I read a recent interview of Michelle Williams as she talked about her late ex-fiance, Heath Ledger, openly for the first time since his unexpected death due to overdosing of a prescription drug in January this year. In the interview, she talked about Ledger’s sleeping issues. “For as long as I’d known him, he had bouts with insomnia,” she says. “He had too much energy. His mind was turning, turning turning — always turning.

Do you have insomnia or have you ever experienced episodes of insomnia? If you have, then you will know how scary this seemingly insignificant disorder is. Why, of course it’s a type of disorder. Not being able to sleep well is a disorder in itself. I know how a lot of people actually pride themselves by sleeping so little at night but unknown to many Singaporeans, sleep is really the most important thing in our lives and the lack of it can cause consequences far more terrible than one can imagine.  

So what’s insomnia exactly? According to the National Sleep Foundation, insomnia, which is Latin for “no sleep,” is the inability to fall asleep or remain asleep. Insomnia is also used to describe the condition of waking up not feeling restored or refreshed. According to Dr. Mark Mahowald, Professor of Neurology at the University of Minnesota Medical School and Director of the Minnesota Regional Sleep Disorders Center at Hennepin County Medical Center, insomnia refers to the inability to get the amount of sleep you as an individual need to wake up feeling rested.

For a good few months to almost half a year when I was 15, I had very bad insomnia. Chronic insomnia to be precise, because acute insomnia lasts only one to several nights and when insomnia persists for longer than a month (to even years), it is considered chronic. Just like most insomnia sufferers, I would face difficulty sleeping for a few nights, followed by a few nights of adequate sleep before the problem returned, ie chronic-intermittent insomnia. Although it felt like I hadn’t sleep much at all for the entire 6 months. The underlying reason for my insomnia was fairly simple and definitely psychological, even though at that point of time, it didn’t occur to me. It wasn’t until the issue was resolved and I could finally sleep well again when I realised what the cause of the insomnia was.

Well, I was 15 and for the first time in my life, there was a boy whom I liked a great deal. Apparently my feelings for him were not reciprocated as there was already some other girl on his mind. Although I didn’t know of it at that point because if I did, I would have tried harder not to fall so deep (but many times I ask myself if I would be successful even if I did know and did try to control myself, because then it wouldn’t be, to put it loosely, love in the first place, right). Of course there was also the financial problem at home and god, I was 15 so there were probably several other issues that one had to deal with during adolescence, even though I can’t recall any now.   

It was not that I would think about him constantly even during bedtime at night. I think it was more like all the issues would haunt me one by one as I lay in bed. Imagine this: you are not occupied with anything physical, you are just lying in bed and your mind is “free” in the sense that you are not thinking about anything in particular – I actually think that’s when one’s most vulnerable. Subconciously, your innermost thoughts that have been weighing down on you, even if you don’t realise, come to you all of a sudden. I couldn’t sleep during all those nights. I would go to bed at 11pm and still be wide awake at 3am before I finally slipped into sleep and a couple of hours later my alarm woke me up for school.  

It was DREADFUL. If it happened to you previously, you would understand the horrifying feeling of tossing and turning on bed for hours, trying to persuade yourself to sleep, trying to void your mind of the thoughts but to no avail, looking at the alarm clock every now and then and feeling the trepidation realising that you were still not sleeping even after hours on the bed and that you had to wake up 2 hours later. For 4 to 5 nights per week, I would only have 2 to 3 hours of sleep. Getting insufficient sleep was of course tiring but the more detrimental part was not being able to fall asleep even though I went to bed early! Even on nights when I could fall asleep slightly faster, it wasn’t a good night’s sleep as I’d difficulty maintaining sleep as I slipped in and out of sleep continuously the whole night.

The worst thing about insomnia is that after facing a few nights when you can’t fall asleep easily, the next time you get onto your bed, you actually start to worry about it happening again, and the more you worry, the more likely it is that you can’t sleep again. Insomnia can be such a vicious cycle. Honestly, looking back at it now, I didn’t know how I survived all those months with all the school workload and vigorous volleyball trainings that I had to perform while being sleep-deprived. If you give me insomnia now, I may just kill myself. Luckily after I sorted out my feelings and resolved the issues, I could sleep well again almost immediately, but the experience was so abominable that I could still remember the feeling of lying on bed with eyes wide open, body feeling extremely tired but mind racing inconsequentially vividly even after 1o years.     

Insomnia can be a disorder in its own right, but it is often a symptom of some other disease or condition. Sometimes insomnia is caused by pain, digestive problems, another medical condition (or medications taken for other conditions) or a sleep disorder. Insomnia can also occur with jet lag, shift work and other major schedule changes.

Most commonly though, it’s psychological causes like stress and worry (the most common cause), disturbing occurrences like loss of a loved one, loss of a job, marital or relationship discord, or anticipation of important events such as weddings or exams (especially students) that disturbs sleep. Insomnia may also signal depression or anxiety. In my humble opinion, insomnia due to such psychological reasons is the easiest and the hardest to cure of all. We all know that once the problem that worries one incessantly is resolved, insomnia is almost always alleviated immediately. Yet anyone who has talked to a troubled friend will know that it’s not always easy for someone who’s feeling depressed to just let go of the negative things torturing him or her. Neither is it possible for domestic or relationship problems to be improved overnight.  

But that doesn’t mean that anyone should leave his or her insomnia problem untreated. Often times, insomnia exacerbates the underlying condition by leaving the patient fatigued and less able to cope and think clearly. If you are depressed and can’t sleep well as a result, trust me, your sleep problem is going to worsen your depression. 10 years ago, people here didn’t know much about sleep even though sleep as a medical field was already expanding widely and rapidly in America. But 10 years down the road, sleep medicine has started to gain importance in the local and regional medical field. We might be slow but it’s better late than never, isn’t it?

If you think that you’ve insomnia, you need to seek help. As in, see a doctor. In Singapore, we actually have specialized sleep clinics in both private and restructured hospitals. It’s unfortunate that a lot of people still don’t know about it. Left untreated, insomnia is linked to increased illness or morbidity. There is a wealth of research indicating that people with insomnia have poorer overall health, more work absenteeism, and a higher incidence of depression.

And seeing a doctor for insomnia doesn’t mean that you have to take sleeping pills, which many believe to be harmful and easy to become dependent on. This is a humongous misconception. There are a number of approaches to treating insomnia, such as behavioral therapy, relaxation techniques, practising good sleep hygiene and of course medications many of which can be taken safely under the doctor’s indications. The doctor will always determine the underlying reason of the insomnia before suggesting suitable treatment.

有病就要医。Don’t suffer in silence anymore.