Insomnia can be solved by being aware of the underlying factors that cause it.
She walked into my room, sat down
and said: “‘Doc, you have to help
me. I haven’t slept well in four
months. I’ve tried everything
and nothing has worked.”
Madam S had stopped drinking
coffee and alcohol, and tried
taking herbal supplements
bought from the pharmacy.
She had bought a new pillow
and asked her husband to sleep
in the other room. She was turning
70 and was looking forward
to enjoying her retirement.
She was quite distressed over
having sleepless nights, which
affected her daytime activities.
She had stopped doing taiji
every morning and couldn’t
spend quality time with her
grandchildren as she was too tired.
I asked her about her sleep
environment, daily routine,
medical history, family background
and how she coped with stress.
She was surprised by the
numerous questions and wondered
how her answers would help.
I explained that our ability to fall
asleep depended on the interplay of
physical and psychological factors.
Upto one in three people
experiences transient insomnia
and one in 10 suffers from chronic
insomnia. People with transient
insomnia tend to experience at
least one night of difficulty falling
asleep, which resolves within
On the other hand, chronic
insomnia sets in if it lasts for
longer than three months.
A study conducted in 2007 found
that almost half of the patients
who visited a sleep clinic in
Singapore had primary insomnia,
which is difficulty sleeping
for no apparent reason, while
a quarter suffered from insomnia
secondary to anxiety disorders,
with a tenth afflicted with
insomnia as a result of depression.
The international classification
of sleep disorders defines insomnia
as having difficulty falling asleep,
staying asleep or waking up
before the desired time that
occur at least three nights a week
for three months.
This is associated with not being
able to function well during the day.
At this point, most people would
start to seek medical attention.
As people age, sleep efficiency
generally deteriorates, resulting
in more dissatisfaction with sleep.
In older people, sleep may be
disturbed by the urge to urinate
frequently at night, which may be
the result of a urinary condition.
Heart or lung problems are
common in older people who
may experience breathlessness
or discomfort when lying down,
affecting their ability to sleep
Chronic pain and a multitude
of prescription medications may
further exacerbate insomnia.
In these instances, addressing
the root cause of difficulty
in sleeping is the recommended
first line of treatment, such as
minimising pain and discomfort.
Even though Madam S was
not suffering from anxiety or
depression, she was sufficiently
distressed by her insomnia to think
that life was not worth living.
Tossing and turning in bed
every night was not the solution,
especially when she experienced
fatigue during the daytime.
This affected her ability to
carry out her daily chores or
even to properly enjoy life. She
was also worried that sleeping
poorly would affect her health.
Her concerns were not
Insomnia is associated with
a higher rate of heart disease,
hypertension and diabetes, and
has been linked to the development
of dementia in later life.
I advised her on how she could
make adjustments to sleep better.
- Sleeping environment:
It should be conducive for rest.
A dark, quiet and uncluttered
room, comfortable bedding
and a comfortable temperature
will help her sleep better.
- Stimulating substances
and activities: Avoid them
near bedtime. Exercise four
hours before bedtime is
discouraged as the adrenaline
rush will keep her awake.
- Caffeinated drinks: They
should not be consumed
near bedtime as caffeine
can remain in the bloodstream
for up to 12 hours.
- Alcohol: Although itmay
cause drowsiness, it interferes
with the normal sleep process,
causing frequent interruptions
and poor sleep quality.
- Sleeping and waking:
I encouraged Madam S to do
this at the same time every day,
even on weekends.
- Set the tone: A warm shower,
light reading and calming
soft music can help one
get a good night’s sleep.
- Avoid daytime naps: This was
one of the hardest things for
Madam S to do as she had to lie
down after lunch every day due
to back pain and would inevitably
doze off for a few minutes.
We also discussed the use of
medications for sleep. Sleeping
pills such as benzodiazepines
are commonly prescribed to
treat insomnia in the short term.
But there is a risk of
tolerance and dependence,which
can lead to a need for higher
Side effects such as drowsiness
and being over-sedated in
the day frequently contribute
to memory impairment
and falls in older people.
Other medications that can
be considered are anti-histamines,
Alternative treatments such as
acupuncture, melatonin and herbal
preparations have been reported to
be helpful to varying degrees for
those suffering from insomnia,
but medical evidence supporting
their use has not been very robust.
to treat insomnia include
relaxation training, stimulus
control and cognitive behavioural
therapy for insomnia.
These involve learning
techniques to relax the mind
and body, building a positive
association between the bedroom
and sleep, as well as addressing
thoughts and behaviours that
underlie and drive a person’s
A therapist, usually a
psychologist, can help with
these over a few sessions.
Madam S agreed to a short course
of sleeping pills, while modifying
her sleep habits at the same time.
She was more upbeat the
next time she saw me. She
had managed to kick the habit
of napping after lunch,
switching her afternoon tea
to a non-caffeinated drink,
and also started to brisk walk
in the morning.
She eventually managed to sleep
without medication. Making small
changes to her lifestyle helped
her sleep better and she was happy
to be able to function as before.