Insomnia : Tired of Being Tired
When Sleep Stops Being Simple
Falling asleep shouldn’t be a nightly battle — but for millions of Australians, it is. Around 30–35% of adults report regular difficulty with sleep, and chronic insomnia affects at least 10%. It’s not just about feeling tired — insomnia increases your risk of depression, cardiovascular disease, metabolic issues, and even lowers pain tolerance.
Understanding Sleep Physiology
Sleep is regulated by two key biological systems:
The Circadian Rhythm – your internal body clock, tied to light/dark cycles. It signals when it’s time to feel alert and when to wind down.
The Sleep–Wake Homeostat – builds sleep pressure across the day. The longer you’ve been awake, the more your body craves sleep.
When these two systems fall out of sync — through stress, poor habits, late-night screens, shift work, or jet lag — insomnia can follow.
Also critical? Melatonin, your brain’s sleep hormone. It rises in the evening (when exposed to darkness), signalling the body it’s time to rest. Bright lights, especially blue light from phones and screens, suppress melatonin and delay sleep onset.
What Causes Insomnia?
Stress and anxiety – overactivation of the HPA axis (your stress system) can delay melatonin and reduce deep sleep.
Poor sleep hygiene – inconsistent bedtime routines, napping, late meals or workouts, screens in bed.
Chronic conditions – pain, reflux, overactive bladder, asthma, hot flushes, etc.
Medications – corticosteroids, stimulants, some antidepressants and beta-blockers.
Hormonal changes – menopause, testosterone decline, thyroid dysfunction.
Lifestyle habits – alcohol may sedate you initially, but disrupts REM sleep and causes early waking.
Evidence-Based Treatments That Actually Work
CBT-I (Cognitive Behavioural Therapy for Insomnia)
Still the gold standard. CBT-I is a structured program that targets negative sleep associations, unhelpful thought patterns (“I’ll never sleep again”), and counterproductive behaviours.
It consistently outperforms medication in long-term studies — with better results at 6- and 12-month follow-up.
💡 You can access CBT-I online in Australia via platforms like This Way Up or through referral to a psychologist trained in sleep therapy.
Sleep Hygiene and Behavioural Optimisation
These aren’t just “soft” tips — they’re built on solid circadian science:
Consistent Sleep/Wake Times – even on weekends
No screens 1–2 hours before bed – reduces melatonin suppression
Use bed for sleep (and sex) only – no working or scrolling
Dim lights in the evening – use warm bulbs and limit stimulation
Avoid caffeine after midday, and limit alcohol before bed
Get morning sunlight – anchors your circadian rhythm and improves melatonin timing
If you can’t sleep after 20 minutes, get up and do something calming – don’t lie there stressing
Medications: When They’re Helpful — and When They’re Not
Melatonin: helpful in older adults, jet lag, or delayed circadian rhythm disorders. Less helpful for classic insomnia.
Doxepin (low dose): a sedating antihistamine-like antidepressant with good evidence for sleep maintenance issues.
Z-drugs or benzos (e.g. temazepam): should be reserved for short-term or crisis use only. Dependence, tolerance, and rebound insomnia are common.
Mirtazapine, amitriptyline: occasionally used off-label for comorbid depression or anxiety, but with side effects (e.g. daytime drowsiness, weight gain).
When to See a GP
If insomnia is frequent (≥3 nights a week) and lasting more than 3 months, or it’s affecting your work, mood, or quality of life — it’s time to seek help.
Also consider assessment for:
Sleep apnoea (especially if snoring or waking unrefreshed)
Restless legs syndrome
Mood disorders
Perimenopausal sleep disruption