer from insomnia as a result of hormone shifts pre-menstruation, during menopause and pregnancy.
  • Age: Those above 60 years of age will encounter a change in circadian rhythm and health conditions which give rise to insomnia more easily.
  • Race: Studies have indicated that black people are more likely to suffer from insomnia, for instance, African Americans, indigenous Australians and Afro-Latinos, etc. 
  • Stressful lifestyle: Those with a stressful life are more likely to suffer from insomnia due to psychological factors.

Signs and Symptoms of Insomnia

Common signs and symptoms of insomnia are basically all related to the lack of sleep, including:

  • Poor sleeping quality: It happens when one cannot reach “deep sleep”. Sleep is classified into “light sleep” and “deep sleep” with 5 different stages of a single sleep cycle. One could only achieve “deep sleep” when stages 3 to 5 of a sleep cycle are successfully reached and sustained. If one wakes up before reaching stage 3 during a sleep cycle, only “light sleep” is attained and the sleep quality is not optimized compared to “deep sleep”. In insomniac patients, “deep sleep” cannot be achieved, hence leading to other symptoms of insomnia.
  • Inability to fall asleep
  • Broken sleep: Wake up earlier than desired
  • Inability to stay asleep
  • Sleepiness during daytime and sleep anxiety at night time
  • Fatigue, lethargy and headache
  • Mental problems: They include irritability, depression, anxiety and impulsivity and are detrimental to mental and social health. They occur owing to the lack of quality sleep.
  • A lack of concentration and attention: Such drawbacks may eventually lead to poor work/academic performance, indecisiveness, poor short and long term memory, accidents such as road traffic accidents (RTA) and industrial accidents.

Complications of Insomnia

As aforementioned, sleep is essential to physiological recovery and well-being. If insomnia persists and is left untreated, it can further result in serious complications, for instance:

  • Poor physical health: For example, the immune system can become poorer as a result of insomnia. One will also be more likely to develop chronic diseases like obstructive sleep apnea, obesity, diabetes, hypertension and cardiovascular disorders such as a 2-3 fold increased risk of irregular heartbeat and stroke.
  • Slower reaction time: A slow reaction may lead to a higher risk of accidents like motor vehicle collisions.
  • Substance abuse: Mental problems caused by insomnia may give rise to substance abuse.
  • Breast cancer: There is a 36% increased risk of breast cancer in insomnia patients.

Diagnosis of Insomnia

Insomnia can be diagnosed according to the Athens insomnia scale and DSM-5 criteria. Such diagnosis consists of two elements, the inability to acquire quality sleep in spite of sufficient attempts and daytime impairment due to insomnia. The following tests can be taken to confirm insomnia and investigate the causes:

  • Physical examination: Physicians may look for the signs and symptoms of insomnia, as well as carry out blood tests to look into any underlying causes.
  • Sleep habits review: The review is presented in the form of questionnaires serving the purpose of gathering information about your sleep habits. A sleep diary can help delineate severity and monitor treatment progress.
  • Sleep study: This requires one to sleep in the institution with multiple machines to monitor numerous parameters like brainwaves (by electroencephalogram, EEG), heartbeat (by electrocardiogram, ECG), muscle movement (by electromyography, EMG), eye movement (by electrooculography, EOG), oxygen saturation and breathing during sleep. 

Treatments of Insomnia

Treatments of insomnia do not necessarily involve medications. Sleeplessness can be relieved with the following approaches: 

  • Treat the underlying causes: Insomnia could be a result of concomitant diseases, psychological traumas or drug abuse. Consult your family doctor to uncover the underlying causes.
  • Cognitive behavioral therapy for insomnia (CBT-I): Cognitive therapy is to alter your prior beliefs, such as the necessity of trying hard to sleep should be avoided. The behavioral part is to alter your behaviors to promote good sleep, like allowing your body to relax during sleep and reducing possible stimuli that arouse you when you are suffering from insomnia.
  • Melatonin: Sleep-inducing hormone, melatonin, can be applied to treat insomnia.
  • Hypnotic medications: For each hypnotic medication, there is a different side effect profile and different efficacy for treating insomnia. You should dicuss with your physicians or pharmacists before purchasing and taking any hypnotic medications. These drugs include diphenhydramine, triazolam, zopiclone and zolpidem. Nevertheless, be cautious about drug interactions and the elderly as bone fractures and other injuries may result as they fall more readily after taking hypnotics. 

Still having trouble sleeping? Here are tips to sleep better and longer!


Is insomnia a mental illness?

Insomnia itself is rarely a mental illness. Even though it is true that it can be caused by some mental blocks and false expectations of sleep, more often it is the symptoms of other mental illnesses like depression, anxiety and bipolar disorders. Moreover, it can be due to the issues in sleep hygiene and circadian rhythm that cause sleeplessness, instead of mental problems.

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This article was medically reviewed by Dr. Cheung Yu, Vincent 張宇醫生. Dr. Cheung is a specialist in family medicine practicing at HKSH Medical Group. He is currently an honorary clinical assistant professor in family medicine at HKU and clinical associate professor (Honorary) in family medicine at CUHK.

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This article was independently written by Healthy Matters and is not sponsored. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.

Dr. Cheung Yu Vincent
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