Insomnia presents differently across the APAC region, shaped by cultural, environmental, and societal influences. Prevalence rates vary significantly between countries:

• Singapore: 15.3% (1996) → 27.6% (2016, Singapore Mental Health Study)
• Japan: 21.4%
• Korea: 17.0% (experiencing symptoms at least three nights per week)
• Macau: 49.0%
• Malaysia (chronic insomnia): 12.2%

These variations can be attributed in part to rapid urbanisation, increasing professional pressures, and the accompanying rise in chronic stress, anxiety, and depression, particularly among the working-age population. Dr Pandya, a Senior Consultant in Advanced Internal Medicine and Sleep Medicine, highlights that “such mental health challenges are strongly associated with disrupted sleep.”

Yet, despite its growing impact, insomnia is often overlooked in many parts of Asia. It is frequently seen as a minor inconvenience or a natural part of ageing, rather than a medical concern requiring attention. Misconceptions around treatment further complicate the issue; many individuals avoid seeking help due to fears about the safety of sleeping pills or the risk of dependency, contributing to widespread underdiagnosis and undertreatment.

Cultural stigma also plays a powerful role. Negative perceptions around mental health conditions and the use of treatments such as CPAP machines continue to prevent individuals from pursuing proper care for sleep disorders.

In some communities, alcohol is used as a sleep aid. However, this approach is a double-edged sword; while it may induce drowsiness, alcohol disrupts sleep quality, worsens existing sleep disorders, and can lead to broader health problems over time.

The underlying causes of insomnia are often complex and multi-factorial. Contributing factors may act individually or in combination, and they can vary across age groups.

Patients with insomnia may have a co-existing sleep disorder, contributing to their symptoms. Common examples include obstructive sleep apnoea (OSA) and restless leg syndrome (RLS). In fact, studies show that up to 50% of people with insomnia also have sleep disordered breathing such as OSA, a condition referred to as COMISA (co-morbid insomnia and sleep apnoea).

Treatment of underlying sleep disorders is strongly recommended in patients with insomnia. Medical approaches may involve sleep studies and CPAP therapy, depending on the diagnosis.

At the same time, lifestyle modifications play a key role in supporting long-term sleep health. These include improving sleep hygiene, managing stress, limiting screen time and stimulants before bed, and maintaining consistent sleep routines.

To illustrate how these different factors interact, the diagram below maps out the behavioural, physiological, and psychological pathways that can contribute to insomnia through heightened arousal. This reinforces the importance of a holistic approach in both diagnosis and management.

In addition to these clinical factors, a range of lifestyle and psychological factors can significantly affect sleep quality. This infographic highlights some of the most common contributors, including chronic health problems, grief or life stressors, mental health conditions, and excessive screen time.

These influences often go unrecognised but can have a real impact on sleep health. For patients struggling with insomnia, addressing these day-to-day stressors is just as important as medical evaluation and treatment.

When asked about innovative treatments for chronic insomnia, particularly in patients who haven’t responded well to conventional approaches, Dr Pandya highlights the growing effectiveness of cognitive behavioural therapy for insomnia (CBT-I). This includes techniques such as stimulus control, sleep restriction, and relaxation therapy, all of which have demonstrated strong results in improving sleep patterns over time.

She also notes that good sleep hygiene remains a foundational component of treatment, supporting other therapeutic strategies.

“For those who continue to struggle despite these measures, certain melatonin-based products or prescription medications may be considered under medical guidance,” she adds. “It’s important that these are used appropriately and tailored to the individual’s sleep profile and underlying health conditions.”

Technology, particularly sleep-tracking devices and mobile apps, can play a supportive role in identifying issues related to sleep onset and sleep maintenance. These tools provide a general overview of a person’s sleep patterns, helping both patients and clinicians detect disruptions and monitor changes over time.

While some sleep trackers have been tested and found to be reliable, not all are equally accurate. They can offer useful general insights before and after treatment, but should not replace formal clinical evaluation when sleep disorders are suspected.

When used appropriately, sleep technology can complement clinical assessments by providing additional context and supporting treatment monitoring.

Breaking the cycle of insomnia often requires more than medication alone. One of the most effective approaches involves addressing behavioural patterns that interfere with natural sleep rhythms.

“Sleep hygiene plays a critical role,” explains Dr Pandya. “This includes avoiding electronic devices before bedtime, steering clear of caffeinated drinks after 2 p.m., and limiting smoking or alcohol consumption in the late evening. These simple lifestyle adjustments can make a significant difference.”

For individuals who rely heavily on medication to manage sleep, it’s advisable to consult a psychiatrist or visit a sleep clinic. In some cases, undergoing a sleep study may help uncover underlying sleep disorders that require more targeted intervention.