Sleep Problems: Why You Cannot Sleep and What Actually Helps

Do you lie awake at night with a racing mind? Wake up multiple times and struggle to get back to sleep? Or feel exhausted despite spending 8 hours in bed? Sleep problems are one of the most common complaints in neurology — and they are very treatable.

Common Sleep Disorders

• Insomnia: Difficulty falling asleep, staying asleep, or waking too early, with daytime impairment. Affects an estimated 30% of adults in India. Can be short-term (triggered by stress, illness, or life events) or chronic (lasting more than 3 months).
• Obstructive Sleep Apnoea (OSA): Repeated partial or complete blockage of the airway during sleep, causing snoring, gasping, and frequent awakenings. Often unrecognised. Causes daytime sleepiness, high blood pressure, and increases heart attack and stroke risk if untreated.
• Restless Legs Syndrome (RLS): An irresistible urge to move the legs, often with uncomfortable sensations — typically worse in the evening and at rest. Significantly disrupts sleep.
• Circadian Rhythm Disorders: The body's clock is misaligned — e.g. night shift workers, or teenagers who cannot sleep until 2am and cannot wake up in the morning.
• REM Sleep Behaviour Disorder: Acting out dreams physically — shouting, punching, kicking. Often an early sign of Parkinson's disease or other neurodegenerative conditions.

The Most Evidence-Backed Treatment for Insomnia

Contrary to what many people think, sleeping tablets are not the first-line treatment for chronic insomnia. Cognitive Behavioural Therapy for Insomnia (CBT-I) is the most effective long-term treatment. It involves sleep restriction, stimulus control, relaxation techniques, and challenging unhelpful beliefs about sleep.

Sleep hygiene improvements also help significantly: consistent sleep/wake times (even on weekends), avoiding screens 1 hour before bed, keeping the bedroom cool and dark, and avoiding caffeine after 2pm.

When to See a Neurologist for Sleep Problems

• Sleep problems lasting more than 3 months
• Daytime sleepiness severe enough to affect driving or work
• Witnessed apnoeas or very loud snoring (OSA screening)
• Leg movements or restless legs causing significant disruption
• Acting out dreams physically
• Excessive sleepiness regardless of time in bed (possible narcolepsy)

"Sleep is as essential to health as diet and exercise. Chronic poor sleep raises the risk of depression, diabetes, heart disease, and dementia. It is not a luxury to treat it — it is a medical necessity."

Dr. Anand Karnam provides sleep disorder consultations at Sri Anand Child and Neuro Center, Chanda Nagar, Hyderabad. Call +91 90633 66983.