Poor sleep is rarely just a sleep problem
Insomnia — difficulty falling asleep, staying asleep, or waking too early despite genuinely wanting to sleep — is one of the most common concerns people bring to a psychiatric consultation, and also one of the most misunderstood. Many people try months of home remedies, over-the-counter aids, or simply "trying to sleep harder" before considering that the sleeplessness might have a specific, identifiable, and treatable cause. By the time someone reaches out for help, they've often been exhausted for so long that the exhaustion itself has become the main problem, layered on top of whatever started it.
The scale is striking: a systematic review published in the Indian Journal of Public Health (2024), pooling 100 Indian studies, found insomnia in 25.7% of people overall — 15.1% in the general population and 32.3% among those already living with a medical condition. Sleeplessness is one of India’s most widespread and least treated complaints.
The good news: chronic insomnia responds very well to structured treatment, and that treatment rarely starts — or ends — with a prescription pad.
What insomnia can look like
Onset insomnia
Lying awake for long stretches before falling asleep, often with a racing or ruminating mind once the lights go off.
Maintenance insomnia
Falling asleep without much trouble, but waking repeatedly through the night and struggling to fall back asleep.
Early morning waking
Waking hours before you need to, unable to fall back asleep — a pattern often, though not always, linked to low mood.
Non-restorative sleep
Getting a reasonable number of hours but still waking exhausted, as though the sleep itself wasn't doing its job.
What actually causes chronic insomnia
Occasional poor sleep — before an exam, after a stressful day — is normal and usually resolves on its own. Chronic insomnia (typically defined as difficulty sleeping at least three nights a week for three months or more) is different: it often develops because a short-term sleep disruption gets reinforced by anxiety about sleep itself. You have a few bad nights, start worrying about sleep before bed, and that worry itself becomes enough to keep you awake — a self-perpetuating cycle that simple sleep hygiene advice rarely breaks on its own. Underlying anxiety, depression, chronic stress, or an irregular schedule frequently sit underneath this cycle, which is why a proper assessment looks at the whole picture, not just the hours slept.
CBT-I — the recommended first-line treatment
CBT-I (Cognitive Behavioural Therapy for Insomnia) is a structured, evidence-based programme — and it's recommended by major clinical guidelines as the first-line treatment for chronic insomnia, ahead of medication, because its effects tend to last well beyond the treatment period itself. It typically includes:
- Sleep restriction therapy — temporarily limiting time in bed to rebuild a stronger association between bed and actual sleep.
- Stimulus control — retraining the mind to associate the bed with sleep, not with lying awake, scrolling, or worrying.
- Cognitive work — addressing the anxious thoughts about sleep itself ("I'll never sleep tonight," "I need eight hours or tomorrow is ruined") that quietly keep the cycle going.
- Relaxation and wind-down strategies — practical techniques to lower physical and mental arousal before bed.
A CBT-I programme with Dr. Heena typically runs over several weeks, with sessions building on each other rather than a single one-off consultation.
What treatment can include
Treatment is never assumed to be medication alone. CBT-I forms the core of most insomnia treatment plans; medication is considered where it genuinely helps — for example, to break an acute, severely disruptive cycle while therapy takes effect — and is generally used for the shortest effective period, with a clear plan discussed upfront rather than left open-ended.
How insomnia connects to anxiety, depression and stress
Sleep and mental health run in both directions — poor sleep can trigger or worsen anxiety and low mood, and anxiety, depression or chronic stress can just as easily be what's driving the poor sleep in the first place. This is why an insomnia assessment with Dr. Heena includes a broader look at mood, stress, and daily functioning, not just a checklist of sleep symptoms. Getting this right matters: treating insomnia in isolation when an underlying anxiety or depressive disorder is actually driving it rarely produces lasting results.
Sleeplessness is often described plainly rather than clinically — "ઊંઘ નથી આવતી" (sleep doesn't come) in Gujarati, or "नींद नहीं आती" / "मुझे नींद की समस्या है" in Hindi. These everyday descriptions are exactly where the conversation starts.
What to expect from a first consultation
The first session is an unhurried, confidential conversation about your sleep history — how long this has been going on, what a typical night looks like, what you've already tried, and how it's affecting your days. Dr. Heena will also ask about mood, stress, and any physical symptoms, since sleep rarely exists in isolation from the rest of your health. From there, a plan is built together — usually anchored in CBT-I, with medication considered only where it genuinely adds value.
A quick self-check
- Has poor sleep happened at least three nights a week for three months or more?
- Do you find yourself worrying about sleep before you even get into bed?
- Is poor sleep noticeably affecting your concentration, mood, or work during the day?
- Have sleep hygiene changes — no screens, a fixed bedtime — failed to make a lasting difference?
- Does poor sleep coincide with, or seem connected to, stress, low mood, or anxiety?
If several of these feel familiar, a structured assessment is worth having — chronic insomnia responds well to the right treatment, and it rarely resolves on its own with more willpower alone.
About Dr. Heena Khanna
Dr. Heena Khanna, MBBS, MD (Psychiatry)
Dr. Heena Khanna is a Consultant Psychiatrist practising at Mahavir Health Campus, Ring Rd, Athwa Gate, Surat. She holds an MBBS and an MD in Psychiatry, and is a member of the Indian Psychiatric Society and the Indian Medical Association. Her practice covers insomnia and sleep difficulty alongside anxiety, depression, stress, and related conditions, using evidence-based approaches including CBT-I and, where appropriate, medication. Online consultations are available for CBT-I follow-up sessions; no referral is required to book a first appointment.