What works when you cannot sleep or keep waking up at night

Dr Pang says the disorder can be classified based on when it happens. Initiating insomnia refers to not being able to fall asleep, while those with maintenance insomnia fall asleep easily, but wake up repeatedly during the night. 

People with terminal insomnia or early arousal wake up in the early morning and find themselves unable to fall asleep again. 

Insomnia can also be classified by its duration. 

Short-term or acute insomnia is very common, Dr Eng says. It is caused by factors like stress, illness, pain, jet lag or even a change in environment, and usually resolves once the trigger condition improves. In such cases, practising good sleep hygiene – such as keeping to a regular sleep schedule and creating a conducive bedroom environment – helps. 

However, others may go on to develop chronic insomnia that persists for months, even after the initial trigger has passed. 

“Many people live with insomnia for a long time, often months or even years. There’s a tendency to normalise the suffering, believing it’s just a part of stress or ageing,” Dr Eng says. 

They usually reach the tipping point when the daytime consequences become unbearable, such as overwhelming fatigue, significant trouble focusing or noticeable changes in mood, like feeling constantly irritable or anxious, he adds. 

Most of Dr Lim’s insomnia patients are middle-aged women. The condition is more common in women because of factors like hormonal fluctuations and a higher rate of mood disorders, he says. 

Many patients at SGH come in looking for a more sustainable solution than popping pills from their doctor. 

“A common story is someone whose life has started to shrink because of their insomnia. They might start cancelling plans or giving up hobbies, and spend, for example, 10 hours in bed hoping to get eight hours of sleep, only to get five to six broken hours,” Dr Eng says. 

“Their bed, which should be a place of rest, becomes a source of frustration.”

In the ResMed survey, 65 per cent of Singapore respondents use wearables such as smartwatches, rings or fitness bands to track their sleep. 

“This sharp jump from 21 per cent in 2025 indicates a shift towards technology-driven sleep awareness, which may be helping more Singaporeans recognise and address poor sleep,” says Dr Carlos Nunez, chief medical officer of California-based ResMed.

But at the same time, their beliefs and behaviour seem to contradict each other. Sixty per cent of those polled say they will seek help for a sleep problem, but only 16 per cent do.

Dr Nunez suggests people may still feel there is stigma attached to a sleep disorder, not know how to get help, or resign themselves to living with it. The survey also showed that respondents turn to do-it-yourself solutions like eye masks and blackout curtains.

At SGH, doctors first look for and treat contributing factors, which could be anything from OSA to other medical conditions or even anxiety and depression.  

If the patient has chronic insomnia, Dr Eng works with a psychologist on cognitive behavioural therapy for insomnia (CBT-I).

This is a structured programme that uses tools like a sleep diary to rebuild sleep habits and reduce sleep-related worry. While medication may be used initially to break the cycle of anxiety and sleeplessness, doctors aim to build long-term sleep skills over several months, instead of reliance on pills, he says. 

“The goal isn’t just to sleep better, but also to regain confidence in their ability to sleep,” he adds. 

Dr Lim, who uses CBT-I, says the approach helps reduce the time insomniacs spend in bed and helps them reframe unhelpful thoughts and beliefs about sleep.

He recalls a client who despaired that she had to be on medication for life. After trying CBT-I, she could sleep well again, drug-free, after a few months. 

“Insomnia is common and frustrating, but it shouldn’t be a source of resignation, hopelessness or shame,” he says. 

Sleeping four to five hours a day is normal for Ms Parada Sritaragul, 36, a Thai national and Singapore permanent resident. 

As head of campaign at a marketing agency, she services clients spanning many time zones in the Asia-Pacific, Britain and the United States. That translates to calls as late as midnight, long hours at work and difficulty falling asleep.

“I feel like I’m in an era when I need to be productive. It’s also the mentality here that we cannot waste time,” says Ms Sritaragul. 

She consulted a sleep lab in Bangkok in 2021. On her doctor’s advice, she dropped her high-intensity and CrossFit exercise classes at night. These raised her cortisol levels, leaving her too wired to relax. 

She now does functional strength training and pilates, which has proven beneficial as she feels it relaxes smaller muscles she may not have realised were tight.

“My doctor says I need to have better control of stress. It’s still a work in progress,” she says. 

While she used to plough through the work week on little sleep, raring to go for the weekend, growing older has meant she is exhausted by Friday. And her usual glass of wine to wind down does not work any more. 

According to the ResMed study, nearly one in 10 of Singapore respondents use alcohol to help them sleep. The reality, however, is that alcohol disrupts rest later at night and is associated with a higher risk of sleep apnoea, Dr Nunez says.

Strategies like having better sleep hygiene can also backfire for people with chronic insomnia, Dr Lim says. 

“In people who are already anxious about sleep, it can sometimes worsen the ‘sleep effort’ by turning bedtime into a test. Some clients come to me stressed out over their elaborate list of bedtime rituals, and part of our work is to help them understand that this is hindering, not helping the problem,” he adds. 

Instead, sleep hygiene works best for healthy sleepers as a way to protect and maintain good sleep. 

Dr Lim is among the speakers at the Knowing Your Sleep Inside Out: Sleep Health Festival on March 14. Tickets are free on a first-come, first-served basis from eventbrite.sg

While sleep trackers can be useful in estimating total sleep, they are not a tool for diagnosing insomnia, he cautions. 

“I discourage sleep tracking for those suffering from insomnia as it can worsen anxiety due to worry about sleep scores and the misuse or misinterpretation of sleep metrics,” he says. 

Trying to catch up on lost sleep by going to bed earlier after a bad night or lying in in the morning can make things worse as your brain learns to associate the bed with sleeplessness, Dr Eng says.

“A much more powerful strategy is to keep a consistent wake-up time every day, even on weekends. This helps anchor your body clock and builds a stronger drive for sleep at night.”

He reiterates that insomnia is not a sign of weakness or personal failure. “If sleep is persistently affecting your daytime life, it’s worth seeking help – effective treatments exist.”