About Insomnia
What Is Insomnia?
Insomnia is a common sleep disorder involving difficulty falling asleep, staying asleep, or waking too early. It can cause fatigue, poor concentration, mood changes, and impaired daytime functioning. Insomnia is multifactorial: medical, psychological, behavioural, and lifestyle factors often interact to create and maintain sleep problems over time. Common contributors include stress, anxiety, depression, medical conditions, hormonal changes, poor sleep habits, caffeine, shift work, or other sleep disorders like sleep apnoea and restless legs syndrome. Because insomnia often has several contributing factors, a coordinated, multidisciplinary approach can look at each of them.
Insomnia, Anxiety and Depression
In population studies, around 40% of people with insomnia also have a mental health condition, most often an anxiety or depressive disorder.1,2
Anxiety increases mental and physical arousal, making it harder to fall or stay asleep. Depression affects sleep architecture and contributes to early waking and non-restorative sleep. Difficulty sleeping can itself create anxiety: many people lie awake ruminating or clock-watching, which further reinforces wakefulness. These patterns are psychological and behavioural, and cannot be resolved by medication alone. During the day, insufficient sleep reduces concentration, emotional regulation, and stress tolerance, which can worsen mood and anxiety over time.
Insomnia and Sleep Apnoea
Many people are diagnosed with insomnia without ever being assessed for obstructive sleep apnoea (OSA), even though OSA is common (population studies find it in between 9% and 38% of adults, more often in men and older people)3 and frequently presents with insomnia symptoms. Apnoeas trigger surges of “fight-or-flight” hormones that cause sudden alertness, making it difficult to return to sleep. Research shows that 30–40% of people with chronic insomnia also meet the diagnostic criteria for OSA.4 Snoring is common in OSA, but its absence does not rule out the condition. The only reliable way to exclude sleep apnoea is a diagnostic sleep study (polysomnography). Our clinic performs home-based sleep studies that record brain activity, breathing and oxygen levels in your usual sleep environment. Early assessment helps avoid misdiagnosis and unnecessary long-term use of sedatives.
How Do I Treat Insomnia?
Sedative medications have limited long-term benefit for insomnia, carry risks of side effects, and may worsen sleep apnoea. International guidelines recommend Cognitive Behavioural Therapy for Insomnia (CBT-I) as the first-line treatment.5 CBT-I is a structured program that retrains the thoughts and behaviours that maintain insomnia, and in clinical trials its benefits lasted after treatment ended.5 If sleep apnoea or another sleep disorder is contributing to insomnia, it should be addressed alongside CBT-I.
Why Does an Integrated Approach Matter?
Insomnia is often influenced by a combination of medical, psychological, and behavioural factors. Treatment involves collaboration between the sleep physician, psychologist and patient. At our clinic, all care occurs in one location. You can see the clinical psychologist and the sleep physician on the same day. That’s why we operate as a fully integrated multidisciplinary team. Our clinicians meet regularly to coordinate management, so your treatment plan takes account of both the medical and psychological sides of your sleep.
CBT-I is less likely to help if underlying issues like untreated sleep apnoea or medication effects are still present. Conversely, treating obstructive sleep apnoea alone is often not enough, as many patients continue to struggle with learned and chronic insomnia patterns.
References
- Ford DE, Kamerow DB. Epidemiologic study of sleep disturbances and psychiatric disorders: an opportunity for prevention? JAMA. 1989;262(11):1479–84. doi:10.1001/jama.262.11.1479
- Ohayon MM, Lemoine P. A connection between insomnia and psychiatric disorders in the French general population. L’Encéphale. 2002;28(5 Pt 1):420–8. PubMed 12386543
- Senaratna CV, Perret JL, Lodge CJ, et al. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Medicine Reviews. 2017;34:70–81. doi:10.1016/j.smrv.2016.07.002
- Sweetman A, Lack L, McEvoy RD, et al. Bi-directional relationships between co-morbid insomnia and sleep apnea (COMISA). Sleep Medicine Reviews. 2021;60:101519. doi:10.1016/j.smrv.2021.101519
- 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. Journal of Clinical Sleep Medicine. 2021;17(2):255–62. doi:10.5664/jcsm.8986