Sleep Medicine Center
Insomnia Is More Than Just Sleeplessness – Understanding Its Definition and Types
Insomnia is one of the most common sleep disorders. It's not just about "not being able to sleep" – it may also present as "not sleeping long enough" or "still feeling tired after sleeping." Clinically, insomnia can be categorized into several types:
Difficulty falling asleep: Taking more than 30 minutes to fall asleep.
Difficulty staying asleep: Waking up multiple times during the night or having trouble falling back asleep.
Early awakening: Waking up earlier than desired and being unable to return to sleep.
Poor perceived sleep quality: Feeling fatigued or lacking energy despite adequate sleep duration.
Based on duration, insomnia can also be divided into:
Short-term/acute insomnia: Often related to life stressors or sudden events, typically lasting from a few days to a few weeks.
Chronic insomnia: Occurs at least three nights per week and lasts for more than three months, often requiring professional intervention.
At the Sleep Medicine Center of Tri-Service General Hospital, we have observed that most patients with chronic insomnia experience stress-related events or emotional distress rather than solely physiological factors. This highlights that insomnia is rarely a standalone issue – it's typically the result of interacting psychological and physiological components.
The Hidden Causes of Sleeplessness: The Roles of Anxiety and Depression
According to international sleep research, 60–80% of chronic insomnia patients also exhibit symptoms of anxiety or depression. These conditions are closely interconnected: anxiety commonly causes difficulty falling asleep, while depression is often associated with early awakening and fragmented sleep.
In states of anxiety, the body experiences a "hyperarousal" response – elevated heart rate, muscle tension, and a racing mind that prevents restful sleep. Even when physically tired, the brain stays hyperactive, making it difficult to fall into stable sleep.
Meanwhile, depressive symptoms significantly impact sleep architecture. Research shows that people with depression frequently wake at 3 or 4 a.m., accompanied by early morning emotional lows, worsening fatigue and hopelessness during the day.
Our Psychiatry Department has analyzed outpatient cases of insomnia caused by emotional issues. We found that individuals who excessively "try to sleep" or worry about "not functioning well the next day" are more likely to fall into a vicious cycle of insomnia and anxiety. Addressing underlying emotional health is thus a vital step in restoring healthy sleep.
How Does the Vicious Cycle Form?
The interaction between insomnia and emotional disorders is often like a tug-of-war. Anxiety leads to excessive focus on sleep itself. When one fails to fall asleep quickly, they become even more anxious. This anxiety triggers physiological reactions – such as increased cortisol levels and sympathetic nervous system activity – which make falling asleep even harder.
This cycle of "worrying about not sleeping → not sleeping → worrying more → sleeping even worse" lies at the heart of chronic insomnia. Many patients report, "The harder I try to sleep, the more awake I feel." Over time, they even develop fear or anxiety about going to bed, turning the bed itself into a trigger for stress.
Daytime consequences of poor sleep – like reduced concentration, low mood, and poor work performance – may damage relationships and self-confidence. These frustrations resurface at night, compounding the insomnia and depressive symptoms.
Clinical experience at Tri-Service General Hospital shows that when patients understand the root causes of insomnia, release the pressure to "force sleep," and adopt behavioral strategies with or without medication, they can gradually break free from this vicious cycle.
You're Not Alone – How We Can Help
If you are struggling with insomnia – whether it's difficulty falling asleep, waking in the middle of the night, or feeling exhausted during the day – anxiety or depression may be underlying factors.
At Tri-Service General Hospital, we offer integrated support:
Department of Psychiatry: For sleep and emotional difficulties, we offer comprehensive psychological assessments and treatment plans, including Cognitive Behavioral Therapy for Insomnia (CBT-I), stress management training, and medication when necessary.
Sleep Medicine Center: If physical causes such as obstructive sleep apnea (OSA) are suspected, we offer in-lab polysomnography (PSG) or home sleep apnea testing (HST) to determine the root cause.
Multidisciplinary Care: Our psychiatrists collaborate closely with specialists in pulmonary medicine, ENT, and other departments to identify coexisting emotional and physical sleep disorders and develop the most suitable treatment strategies.
We believe every patient deserves restful, restorative sleep. With accurate diagnosis and structured support, recovery from insomnia is truly within reach.
When Should You See a Doctor?
Many people consider temporary sleeplessness a normal reaction to stress. However, if the following issues persist, we recommend professional evaluation:
Difficulty falling asleep, staying asleep, or early awakening occurring more than three times a week for over three months.
Daytime fatigue, lack of focus, low mood affecting work or life quality.
Reliance on over-the-counter or prescription sleep aids without lasting benefit.
Coexisting anxiety or depression symptoms, or suicidal thoughts.
Loud snoring, observed apnea, sudden awakenings, or excessive daytime sleepiness.
What You Can Do: 5 Sleep Hygiene Tips
Besides medical treatment, small lifestyle changes can significantly improve sleep. Here are five common tips from our Sleep Medicine Center:
Maintain a regular sleep schedule: Go to bed and wake up at consistent times every day, including weekends.
Limit daytime naps: If needed, keep naps under 30 minutes to preserve nighttime sleep drive.
Relax before bed: Use deep breathing, meditation, a warm bath, or calming music to wind down your brain.
Avoid blue light and stimulants: Refrain from using screens and consuming caffeine or nicotine within one hour of bedtime.
Use your bed only for sleep: Only go to bed when sleepy. Avoid reading, scrolling on your phone, or worrying while in bed.
Conclusion: Reclaim Your Nights by Understanding Yourself
Insomnia is more than just sleeplessness – it can be a signal of mind-body imbalance or emotional distress. When we are overwhelmed or driven by perfectionism, we often overlook our own fatigue and anxiety.
If you're caught in the cycle of "the more I want to sleep, the less I can," remember: you are not alone. Our teams at the Sleep Medicine Center and Department of Psychiatry are here to help you regain balance and restore your inner healing power.
By understanding insomnia and making evidence-based changes in your lifestyle, you can break the cycle and wake up to brighter, more stable mornings.
Note: All medications should be prescribed by a qualified physician. If long-term use is necessary, please attend regular follow-ups to monitor dosage and effectiveness.