Updated: Jan 12, 2022
In this Article
Sleep is important to us. Other than getting sufficient rest, memory and learning are also connected to having enough sleep. Occasionally, we may find ourselves tossing and turning in bed or staring at the ceiling, unable to fall asleep. This may be due to stress, anxiety or excitement — for example, starting a new job. Difficulties falling asleep, or insomnia, can pose challenges to the sufferer’s quality of life. In Singapore, insomnia has a prevalence rate of 22.6%, making it a serious health concern. 
What is insomnia?
Insomnia is a sleep disorder that is characterised by difficulties falling asleep or staying asleep or the lack of quality sleep. The amount of sleep required for an average adult is at least 7 to 8 hours, while an average child requires 9 to 13 hours of sleep.  Insomnia can result in lethargy, mood swings and can even affect the sufferer’s daily routine. Long-term insomnia can also result in a series of health complications, such as heart disease and diabetes.
What causes insomnia?
Many factors can cause insomnia, such as environmental, physiological and psychological factors. 
Environmental factors that cause insomnia include:
Life stressors such as relationship troubles, change of jobs and financial difficulties
Changes to body clock such as jet lag
Poor sleeping environment such as the room being too noisy, too hot, too cold or the bed being too uncomfortable
Irregular sleeping pattern due to shift work
Certain medical conditions can also result in insomnia, especially when patients experience pain or discomfort. Examples of medical conditions that can result in insomnia include: 
Conditions that cause chronic pain e.g. arthritis and fibromyalgia
Gastrointestinal disorders e.g. heartburn
Hormone fluctuations e.g. menopause, menstruation, thyroid disorders
Chronic Obstructive Pulmonary Disease (COPD)
Other sleep disorders e.g. sleep apnea and restless leg syndrome
Neurological disorders e.g. Alzheimer’s disease and Parkinson’s disease
Apart from medical conditions, the use of certain medications or stimulants (caffeine) or substance abuse can also result in insomnia.
Psychological factors such as mental disorders can also result in insomnia. Mental disorders that can cause insomnia include:
What are the types of insomnia?
Insomnia is most commonly classified according to the duration it affects the patient. Transient insomnia occurs for less than one month, short-term insomnia lasts between 1 and 6 months and chronic insomnia lasts more than 6 months.
Although insomnia is generally classified according to the duration that the patient is affected, there are different subtypes of insomnia that are used by researchers to better understand how it might be experienced by the patients.
Adjustment insomnia: This describes a period of insomnia linked to life events (e.g. stress, anxiety or unfamiliarity to a new environment).
Drug or substance-induced insomnia: This refers to insomnia or difficulty sleeping due to medication or recreational drug use (e.g. caffeine, alcohol, cold medication and cannabis).
Comorbid insomnia: This refers to insomnia caused by an existing medical condition (e.g. anxiety, depression, arthritis and cancer).
Onset insomnia: This refers to difficulty sleeping at the beginning of the night or at “sleep onset”. People with onset insomnia typically observe a delay in sleep for more than 30 minutes.
Middle insomnia: This refers to difficulty staying asleep. People with middle insomnia typically wake up once or more in the middle of the night and have trouble falling back asleep.
Late insomnia: This refers to when sufferers wake up too early and have trouble falling asleep. Late insomnia tends to occur around 3-5 am.
Conditioned insomnia: This occurs when becomes a conditioned behaviour, and difficulties falling asleep or staying asleep continues even after removing the cause of insomnia.
Behavioural insomnia of childhood: This typically occurs in children under 5 years old, who have not been given a strict or specific bedtime.
Idiopathic insomnia: This refers to insomnia without any apparent causes, such as medical or psychological conditions.
Paradoxical insomnia: This is a form of insomnia when the person is actively sleeping but feels like they are not.
Sleep hygiene insomnia: This form of insomnia is caused by poor sleep hygiene (e.g. use of electronics before bed, drinking coffee or alcohol in the evening or having a poor bedtime routine). 
What are the symptoms of insomnia?
Symptoms of insomnia include:
Difficulty falling asleep
Waking up several times in the middle of the night
Difficulty returning to sleep
Feeling tired or lethargic in the day
Waking up too early
Not feeling well-rested after a night’s sleep
Irritability, depression or anxiety
Having problems focusing on or remembering something
How does insomnia affect the brain?
Other than feeling lethargic or irritable, insomnia can also affect the brain and your cognitive skills. This is because the lack of rest from insomnia results in the brain being exhausted and unable to fully perform its tasks.
A study done has shown that insomnia affects working task memory, which is the ability of the brain to process and store short-term information. 
Other than working task memory, insomnia can lead to reduced grey matter in the frontal lobe of the brain, which is responsible for important neurological processes such as memory, learning and attention span.
What are the complications of insomnia?
Apart from affecting our brain function, chronic insomnia can also result in a plethora of health complications such as:
Increased risk of cardiovascular diseases such as arrhythmia, high blood pressure, heart disease and heart failure
Increased risk of stroke
Increased risk of diabetes
Weight gain or obesity
Complications in pregnancy such as premature birth and increased risk of preeclampsia
Weakened immune system which may result in inflammations
Depression, anxiety or suicidal thoughts
Worsening of existing medical conditions such as asthma
How is insomnia diagnosed in Singapore?
Insomnia can only be diagnosed if symptoms of insomnia are present for at least three days per week, despite sleeping in a safe, dark environment. If insomnia occurs for more than 3 months, the patient can be diagnosed with chronic insomnia. If insomnia occurs for less than 3 months, the patient will either be diagnosed with transient or short-term insomnia.
Firstly, your doctor will look at your health history to ascertain if there are any medical conditions, medicines or stressors in life that may be causing you to have difficulties falling asleep or staying asleep.
Next, your doctor will also ask about your sleep history. He or she will ask about your insomnia in detail, such as:
How long it has been occurring,
What your sleep is like
How long does it take for you to fall asleep
Your doctor may ask you to keep a sleep diary documenting your sleep timings and sleep patterns for 1-2 weeks to help in determining your sleeping habits.
Your doctor will also conduct a physical examination to further determine if there are any medical conditions such as asthma or COPD that are causing your insomnia. Additional laboratory tests (e.g. blood tests) may also be ordered to rule out any underlying medical conditions like hormone or thyroid issues.
Lastly, your doctor may order you to do a sleep study overnight where researchers monitor your sleep. During the sleep study, sensors are placed on your scalp, face, eyelids, chest, limbs and finger. Brain wave activities, heart rate, breathing rates, oxygen rates and muscle movements before, during and after sleep are monitored.
What are treatments for insomnia in Singapore?
If insomnia is not caused by any medical conditions, they are typically treated by either medication or cognitive behaviour therapy.
One way of treating insomnia is through medication, although they are often not the first line of treatment. Sleeping pills that can help you fall asleep include doxepin (Silenor) and ramelteon (Rozerem).  Antidepressants such as amitriptyline may sometimes be prescribed instead of sleeping pills. However, such medications have side effects which include dizziness, headaches, prolonged drowsiness and it can also affect memory and performance.
In Singapore, sleeping pills have to be prescribed by a doctor.
Cognitive behaviour therapy (CBT)
CBT can be used for insomnia by improving sleep patterns to ensure that you get quality sleep. 
CBT uses several techniques to treat insomnia and help improve sleep such as:
Sleep hygiene: CBT helps to inculcate good sleep hygiene including getting rid of distractions in your bedroom and keeping a fixed sleep schedule.
Sleep restriction: Sleep restriction limits the time spent in bed to just the hours that you spend sleeping. For example, if you take 2 hours to fall asleep, you may be asked to go to bed later. This helps to increase sleep efficiency and reduce waking during the night.
Relaxation training: This uses meditation techniques, guided imagery and breathing techniques to help prepare the body for sleep. These techniques can help to calm the body and make falling asleep easier.
Cognitive restructuring: This treatment helps insomnia sufferers to manage stress and control their thoughts by replacing them with positive thoughts. This can help them overcome the sleeping difficulties caused by their worry and fear.
Stimulus control training: Stimulus control training helps chronic insomniacs reduce negative associations with sleep and bedtime. During this training, insomniacs would have to only use the bed for sleeping or sex, lying in bed only when they are sleepy, as well as getting up at the same time every morning.
How can I prevent insomnia?
Being well-rested is important to most people, and being an insomniac can no doubt be annoying. Here are some tips that can help you prevent insomnia and get a restful sleep:
Purchase a comfortable mattress.
Ensure that your room is neat and decluttered.
Avoid using the bed for activities such as watching the TV, eating or working.
Establish a regular “sleep-wake” cycle.
Avoid napping as it may make falling asleep at night harder.
Limit consumption of caffeine in the late afternoon and evening.
Reduce blue light exposure at night or 2 hours before you head to bed.
Avoid eating a heavy meal right before bed.
Take a relaxing bath or shower before heading to bed.
Are there alternative treatments or home remedies for insomnia?
Some alternative and home remedies that can help with insomnia include:
Light therapy: If you have trouble falling asleep at night, you can go for a walk outdoors in the morning. If you are waking up too early in the morning, you can go for a walk in the late afternoon or evening. This is to expose you to light, which helps to tell your body when to sleep and wake up.
Meditation and relaxation techniques: Regular meditation has shown to promote sleep by slowing breathing and reducing stress hormones levels. It can also relax the body and calm the mind.
Here are some tips on how to effectively manage your stress.
Acupuncture: Acupuncture has been proven to be effective in treating insomnia with few side effects.
Aromatherapy: Essential oils such as lavender, chamomile and ylang-ylang has been said to be one of the most soothing essential oils and can help people fall asleep.
Music therapy: Playing slow and gentle music has said to improve sleep quality, decrease nightly awakenings and lengthen sleep duration.
Hypnotherapy: Through hypnosis, the subconscious mind and brain waves can be reprogrammed for REM sleep. This helps improve sleep quality and duration.
Exercising: A study has shown that people who get 60 minutes of exercise five days a week have more normal REM sleep than those who did not.
Why do pregnant women suffer from insomnia?
Insomnia is common amongst pregnant women and can worsen as their pregnancy progresses. Pregnant women suffer from insomnia due to the physical discomfort they may feel during their pregnancy, such as backaches, heartburn, cramps, tingling legs and fetal movement. 
Insomnia is often said to be the worst in the third trimester, as the pressure of the growing fetus starts to have an increasing impact on the muscles, joints and blood flow of the mother.
Can insomnia be cured?
Yes, it is possible to cure insomnia, especially if your insomnia was due to lifestyle habits instead of any underlying medical conditions. However, insomnia cannot be cured in a matter of days. This is because it involves breaking old routines and establishing a new set of healthier bedtime routines, which may take some time. 
How much do insomnia treatments cost? Are they Medisave claimable?
Therapy for insomnia typically cost about $60-$200 per session, depending on whether you visit a government hospital or a private therapist.
However, treating insomnia can also be costly, especially if you require a polysomnogram (sleep study). A sleep study can cost at least $700, after subsidies, at Singapore General Hospital.
Outpatient insomnia treatments are not Medisave claimable. However, if you have to be warded in a hospital for a polysomnogram, you can claim up to $550 from your Medisave.
It is absolutely annoying to have difficulties falling asleep or staying asleep. Furthermore, it can lead to lethargy and fatigue the next day, which can affect your performance at school or work. Sometimes it may even lead to accidents on the road. If you are having difficulties falling asleep, please seek professional help as soon as possible, so it does not affect the quality of your life any further.
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This editorial section solely expresses the opinion of frankie and is not endorsed nor commissioned by any external party. The list is non-exhaustive. At frankie, we believe that your best provider of medical advice is your doctor. Please consult a doctor before undergoing any treatment or procedure.
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