I am 50, male with chronic insomnia. How to manage it?

Question

Hello doctor,

I am a 50-year-old male who has been struggling with insomnia for the past 10 months, where I find it very hard to fall asleep and often wake up multiple times during the night. On average, I get only three to four hours of disturbed sleep, which leaves me exhausted and irritable during the day.

I have tried avoiding caffeine, limiting screen time at night, and following a sleep routine, but the problem persists. My doctor prescribed me a short course of sleeping pills, but I am worried about becoming dependent on them. I also have hypertension, with my blood pressure usually around 152/94 mmHg despite being on medication, and I was recently told that my fasting blood sugar is 124 mg/dL with an HbA1c of 6.3%, which suggests prediabetes.

My vitamin D level is low at 17 ng/mL, and my BMI is 30, which puts me in the obese range. Because of poor sleep, I struggle with concentration at work, frequent headaches, and occasional mood swings. My STOP-BANG score was 4, raising suspicion for possible sleep apnea, though I have not had a sleep study yet.

Could you please guide me on how to manage chronic insomnia safely, especially with my high blood pressure and borderline diabetes, and whether non-medication approaches or further testing would help improve my sleep quality?

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Chronic insomnia, especially in the setting of high blood pressure, prediabetes, obesity, and possible sleep apnea, requires a careful, holistic approach rather than long-term reliance on sleeping pills.

Since your STOP-BANG (snoring, tiredness, observed apnea, pressure (high blood pressure), body mass index (BMI), age, neck circumference, and gender) score is 4, a sleep study (polysomnography) is strongly recommended to rule out or confirm obstructive sleep apnea, which can lead to fragmented sleep, daytime fatigue, worsening hypertension, and poor glucose control.

Addressing lifestyle factors will also support both sleep and overall health: weight reduction through a balanced diet and regular physical activity can improve blood pressure, glucose levels, and sleep quality. Correcting your vitamin D deficiency with appropriate supplementation may also support mood and energy, while maintaining strict sleep hygiene practices remains essential.

Cognitive behavioral therapy for insomnia (CBT-I) is considered the most effective non-drug treatment. It helps retrain your brain to associate the bed with sleep and reduces anxiety related to sleeplessness. If short-term sleep medication is needed, it should only be used under medical supervision and for limited periods, while simultaneously exploring safer, long-term strategies. In addition, stress management, mindfulness, and relaxation techniques before bedtime can be very helpful.

Therefore, arranging a sleep study, pursuing CBT-I, addressing weight management and vitamin D deficiency, and working closely with your doctor to optimize blood pressure and blood sugar control will likely provide safer and more sustainable improvements in your sleep and overall health.

I hope this helps.

Please feel free to reach out to me anytime. I am always here to help.

Thank you.