Insomnia

Energy, Sleep & Stress Care
Written By Jennifer Tang

Overview

Insomnia is a common sleep disorder involving difficulty falling asleep, staying asleep, or getting enough restorative sleep despite having adequate opportunity to sleep. It can lead to fatigue, difficulty concentrating, irritability, reduced productivity, and other daytime difficulties.¹˒²

At Tangible Health, we look at your sleep pattern, daily schedule, stress, mental health, medications and supplements, caffeine and alcohol use, physical symptoms, life-stage changes, and other sleep concerns. Care focuses on identifying factors that may be disrupting sleep while supporting evidence-based approaches such as cognitive behavioural therapy for insomnia (CBT-I) when appropriate.¹˒³

What Is Insomnia?

Insomnia involves difficulty falling asleep, staying asleep, or returning to sleep after waking, together with problems functioning during the day. Importantly, the sleep difficulty occurs despite having enough time and an appropriate opportunity to sleep.²˒⁴

Insomnia may be short-term, often developing around stress, illness, travel, schedule changes, or major life events. Chronic insomnia disorder generally involves sleep difficulties at least three nights per week for three months or longer, together with daytime impairment.²˒⁴

Insomnia is different from simply not giving yourself enough time to sleep. It can also coexist with depression, anxiety, chronic pain, menopause, and other health conditions rather than always being caused by them.¹

Common Symptoms of Insomnia

Sleep Symptoms

  • Difficulty falling asleep

  • Frequent or prolonged awakenings

  • Difficulty returning to sleep

  • Waking earlier than intended

  • Feeling dissatisfied with sleep quality

Daytime Symptoms

  • Fatigue or low energy

  • Difficulty concentrating

  • Problems with memory or attention

  • Irritability or mood changes

  • Reduced motivation or productivity

  • Difficulty functioning at work, school, or home²˒⁴

Marked daytime sleepiness, especially falling asleep unintentionally or in inappropriate situations, may suggest another sleep disorder rather than uncomplicated insomnia.¹

Causes & Contributing Factors

Insomnia often develops through several interacting factors rather than one single cause.

Stress & Mental Health
Stressful life events can trigger short-term insomnia, while anxiety, depression, and ongoing worry may contribute to or coexist with persistent sleep difficulties. Once insomnia becomes chronic, learned sleep behaviours and worry about sleep can also help maintain the problem even after the original trigger has passed.¹

Sleep Schedule & Daily Habits
Irregular sleep schedules, shift work, frequent naps, excessive time awake in bed, late caffeine use, alcohol, nicotine, and changes in light exposure can interfere with normal sleep timing or sleep quality.³

Medical Conditions & Pain
Chronic pain, respiratory symptoms, reflux, urinary symptoms, and other health concerns can make it difficult to fall or remain asleep. Treating an accompanying condition can be important, although chronic insomnia may still need its own treatment.¹

Medications & Substances
Some prescription medications, over-the-counter products, stimulants, caffeine, alcohol, nicotine, and other substances can interfere with sleep. Regular use of sleep medications also deserves review because benefits, side effects, dependence, and withdrawal risks vary between treatments.³˒⁵

Other Sleep Disorders & Life-Stage Changes
Sleep apnea, restless legs syndrome, circadian rhythm disorders, and other sleep conditions can sometimes resemble or contribute to insomnia. Loud snoring, gasping, witnessed pauses in breathing, or prominent daytime sleepiness warrant consideration of sleep apnea.⁶ Sleep difficulties are also common during the menopause transition, including both difficulty falling asleep and waking during the night.⁷

Our Approach to Insomnia

At Tangible Health, we focus on understanding your specific sleep pattern and the factors most relevant to keeping it disrupted.

Your Sleep Patterns & Daily Routine
We look at bedtime and wake time, how long it takes to fall asleep, nighttime awakenings, naps, work schedule, caffeine and alcohol, evening routines, and how sleep difficulties affect you during the day.

Your Health & Contributing Factors
We review stress, mood, medications and supplements, pain, menopause or other life-stage changes, and symptoms that may suggest sleep apnea, restless legs syndrome, or another sleep disorder. The goal is not to assume poor sleep comes from cortisol imbalance, blood-sugar instability, or a hidden hormonal problem. Instead, we identify specific behavioural, environmental, medical, or psychological factors that may be useful to address.

Your Goals
Your goals may include falling asleep more easily, spending less time awake during the night, reducing anxiety around sleep, feeling more rested during the day, reducing reliance on sleep aids, or developing a more sustainable sleep routine.

Treatments That May Be Included

For chronic insomnia, CBT-I is the recommended first-line treatment. It combines approaches such as stimulus control, adjusting time in bed, cognitive strategies, relaxation techniques, and sleep education. Sleep hygiene can support treatment, but sleep hygiene alone is generally not sufficient for chronic insomnia.¹˒³˒⁵

Your supportive care plan may include:

  • Lifestyle Medicine to support consistent sleep and wake times, light exposure, physical activity, caffeine and alcohol habits, and a sleep-supportive environment

  • Naturopathic Counselling to support stress management, behaviour change, sleep-related worry, and implementation of sustainable routines

  • Clinical Nutrition to support regular nutrition and address caffeine, alcohol, meal timing, or nutritional concerns relevant to sleep

  • Nutraceuticals & Supplements when there is a specific indication, with attention to evidence, timing, side effects, and medication interactions

  • Botanical Medicine in selected circumstances based on evidence, safety, medical history, and potential interactions

  • Medication & Supplement Review to identify treatments that may interfere with sleep and review regular use of prescription or over-the-counter sleep aids

  • Collaborative Care with a CBT-I provider, family doctor, psychologist, sleep physician, psychiatrist, or other healthcare professional when appropriate

Prescription medication may sometimes be used for insomnia, but treatment should be individualized according to the type and duration of insomnia, other health conditions, previous treatment, and potential harms.³˒⁵

What to Expect

Initial Assessment
We begin with a detailed review of your sleep schedule, difficulty falling or staying asleep, nighttime awakenings, daytime symptoms, naps, caffeine and alcohol, stress, medications and supplements, physical symptoms, and medical and mental health history.

Sleep Patterns & Contributing Factors
A sleep diary can help identify patterns in bedtime, wake time, awakenings, naps, and sleep consistency. We also look for symptoms suggesting another condition such as sleep apnea, restless legs syndrome, a circadian rhythm disorder, anxiety, depression, chronic pain, or medication-related sleep disruption.¹˒⁴ A sleep study is not automatically required simply because someone has insomnia. It may be appropriate when symptoms suggest another sleep disorder, particularly sleep apnea or a sleep-related movement disorder.⁶

Personalized Plan
Your plan is developed around your sleep pattern, contributing factors, existing treatment, medications and supplements, and personal goals. For chronic insomnia, this may include referral for or coordination with CBT-I rather than relying on sleep hygiene or supplements alone.¹˒³

Ongoing Support
Follow-up focuses on sleep onset, nighttime awakenings, daytime function, sleep-related worry, treatment response, and progress toward your goals. Recommendations can be adjusted as your sleep pattern changes.

When to Seek Support for Insomnia

Consider speaking with a healthcare provider if:

  • Sleep difficulties persist for several weeks or continue to recur

  • You regularly have difficulty falling or staying asleep

  • Poor sleep is affecting concentration, mood, work, school, or daily function

  • You rely regularly on prescription or over-the-counter sleep aids

  • Anxiety about sleep is becoming a significant problem

  • Pain or another health condition is repeatedly disturbing sleep

  • Sleep problems begin or worsen during pregnancy, postpartum, or menopause

  • You experience uncomfortable sensations or an urge to move your legs at night

  • You snore loudly, gasp during sleep, or someone notices pauses in your breathing⁶

Seek prompt or urgent medical care if:

  • You repeatedly fall asleep while driving or during other potentially dangerous activities

  • You experience severe difficulty breathing or chest pain

  • Sleep loss occurs alongside severe agitation, confusion, hallucinations, or a major change in behaviour

  • You have thoughts of suicide or self-harm

  • You feel unable to keep yourself or someone else safe

Book An Appointment

Frequently Asked Questions

  • Insomnia occurs when you have adequate opportunity and circumstances for sleep but still have difficulty falling asleep, staying asleep, or functioning well because of poor sleep. Simply staying up too late or not allowing enough time for sleep is sleep restriction rather than insomnia.²

  • Chronic insomnia generally involves difficulty sleeping at least three nights per week for three months or longer, together with daytime consequences.²˒⁴

  • CBT-I is a structured treatment that uses behavioural and cognitive strategies to improve sleep. It may include stimulus control, carefully adjusting time in bed, relaxation, sleep education, and addressing thoughts or behaviours that perpetuate insomnia. It is the first-line treatment for chronic insomnia.¹˒³

  • Healthy sleep habits are useful, but sleep hygiene alone is usually not sufficient for chronic insomnia. CBT-I addresses additional behaviours and thought patterns that can keep insomnia going.¹

  • Not necessarily. CBT-I is generally recommended first for chronic insomnia. Medication can sometimes be appropriate depending on the individual, but potential benefits, side effects, dependence, and interactions should be reviewed.³˒⁵

  • Melatonin can be useful in certain situations involving sleep timing or circadian rhythm, but it is not a universal treatment for chronic insomnia. Its usefulness depends on the sleep problem, timing, dose, age, other medications, and individual circumstances.³

  • Yes. Difficulty falling asleep and waking during the night are common during the menopause transition. Symptoms such as hot flashes and night sweats may also disrupt sleep, and insomnia can coexist independently with menopause.⁷

  • Naturopathic care can support sleep routines, stress management, nutrition, medication and supplement review, and assessment of relevant health factors. For chronic insomnia, care should also incorporate or coordinate with evidence-based CBT-I and appropriate medical assessment when another sleep disorder is suspected.¹˒³

 

Related Care

Insomnia may overlap with several areas of health. You may also benefit from:

Jennifer Tang
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