Sleep Problems: What's Going On, and Where to Start
Sleep Problems: What's Going On, and Where to Start
Most people don’t come to a psychiatrist about sleep.
They come about something else — low mood, worry, drinking, a teenager who’s become unrecognisable — and somewhere in the first ten minutes it turns out they haven’t slept properly in eight months. Often nobody has asked.
That’s why there’s a whole section of this site about sleep, written by a psychiatrist rather than a sleep coach. Not because sleep is a nice wellness topic. Because in a great many of the people I see, it was the first thing to go, and often the first thing anyone could have done something about.
If you’ve landed here at an unhelpful hour, this page is a starting point. It’s short by design. Its main job is to work out which of the more detailed articles is actually yours.
The short answer
Bad sleep for a few weeks after something difficult is normal and usually settles by itself.
Bad sleep for months, with your days paying for it, is a different thing and it rarely unwinds on its own.
Three questions sort out most of it:
How long? Weeks is one situation. Three months or more is another.
Which part of the night? Getting to sleep, staying asleep, or waking far too early — these point in different directions.
Is anything else going on? Mood, worry, drinking, breathing, pain. Sleep is very often the loudest symptom of something quieter.
Two things worth knowing before you go further: sleeping tablets are not the first answer, and the sleep-hygiene advice you’ve already read is, on its own, usually not enough for a long-standing problem.
Why a psychiatrist writes about sleep at all
Fair question. It’s not our organ, strictly speaking.
But sleep sits underneath most of what we treat, and it moves in both directions. Depression disturbs sleep — everyone knows that part. What’s less known is that long-running insomnia also raises the risk of developing depression later. It isn’t only a symptom. It can be a beginning.
Beyond that, in ordinary practice: sleep is usually the earliest thing to change and the last thing to recover. Sleep that stays broken after mood has lifted is one of the more reliable signs that things may slip back. And a sudden drop in the need for sleep — feeling great on four hours — means something quite different and quite urgent.
So sleep isn’t a soft topic we’ve wandered into. It’s a large part of the actual work.
Which of these is you?
Not a test, and nothing here tells you what you have. It’s a way of finding the right article faster.
“I’ve been lying awake for months and I’ve tried everything.” Start with the article on trouble sleeping. The most useful thing in it is the part almost nobody gets told — that after a while it isn’t the original stress keeping you awake anymore, it’s the entirely sensible things you started doing about it.
“I don’t know if this is bad sleep or something more.” Go to the article on sleep and low mood. It covers the pattern where both are running at once, why “which came first” turns out to be the wrong question, and the one sleep change that needs seeing someone soon rather than eventually.
“I’ve been having a drink at night to get to sleep, and it’s crept up.” The article on alcohol and sleep is for you. Please read the safety part at the top of it before you do anything else — if drinking has been regular, stopping suddenly on your own can be dangerous, and that’s worth knowing tonight rather than next week.
“It’s my teenager, not me.” Dr. Anita Daund’s article on adolescent sleep explains why the body clock genuinely shifts later at puberty, why it isn’t the phone, and what’s worth doing before the next argument at eleven at night.
Other things that affect sleep
Not everything needs a full article, and some of these need a doctor rather than a page. Worth knowing they exist:
Breathing problems in sleep. Heavy snoring, someone noticing you stop breathing, morning headaches, and heavy daytime sleepiness despite plenty of hours in bed. This gets mistaken for depression more often than it should, sometimes for years. It needs a proper sleep assessment, and it’s very treatable.
Restless legs. A crawling, restless urge to move in the evening that eases when you walk and returns when you sit. Specific, treatable, and iron levels are often part of the story.
Shift work. A genuinely different problem with a different approach. Most standard sleep advice doesn’t apply, and telling a night-duty nurse to keep a fixed bedtime isn’t useful.
Physical causes. Thyroid, ongoing pain, breathing conditions, and the side effects of medicines already being taken for something else. Worth ruling out with your physician before assuming it’s psychological.
Later life. Sleep changes shape as people age — lighter, more broken, earlier. Some of that is ordinary. A clear change from a person’s own usual pattern is not, and in older adults a shift in sleep is sometimes the first sign of something worth checking.
After a baby. Broken sleep is unavoidable in that period. Not being able to sleep even when the baby does is a different signal, and it’s one worth mentioning to a doctor rather than absorbing.
What doesn't work, honestly
A short list, because a lot of effort gets spent here.
Sleep-hygiene tips alone. They help a bit at the start and they are not a treatment for a problem that’s been running for months. Being told to keep the room dark for the fourth time is not going to be the thing.
Trying harder. Sleep isn’t something you do. It’s what happens when you stop doing. Effort is the one input that reliably makes it worse.
Going to bed earlier. The most natural response to a bad night, and it backfires almost every time. More hours in bed means more hours awake in bed.
Catching up at the weekend. Two extra hours on Sunday morning shifts the body clock, so Sunday night becomes the worst night of the week. Then Monday is miserable and everyone blames the job.
Taking a name from a friend. No medicine is named anywhere on this site, and that’s deliberate. What suits one person can be wrong or unsafe for another, and sleep medicines in particular depend heavily on what’s causing the problem and what else is being taken.
What actually helps
Fix the wake-up time, not the bedtime. You can’t choose when you fall asleep. You can choose when you get up, and that’s the lever that moves the whole system. Every day, weekends included.
Get out of bed when you’re awake. Twenty minutes or so of lying there, get up, dim room, something dull, back only when sleepy. It feels wrong and it works.
Spend less time in bed, not more.
Ask about talking therapy for insomnia. There’s a structured, short course built specifically for long-standing sleep problems, and major clinical guidelines put it ahead of medication as the first move for adults. It isn’t as easy to find in India as it should be. It’s still the thing to ask about first.
Deal with what’s underneath. If low mood, anxiety or drinking is part of the picture, treating the sleep alone tends not to hold.
When to see a doctor
- Sleep has been poor most nights for around three months or more, and your days are suffering for it.
- You’re waking at three or four with a heaviness that’s worst in the morning.
- You’re sleeping a great deal and still exhausted.
- Someone has seen you stop breathing in your sleep, or you’re very sleepy through the day despite enough hours in bed.
- You’re using alcohol or anything else to get to sleep, and it’s increasing.
- You’ve had a stretch of needing very little sleep and feeling unusually energetic and good — that one is worth attention soon rather than eventually.
- The nights bring thoughts that frighten you. Please don’t wait on this one.
Seeing a psychiatrist about sleep does not mean admission, and it doesn’t mean medication is the automatic answer. Mostly it means somebody finally asks the questions in the right order.
The articles in this section
Trouble sleeping — what’s normal and what isn’t. Why a bad patch becomes a long problem, what genuinely helps, and what quietly makes it worse.
Sleep and low mood. How bad sleep and low mood feed each other, the patterns worth noticing, and the one change that needs seeing someone quickly.
Drinking to fall asleep. How it starts, why the amount goes up, why stopping is harder than people expect, and how to do it safely.
Teenagers and sleep — by Dr. Anita Daund. Why the adolescent body clock shifts, why it isn’t laziness, and what to do before the next argument.
Sources
- American Academy of Sleep Medicine — clinical practice guideline on behavioural and psychological treatments for chronic insomnia in adults (2021)
- American College of Physicians — guideline on the management of chronic insomnia disorder in adults (2016)
- NICE Clinical Knowledge Summaries — Insomnia
- Baglioni et al., Journal of Affective Disorders(2011) — insomnia as a predictor of depression
- International Classification of Sleep Disorders, 3rd edition
If tonight is hard
If you’re having thoughts of harming yourself, or the night feels unbearable, please talk to someone now.
Tele-MANAS — 14416 or 1800-891-4416. Free, 24 hours, available in Marathi.
You can also go to the nearest hospital emergency department, or ask someone at home to sit with you.