Psychiatry · Condition guide

Sleep problems and insomnia

Poor sleep affects mood, concentration, health and sex. Long-term insomnia is very treatable, usually without relying on sleeping pills.

Written and medically reviewed by Dr Shivadev M, MBBS, MD (Psychiatry), FECSMLast reviewed November 2026

What insomnia is

Insomnia means difficulty falling asleep, staying asleep, or waking too early, at least three nights a week for three months or more, despite having the chance to sleep, and affecting how you feel and function during the day.¹

Why it happens

Stress and a busy mind, especially at bedtime.
Anxiety and depression, which both disturb sleep, while poor sleep in turn worsens mood.
Habits that keep it going: long hours in bed awake, irregular sleep times, screens, daytime naps, caffeine and alcohol.
Shift work and late-night work, common in Bengaluru's tech and service sectors.
Medical causes: pain, frequent urination, reflux, thyroid problems, and some medicines.
Other sleep disorders such as sleep apnoea or restless legs.

How I assess it

A detailed sleep history, ideally with a two-week sleep diary.
A validated questionnaire, the Insomnia Severity Index, repeated at follow-up.²
Screening for anxiety, depression and substance use.
Screening for sleep apnoea, especially with loud snoring, pauses in breathing or daytime sleepiness, and referral for a sleep study when needed.

Treatment

Cognitive behavioural therapy for insomnia (CBT-I). International guidelines recommend this as the first treatment for chronic insomnia.^3,4 It includes setting a consistent sleep window, strengthening the link between bed and sleep, and working with the worries that keep you awake.
Treating anxiety or depression when they are part of the picture.
Short-term medicines in selected situations. Some sleeping pills can cause dependence and next-day drowsiness, so they are used at the lowest effective dose for the shortest time.^3,5
Practical changes to light, screens, caffeine, alcohol and exercise.

Common questions

Are sleeping pills safe to take every night?

Many sleeping pills are meant for short-term use only, because of dependence and next-day effects. CBT-I is the recommended long-term treatment.

How quickly does CBT-I work?

Many people notice improvement within a few weeks. Sleep may feel slightly worse at first, then improves steadily.

Can poor sleep affect my sex life?

Yes. Poor sleep lowers desire and energy, and untreated sleep apnoea is linked with erectile difficulty and low testosterone.

Is melatonin a good option?

Melatonin helps some sleep timing problems and is sometimes used in older adults, but it is not a strong treatment for most chronic insomnia. Ask before starting any supplement.

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Related guides

References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). Washington, DC: APA; 2022.
Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2(4):297–307.
Riemann D, Espie CA, Altena E, et al. The European Insomnia Guideline: an update on the diagnosis and treatment of insomnia 2023. J Sleep Res. 2023;32(6):e14035.
Qaseem A, Kansagara D, Forciea MA, et al. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;165(2):125–133.
Gupta R, Das S, Gujar K, et al. Clinical practice guidelines for sleep disorders. Indian J Psychiatry. 2017;59(Suppl 1):S116–S138.

This page is general information and does not replace a consultation with a doctor who has assessed you. Read how these pages are written in our editorial policy.