You have described difficulty falling and staying asleep, and inability to stop thinking at night. This is commonly seen in patients with psychologically-based insomnia, such as psychophysiological insomnia (also known as "learned insomnia" or "conditioned insomnia"), and in patients who are depressed or anxious.
In psychophysiological insomnia and anxiety, it is typical for the person to find it difficult to fall asleep. Waking up early in the morning is more characteristic of depression.
Generally, all of these conditions are associated with an excessively high arousal state at bedtime. Even though one feels tired and has been awake and active all day, the mind cannot be switched off.
This high arousal state can be emotional - due to stress, anxiety or depression, for example - or physical, usually from exercising too late at night or eating a heavy meal right before bedtime.
To begin with, you can take simple measures to reduce the high arousal state at bedtime. For instance, you can develop a regular wind-down routine before bedtime, about one to two hours before the desired time to sleep.
Reading, relaxing with a hobby or listening to music, taking a warm bath and anything that is done in a quiet, serene setting without bright lights are all ideal.
Bright lights, using electronic media such as the iPad, playing computer games, or watching TV programmes with emotionally disturbing or stimulating content can delay the onset of sleep.
This is because the illumination entering the eyes from artificial room lighting and electronic media can affect our body's internal sleep clock in the brain. Therefore, a quiet, darkened, pleasant and relaxing bedroom environment is ideal.
It is best to avoid working till late at night to prevent excessive mental stimulation, which affects sleep.
Physical factors like late heavy meals and vigorous exercise should be avoided four to five hours before bedtime.
Exercise has many health benefits, including relieving stress and depression, and promoting deep sleep. A good time to exercise is after work and before dinner. Leisurely exercise at the end of the work day is recommended for those who have a lot of mental stress at work.
Running late at night is not ideal because physical - and mental activation - can cause the kind of arousal which prevents sleep in people who are prone to psychophysiological insomnia.
If these simple measures are not effective, it is best to seek medical attention early. A bedside evaluation by the doctor can usually help to determine the cause of the problem.
If there is significant depression or anxiety, a course of medication may be required. In some cases, a sleep study may be needed to help determine if there are any physical problems disrupting sleep.
Using aromatherapy and drinking warm milk may help to reduce arousal. For example, a pleasant aroma evocative of positive memories can help to relax a person, and a glass of warm milk can similarly help to reduce mild hunger pangs, if any.
Sleeping pills are rarely indicated for the long term, and will need close supervision by a doctor. It is best to seek medical advice early and avoid self-medication.
