I am a 21-year-old student with a terrible case of insomnia. I have tried everything possible to get a good night’s sleep, from exercising till exhaustion to using sleeping pills–all to no avail. I feel tired and sleepy but I can barely get myself to sleep for two hours. Some days, I am up all night and asleep all day. This has been going on for six months now. I started having this problem in my teenage and it's only gotten worse. What should I do? —An insomniac

Answered by Rishav Koirala, Psychiatrist and Researcher

Most of the time when a patient claims to have a sleeping disorder or insomnia, it is usually a secondary problem. Mostly, it is a symptom of other mental health issues like anxiety and depression. My professional experience tells me that it is only about 10 percent of the time when sleeping disorder is a primary issue. So, to figure this out, you will have to go through a proper assessment with a professional to identify the root cause of your sleeping disorder. Only then can we move towards treatment. 

You also mentioned the activities you have tried to sleep better. You should know that some of those activities do more harm than good. For instance, tiring yourself out through exercise is not good, for excessive workout has a bad effect on your sleep, causing distress and sleep disorder. On the sleeping pills, did you take them after professional consultation? If not, I suggest you get off those pills immediately. If a professional prescribed it, then chances are those pills do not suit you. If that medication does not work, another might. 

Concerning your sleep pattern, sleeping all day and being awake at night is the worst enemy of your mental health. I suggest you look up ‘sleep hygiene’ on the internet and try some of the tips to improve your sleep schedule. Some things included with ‘sleep hygiene’ are: going to bed and waking up at the same time every day, including weekends; ensuring your bedroom is quiet, dark, relaxing and at a comfortable temperature; and avoiding large meals, caffeine and alcohol before bed.

Further, there are times when we feel like we have not fallen asleep, while our body is actually getting enough sleep. We wake up thinking we got minimal rest but in reality, our body will have had an adequate amount of sleep to support us throughout the day. You getting only two hours of sleep a night for the past six months also suggests this. If a human body gets only two hours of sleep a day, it will not function after a week or even less. So your body might be getting adequate sleep but you feel sleep-deprived because of stress. 

My first suggestion for you would be to go through some techniques to maintain sleep hygiene, which you will find on the internet. Second, it is good to seek professional help, if you haven’t, to identify the root cause of your sleep disorder. Only then can you proceed to the solution.