Insomnia

At 3:07 every night, Rafi is awake. A partner at a law firm in Motijheel, he checks the phone, then the news, then the phone again. By 4:30, as the azaan rises from the mosque behind the building, he is calculating how few hours are left before court. He has tried warm milk, a new mattress, and a sleeping tablet from the pharmacy, which worked for a week.

An illustration drawn from common experience. The person is invented; the pattern is not.

Understanding insomnia

Insomnia is trouble falling asleep, staying asleep or waking too early, on at least three nights a week for months, with tiredness and poor concentration the next day. It is often kept going by habits and worry about sleep itself: lying in bed awake, napping, screens, caffeine late in the day. Poor sleep is also a feature of depression, anxiety and many physical conditions, and loud snoring with pauses in breathing can point to sleep apnoea, which needs medical assessment.

How common is insomnia?

In Bangladesh, the national mental health survey of 2018–19 diagnosed a sleep-wake disorder in 1% of adults. That counts diagnosed disorders only, not everyone who sleeps badly.

The finding worth knowing

The American College of Physicians recommends cognitive behavioural therapy for insomnia, CBT-I, as the first treatment for chronic insomnia in adults, before sleeping tablets. It works on the habits and thoughts that keep insomnia going.

Signs and symptoms of insomnia

• Lying awake for long periods most nights
• Dreading bedtime, or watching the clock
• Daytime tiredness, irritability, poor concentration
• Relying on tablets or alcohol to sleep

Treatment for insomnia

A doctor checks for medical and psychiatric causes first, including depression, anxiety, sleep apnoea and medicines. CBT-I then follows a structured plan over several weeks. Medication may help for a short time in some cases, as a decision made together.

What getting better can look like

Rafi’s first change may feel backwards: less time in bed, a fixed waking time, the phone in another room. A few weeks later, 3:07 comes and goes without him, and he hears the azaan only on the mornings he chooses to.

Common questions about insomnia

Should I take sleeping pills for insomnia?

For chronic insomnia in adults, the American College of Physicians recommends cognitive behavioural therapy for insomnia, CBT-I, as the first treatment, before sleeping tablets. Medication may help for a short time in some cases, as a decision made with a doctor. If you already take a sleeping tablet, discuss any change with the doctor who prescribed it.

Can loud snoring be a sign of a sleep problem?

It can. Loud snoring with pauses in breathing can point to sleep apnoea, a condition that disturbs sleep and needs medical assessment. A doctor checking poor sleep also looks for depression, anxiety, other physical conditions and the effects of medicines.

When to see a psychiatrist

If poor sleep has lasted more than a month and is affecting your days, it is worth treating properly.

Care here is personal: built around your history, your health and what you want to change, and reviewed with you as it goes.

If you or someone else is in immediate danger, call 999 or go to the nearest hospital emergency department.

Sources

• Alam et al., Asian Journal of Psychiatry, 2023 (PMID 38199203), from the National Mental Health Survey of Bangladesh 2018–19
• Qaseem et al., Annals of Internal Medicine, 2016 (PMID 27136449)