All About Insomnia: Principles, Diagnosis, Treatment

November 30, 2023

All About Insomnia: Principles, Diagnosis, Treatment

Like any other day, you head to your bedroom without the thought of not being able to sleep. You simply had things on your mind or an important day ahead.

"How will that go..."
"I have my midterm this week, I should do well..."
"I have an important presentation the day after."

Strangely enough, your eyes are wide awake. The thoughts about sleep keep coming.

"Why can't I sleep?"

Eventually tossing and turning, you check your phone. A lot of time has passed, and you still can't sleep. The more the thought of 'sleep itself' arises,

"Should I count sheep?"

You unknowingly fall asleep. It's already morning. The condition is not good. You're not sure when you fell asleep but you tossed and turned a lot last night. First, you get out of your bed to start the day. It might be a bit tiring and jittery, but a day that's not too different from others passes. And the night comes again. You think,

"It took a lot of time to fall asleep yesterday. It took almost an hour."

There is an important presentation tomorrow. The thought of having a good night’s sleep becomes stronger, and you come up with an amazing method.

“"Then let’s go to bed an hour earlier today. It is safe. Because I am tossing around for about an hour, but then, the time to fall asleep will be similar anyway. Then I can spend the day tomorrow in good condition."

It was a safe idea. If you go to bed for more sleep, even if you can't fall asleep for a while, you can secure enough sleep time anyway. You enter your bedroom earlier than usual.

But of course, sleep is nowhere in sight. There were no other changes, but only when you went to bed earlier. Time flies that way. You see your phone and it's already the time when you use to go to bed. Your eyes are still wide awake. Now the feeling of anxiety is amplified.

"What... I went to bed an hour earlier, intending to sleep early, but it turned out not any different from yesterday."

Because it didn't go as planned even though I was safe and went to bed early, my anxiety grows much bigger. The pacing overwhelms the bedroom. And that night, I managed to fall asleep late at night.

Nothing is different the next day. Of course, you will try a variety of things. You will try to change your pillow and also to exercise before going to bed. Regrettably, these are not helpful. If anything, it rather interferes with your sleep.

Thus, you end up losing your night.

Causes and Diagnoses of Insomnia

How is it? Is it similar to your case? Although all of the content might not be the same, the results of anxiety and impatience overwhelming from your bedroom will be similar. It is because it is the core of insomnia.

A lot of people are struggling with insomnia. According to the National Health Insurance Service, the number of people who received treatment for insomnia in 2020 was 670,000, increasing about 8% annually since 2016. Office workers are no exception. Many office workers are suffering from insomnia. According to related statistics, the common causes of insomnia in office workers are the following:

  • Burnout
  • Excessive work stress
  • The burden of work
  • Tangled sleep patterns due to parenting

Insomnia means not being able to sleep even though there is plenty of time to sleep. In other words, not being able to sleep because they are busy due to work or parenting is not insomnia. It is more important to secure sleep time in such cases. Insomnia, on the other hand, refers to the case where one cannot sleep, and even though there is plenty of time to sleep and even though I try, I cannot sleep. In insomnia, the following symptoms often appear.

  • It takes more than 30 minutes to fall asleep making it hard to fall asleep.
  • I wake up from sleep often or it is hard to fall back to sleep after waking up.
  • I wake up in the early morning and it is hard to go back to sleep.

And if these symptoms cause difficulty in daily life, the problem occurs more than three times a week, and continues for more than three months, we call it insomnia.

Insomnia can occur due to various causes. It can be caused by mental stress, poor sleep habits, medication you are taking, or other diseases. Sometimes, insomnia can be caused by sleep-related disorders such as restless leg syndrome and sleep apnea. In addition, among those who have been suffering from chronic insomnia for more than 3 months, as many as 50% are reported to be suffering from psychiatric disorders such as anxiety and depression.

Yet, symptoms of sleeplessness itself are quite common, experienced by about 35-50% of the total population. Among them, 40-70% become chronic within 1-20 years. Insomnia generally occurs more frequently in women than in men, and tends to occur more often as one gets older.

Inaccurate Information about Insomnia

Given that 35-50% of the total population experiences it at least once, maybe, that is why? There is also a variety of information about how to improve insomnia. The unfortunate part is that most of the solutions that many people are spending their time and money on are hardly effective. Let's look at the common misconceptions.

Sleeping pills

Sleeping pills are sedatives that turn off the biological clock to induce sleep. Sleeping pills like benzodiazepines and zolpidem can help relieve insomnia symptoms in the short run. However, most sleeping pills have resistance and addiction, therefore they are generally used only in small amounts and for short periods. Resistance means that they have various side effects when you stop taking them, and addiction means that they may have fatal side effects if you fail to adjust the drug dose. Therefore, such drugs should only be used in small amounts and for short periods. This means that sleeping pills cannot be a long-term solution for treating chronic insomnia that lasts over 3 months.


Melatonin is a sleep inducer. If sleeping pills turn off the biological clock to induce sleep, melatonin changes the time setting of the biological clock to let them know 'now is the time to sleep'. Therefore, melatonin works most effectively against sleep rhythm disorders, insomnia due to jet lag, etc. Recent research reports that melatonin has slightly helped to improve sleep quality, but still, there is insufficient evidence as a solution for insomnia.


Sometimes, people who suffer from insomnia take tryptophan as a sleep supplement. Some people even say that they have overcome insomnia with tryptophan. Unfortunately, tryptophan does not really help insomnia. Tryptophan is used in our body as a precursor material, i.e., the ingredient to make melatonin. However, tryptophan is also actively used in many other metabolic processes in the body. Just by taking a little tryptophan supplement does not make our body produce a lot of melatonin and even if it does, the effect of melatonin on insomnia has not been proven yet. The effect of tryptophan on insomnia has not been proven more so.


In studies conducted in 2011 and 2012, it was reported that magnesium helped some elderly insomnia patients. However, according to a study reported in 2021, there is little evidence of the effect of magnesium supplements on elderly insomnia patients. However, in the study, it was interpreted that using it is “not bad at all" since magnesium can be found anywhere and is cheap.


Some antidepressants are known to have a sleep-inducing effect, but there is insufficient evidence that these drugs are effective for insomnia in the long term. However, there are reports that treating it separately is effective when insomnia and other psychiatric disorders coexist, so it may be effective to take antidepressants that help sleep when taking antidepressants to treat depression.


There have been many attempts to achieve deep sleep through specific scents, however, unfortunately, to date, there is insufficient evidence that certain scents cure insomnia and provide better sleep. Sure, such scents can relax us and thereby make us fall asleep more peacefully for a day or two. But, again, feelings and facts are two different issues. Given that smell is the most adaptive sense among all body sensations, the method of inducing better sleep through fragrance is not very effective in the long run.


Many people consider the pillow as the most important part of their sleep environment. Of course, if one feels uncomfortable because the pillow is too high or low, it would be a good idea to change the pillow. However, changing a pillow doesn't necessarily lead to better sleep. There are few well-designed studies proving that changing pillows brings changes to sleep. Feelings and facts are different issues. So, if you are seeking a pillow to cure insomnia, or planning to purchase a pillow at a considerable cost, it would be better to stop. Pillows marketed as 'magic pillows', 'deep sleep pillows', 'honey sleep pillows' are, after all, just similar to the pillows we have in our bedrooms. The same goes for bed mattresses.

Primary Treatment for Insomnia: Cognitive Behavioral Therapy

Cognitive-behavioral therapy for insomnia refers to a program composed of cognitive therapy and behavioral therapy. Cognitive therapy includes education about sleep habits, stimulus control, relaxation techniques, and worry relief while behavioral therapy refers to the process of gradually improving sleep efficiency by limiting sleep time. The effect of cognitive-behavioral therapy for insomnia has already been proven by numerous studies.

The American College of Physicians (ACP) strongly recommends applying cognitive-behavioral therapy first for insomnia that lasts for more than three months. If cognitive-behavioral therapy alone doesn't work, it is recommended that the pros and cons be compared after discussing whether to combine 'short-term' drug use with a doctor.

In a review paper published in Lancet, a top medical journal in 2012, by Dr. Morin, a world-renowned authority in the field of insomnia, it was said that benzodiazepine-class drugs and cognitive-behavioral therapy are the most effective treatments for insomnia. He further mentioned that benzodiazepine-class drugs are effective only when used in the short term, and there is insufficient evidence for long-term use and, instead, side effects may occur.

Although cognitive-behavioral therapy has been sufficiently proven as the primary treatment for insomnia, it is still not properly utilized in our country. There is a lack of awareness about cognitive-behavioral therapy itself, and going to the hospital every week for cognitive-behavioral therapy is not easy. It is too much to overcome all these things by myself for the other six days when not going to the hospital. In fact, there are already numerous books about cognitive-behavioral therapy for insomnia, and since NHS (National Health Service) in the UK has made a program that can be done alone and distributed it for free, you can proceed with it without having to visit a hospital.

However, it is too hard to go through this all by myself. What's more, even in family medicine and internal medicine in Korea, where many sleeping pills are prescribed, it is a major problem that these doctors have not received systematic education about cognitive behavioral therapy for insomnia. Nevertheless, there are many clinics or programs conducting cognitive-behavioral therapy if you look for one. Thus, let's stop spending money on pseudoscience without sufficient evidence, and seek and utilize professional and proven treatments.


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