THMC Mental Health & Innovation Centre
ADHD and Dementia Assessment
緻安精神健康醫療創新中心
Mental Health Clinic Specializing
in ADHD and Mood Disorders
for Children and Adults
Open as Usual on Saturday Afternoons
失眠
Insomnia
Insomnia is a common medical problem globally. Studies have shown that 11.7%–36% of the population could be affected by insomnia [1]. Insomnia is characterised by initial insomnia (i.e., cannot fall asleep), middle insomnia (i.e., waking up more than 2 times in the middle of the night, not due to toilet usage) and terminal insomnia (i.e., early morning awakening) with a negative impact on the next day's functioning.
A case of insomnia
Mr Lee, a 35-year-old executive, feels that his work is stressful. It takes him 3 hours to fall asleep, and he wakes up four times in the middle of the night due to vivid dreams and nightmares. He wakes up at 5 am and cannot fall asleep again. He feels unrefreshed after he wakes up. He falls asleep in the daytime and affects his driving performance. He almost crashed his car last week.
How common is insomnia?
Approximately 1/3 of adults worldwide have symptoms of insomnia. Around 10 percent of adults meet the diagnostic criteria for insomnia disorder.
What are the next-day consequences of insomnia?
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Fatigue or low energy
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Daytime sleepiness
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Impaired attention or memory
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Mood disturbance/irritability
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Impaired occupation or academic function
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Impaired interpersonal or social function
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Impaired driving ability
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Reduced motivation/energy/initiative
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Increased errors/accidents
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Tension headaches
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Drug and alcohol misuse to help sleep
I tried the sleep hygiene technique, but it did not work. How can a family doctor/psychiatrist help me?
A family doctor or psychiatrist will discuss medication or pharmacological treatment with you. An optimal pharmacologic treatment for insomnia should improve sleep onset, sleep maintenance, sleep quality and daytime functioning. As some patients suffer from chronic insomnia, the medications should be safe and effective for long-term use. There are medications without next-day residual effects of drowsiness.
Are all sleeping medications addictive?
Traditional sleep medications (e.g. benzodiazepine) can be addictive. Currently, there are other medications that work differently than benzodiazepine and can help to sleep and are not associated with dependency.
Source:
Academic papers in which Dr Roger Ho is one of the co-authors
Soh HL, Ho RC, Ho CS, Tam WW. Efficacy of digital cognitive behavioural therapy for insomnia: a meta-analysis of randomised controlled trials. Sleep Med. 2020 Nov;75:315-325. doi: 10.1016/j.sleep.2020.08.020. Epub 2020 Aug 26. PMID: 32950013.