Insomnia as a symptom: treat the underlying cause

Insomnia and other sleep disorders are common problems that patients present to their doctors.

Sleeping pills are usually not the best solution.

They sedate the brain and by doing so may increase our risk for accidents including falls. This is particularly risky in the elderly who happen to be the group that is prescribed the most sleeping pills. Sedation may persist into the morning, impairing our judgment and alertness at home, at work and on the road.

The regular use of sleeping pills may result in dependence – when your brain requires a pill every night to fall asleep and tolerance – when the same dose no longer works and you have to switch to a stronger medication.

Instead, you and your doctor could think of sleeping difficulties as a symptom – a marker for a more significant problem. Together you can treat the underlying cause.

Early insomnia – or difficulty falling asleep – can be due to anxiety, stress or stimulants. Avoid exciting activities (i.e. vigorous exercise and arguments) just before bedtime along with caffeinated drinks. Reduce unnecessary stress, and adopt strategies to manage anxiety during the day. These might include meditation, self-reflection, debriefing with your friends or professional counseling. Moderate exercise earlier in the day is often helpful.

Middle and late insomnia, such as early morning awakening can sometimes be a symptom of depression. If you are having persistent symptoms, don’t hesitate to talk to your doctor.

Some medical conditions can interrupt your sleep. These include bladder problems (such as enlargement of the prostate), congestive heart failure (when individuals feel more short of breath when lying flat) and asthma (wheezing or bronchospasm that is often worse at night or in the early morning). Nocturnal symptoms suggest that something more is needed to adequately control the underlying condition.

Nonrestorative sleep can be a sign of a respiratory problem, including obstructive sleep apnea. If you have significant daytime sleepiness, talk to your doctor. The diagnosis can be confirmed with noninvasive tests.

Next: non-drug sleeping solutions.

Dr. Davidicus Wong is a physician and writer. His Healthwise column appears regularly in the Burnaby Now, Vancouver Courier and Royal City Record. You can find his posts at


About Davidicus Wong

I am a family physician. I write a weekly newspaper column, Healthwise for the Vancouver Courier, Burnaby Now, Royal City Record and Richmond News.
This entry was posted in Healthy Living, stress management and tagged , , . Bookmark the permalink.

3 Responses to Insomnia as a symptom: treat the underlying cause

  1. Jaime says:

    Hi Dr. Wong,

    I really enjoy reading your articles in the Courier and on your website. They are both great resources to finding pieces of inspiration, reassurance, and guidance.

    With regards to middle and late insomnia or early morning awakening, does this refer to waking up at odd hours throughout the night or feeling the need to wake up unnecessarily early?



    • Thank you, Jaime. Late insomnia refers to early morning awakening (waking up before you’ve had enough sleep and not being able to fall asleep again). Early insomnia refers to difficulty falling asleep when you first go to bed. Middle insomnia refers to awakening in the middle of your sleep time and having difficulty falling back to sleep.

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