Question: Can you describe a recent patient whose sleep problem reflects a broader pattern you’re seeing in Singapore?
In my clinical practice, sleep difficulties are among the most common presentations. Patients typically report difficulty falling asleep, frequent night awakenings, or early morning waking. In many cases, these are associated with underlying anxiety or depressive disorders.
For example, a 20-year-old university undergraduate recently consulted me for insomnia. She took two to three hours to fall asleep and described persistent worry during this time about academic performance, her long-distance relationship, and ongoing tension with her overprotective parents.
Another increasingly common pattern is “revenge bedtime procrastination”. These patients deliberately delay sleep to reclaim personal time after a long day, often scrolling social media, watching short videos, or streaming content. While it feels like personal space at night, many experience regret and daytime fatigue.
In this group, contributing factors may include delayed sleep phase tendencies, ADHD-related difficulties with self-regulation, or problematic digital device use.
I also see middle-aged patients in their 40s and 50s who have become dependent on long-term hypnotic medications, often presenting when prescriptions are discontinued due to changes in providers or prescribing concerns.
A smaller group presents with chronic insomnia driven by sleep-related anxiety. They may develop rigid bedtime routines, frequent clock-watching, and sometimes rely heavily on sleep trackers, which can paradoxically worsen anxiety.
Q: Are these issues getting more frequent or more severe compared to a few years ago?
Sleep deprivation is certainly more common today. Excessive screen use—especially smartphones and short-form videos—is a far more frequent driver of sleep problems.
There is also a subset whose sleep is affected by highly stimulating or compulsive online content (e.g. pornography), which can significantly delay sleep onset and disrupt sleep patterns.
Q: Do you notice differences between men and women?
Sleep problems affect both sexes broadly equally. However, women may be more vulnerable to insomnia due to hormonal changes across the lifespan, including menstruation, pregnancy, and menopause, as well as higher rates of anxiety and depression.
Q: What are the less obvious consequences of chronic sleep deprivation?
Acute sleep loss over one or two nights is usually reversible. Chronic sleep deprivation, however, acts more like sustained physiological stress.
In the short term, it affects concentration, emotional regulation, and energy levels. Over time, it is associated with increased risks of hypertension, cardiovascular disease, cognitive decline including dementia, and possibly other systemic health conditions.
Q: When does poor sleep become a clinical concern?
It becomes clinically significant when it impairs daytime functioning—such as work or academic performance—or causes significant distress.
Q: What habits are hardest for patients to change?
Sleep hygiene is often underestimated. Similar to hand hygiene, it refers to behaviours that support good sleep.
This includes maintaining a regular sleep–wake schedule, avoiding caffeine after mid-afternoon, and avoiding late-night exercise. While simple, these changes are often difficult to maintain, even though they can make a meaningful difference.
Q: What tends to be the simplest intervention that moves the needle?
Behaviourally, reducing exposure to highly stimulating digital content can be very effective. Removing or limiting habit-forming apps helps reduce cognitive arousal at night. Blue light from screens can also suppress melatonin and delay sleep.
Pharmacologically, dual orexin receptor antagonists (DORAs) are a newer class of sleep medications that block orexin, a wake-promoting neurotransmitter, and can be effective for insomnia when appropriately prescribed.
Q: How long does it take to see improvement?
It depends on the intervention.
Cognitive behavioural therapy for insomnia (CBT-I) remains the gold standard. It helps patients reframe unhelpful beliefs about sleep and improve behaviours, but meaningful improvement usually takes several weeks.
Medications may work more quickly, but should be used under medical supervision, alongside addressing contributing factors such as stressors in relationships or work, anxiety, mood symptoms, and poor sleep habits.
If your sleep has been persistently disrupted, or you’re finding that fatigue is beginning to affect your mood, focus, or day-to-day functioning, it may be worth looking beyond quick fixes. At Private Space Medical, our team of experienced psychiatrists and psychologists takes a thoughtful, individualised approach—addressing not just the symptoms, but the underlying patterns shaping your sleep. Reaching out can be a quiet first step towards more restorative nights and steadier days.
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Dr Victor Kwok
Senior Consultant Psychiatrist
Senior Consultant Psychiatrist
