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Understanding Insomnia
Almost everyone has occasional bad nights. Yet, insomnia is different. It is difficulty falling asleep, difficulty staying asleep, or waking far too early — despite having the time and the opportunity to sleep — and it leaves you tired and listless the next day. Sleep problems are common locally: in the Singapore Mental Health Study 2016, more than one in four Singapore residents reported scores suggestive of poor sleep.
What is insomnia?
Insomnia can be classified according to the duration of impact, and the difference matters because the treatment is different.
- Short-term (acute) insomnia lasts days to a few weeks, usually with an obvious cause — a stressful deadline, a newly diagnosed illness, grief from the passing of a loved one, a newborn being brought home, or a flight across time zones. It typically settles down once the cause passes.
- Long-term (chronic) insomnia is diagnosed when sleep is disturbed at least three nights a week, for three months or longer, and it is affecting your daytime function, be it energy levels, mood, concentration or performance.
That last part — the functional impact — is important. If you sleep five hours a night and feel perfectly well, you are a short sleeper. A core aspect of insomnia is determined by the daytime cost and impact on your life and work, not by the net number of sleeping hours you get to clock.
Why insomnia keeps going after the cause has gone
A common question posed by patients is this: “The stress is over — so why am I still not sleeping?” The answer is that insomnia is usually kept alive by something different from what started it.
A bad patch of sleep is understandably frightening, so we start putting in effort to solve the problem. Some go to bed earlier to “catch up”, or lie in bed longer than they have to on weekends. Others nap, and repeatedly check the clock. Each of these is reasonably instinctive, yet each of them quietly makes things worse — because spending more hours in bed than you truly need dilutes your sleep, and because the bed slowly stops being a cue for sleep and becomes a cue for lying awake, frustrated.
Important considerations
Before trying to treat insomnia on your own, it is important to see your doctor to check for other conditions that have effects that mimic insomnia. Some are easily missed but actually treatable:
- Obstructive sleep apnoea (OSA) — loud snoring, gasping or choking at night, morning headaches, being sleepy rather than merely tired during the day, or falling asleep performing routine tasks such as reading articles or driving at the wheel
- Restless legs syndrome — an urge to move the legs in the evening, relieved by moving
- Bodily pains, gastric reflux, an overactive bladder, or unexplained breathlessness that wakes you repeatedly
- Thyroid problems
- Peri-menopausal symptoms
- Depression and anxiety — early morning waking is a classic feature of depression, while a racing mind at lights-out is more typical of anxiety
- Psychoactive substances
- Caffeine, which lingers far longer than most people assume — found in carbonated beverages, teas and coffee products
- Alcohol, which shortens the time to fall asleep but fragments sleep in the second half of the night
- Cigarette smoking and nicotine
- Selected medications, such as oral steroids, certain inhalers, and some nasal decongestant or flu medications
- Shift work and irregular schedules, which unsettle the body clock rather than sleep itself
The treatment that works best is not a tablet
Many patients view insomnia as a simple problem to be solved and want a quick fix — like looking for a cough syrup to treat a cough, or blood pressure lowering medications for hypertension.
This surprises many people. The first-line treatment for chronic insomnia is actually a structured, short psychological programme called cognitive behavioural therapy for insomnia (CBT-I). It is the only insomnia treatment to receive a strong recommendation from the American Academy of Sleep Medicine, a position also endorsed by the World Sleep Society. It typically runs over four to eight sessions. CBT-I is practical. It usually combines:
- Individually customised sleep scheduling
- Sleep hygiene — healthy habits and adjustments to the environment for better sleep quality
- Stimulus control — rebuilding the link between bed and sleep
- Constructive worry — concrete steps to reduce arousal of thoughts and manage or prevent ruminations in bed
- Cognitive restructuring — countering and managing negative thoughts about sleep, to build more balanced perspectives that reduce the thoughts keeping the body’s wakefulness and alarm system switched on at bedtime, and in turn improve sleep quality and quantity, as well as mood
- Relaxation techniques for a body that has learnt to stay wakeful at night
One important caveat
Standard sleep hygiene advice — dim the lights, cut the caffeine, buy a better mattress — is sensible. However, the evidence suggests that it is not enough on its own for chronic insomnia. If you have already tried it without success, that is not a personal failure. It means you will likely benefit from the more complete programme.
Sleep medication has a genuine place and time — for short-term insomnia with a clear trigger, for people who cannot access CBT-I, or as a temporary bridge alongside CBT-I. While there are medications for long-term insomnia, improvements in sleep tend to fade once the medications are stopped.
The core concerns with sustained use of sedative sleeping tablets are tolerance (needing more for the same effect), dependence, next-day grogginess, and an increased risk of falls and confusion in older adults.
If you are already taking something nightly and want to get off it, do not stop abruptly — some of these medications need to be tapered, and working with your doctor alongside CBT-I yields much better results.
- Fix your wake-up time, including weekends. This anchors the body clock more powerfully than a fixed bedtime.
- Get out of bed if you are lying awake for what feels like 20 minutes or so. Read something dull in dim light, then return when sleepy.
- Turn the clock away. Clock-watching feeds negatively on the math of how little time is left for sleep.
- Get bright light in the morning — even 10 to 15 minutes of being outdoors helps.
- Stop caffeine by early afternoon, and remember that tea, soft drinks containing caffeine (such as cola) and some medications count too.
- Skip the night booze. Alcohol is a poor sleeping aid and a common hidden cause of poor sleep.
- Keep the last hour before bed low-stimulation — no work email, no doom-scrolling, no drama or movie streams.
- Sleep has been a problem for three months or more
- You snore loudly, or someone has noticed that you stop breathing in your sleep
- You feel sleepy while driving, or at work
- You are relying on alcohol or over-the-counter medication to get to sleep
- Your mood, appetite, or interest in life has dropped alongside your sleep
- You are worried about your sleeping tablets, or want help coming off them
Poor sleep and poor mental health feed off each other, so it is wise to treat insomnia early rather than waiting for it to fix itself.
If you need help right now
If you are having thoughts of harming yourself, please reach out immediately:
Samaritans of Singapore (SOS) — 24-hour hotline 1767, 24-hour CareText via WhatsApp 9151 1767
National Mindline 1771 — 24-hour helpline 1771, WhatsApp 6669 1771, or webchat at mindline.sg
In an emergency, call 995 or go to the nearest Emergency Department.
Your family doctor is often the easiest place to start, and no referral is needed. Our doctors can talk through what you are experiencing, check for physical causes, start treatment where appropriate, and stay involved over time — with the option of referral to a specialist if that becomes necessary.
Here at Qualitas-Frontier Healthcare, we also run a dedicated counselling and psychotherapy service staffed by expert clinical psychologists, available as in-person sessions at our clinics or as tele-counselling from the privacy of your own home. This includes cognitive behavioural therapy for insomnia (CBT-I), delivered as a structured programme by our clinical psychologists.
WhatsApp: +65 8683 8467
Hotline: +65 6991 5511
Email: contact@frontierhealthcare.com.sg
Reaching out is the first step towards an even healthier version of you, and we are here to support you every step of the way.
This article was first published on 1 October 2026. It is meant for general information and does not replace personalised medical advice. If you are concerned about your own health or someone else’s, please speak to a doctor.
- Sleep quality of Singapore residents: findings from the 2016 Singapore Mental Health Study. Sleep Medicine: X. 2022. PMID: 35243325.
- Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021;17(2):255–262. PMID: 33164742.
- Morin CM, Bei B, Bjorvatn B, et al. World Sleep Society international sleep medicine guidelines position statement endorsement of the AASM clinical practice guideline. Sleep Med. 2023;109:164–169.
- Insomnia during the COVID-19 pandemic: prevalence and correlates in a multi-ethnic population, Singapore. BMC Public Health. 2024. doi:10.1186/s12889-024-20820-2.
- Subramaniam M, Abdin E, Vaingankar JA, et al. Tracking the mental health of a nation: prevalence and correlates of mental disorders in the second Singapore Mental Health Study. Epidemiol Psychiatr Sci. 2019. PMID: 30947763.
Contributors
Dr John Soh – Family Physician
MBBS (National University of Singapore), GDFM (National University of Singapore)
Dr Wong Mei Yin — Senior Principal Psychologist
Doctor of Psychology in Clinical Psychology (Murdoch University, Australia)
MA (Applied Psychology – Counselling Psychology) (NIE NTU)
MPhil (University of Nottingham, UK)
Registered Psychologist (Singapore)
Registered Psychologist (Endorsed Area of Practice: Clinical Psychology), Psychology Board of Australia (AHPRA)
Dr Lim Kok Kwang — Senior Consultant Clinical Psychologist
PhD (University of Tennessee at Knoxville, US)
Registered Psychologist (Singapore)
Registered Psychologist (Endorsed Area of Practice: Clinical Psychology), Psychology Board of Australia (AHPRA)
