What can cause waking up hourly with chronic insomnia?

Question

Hello doctor,

I am 41 years old, and I have not had a full night of sleep in over six months. I wake up multiple times, sometimes every hour, and lie awake with racing thoughts. I have tried melatonin, sleep hygiene tips, and meditation, but nothing helps.

My recent sleep study did not show sleep apnea, yet my fatigue is unbearable. My morning cortisol level was slightly elevated at 27 mcg/dL.

Kindly answer my following questions:

Is this chronic insomnia?
At what point are prescription medications considered safe and necessary?
I just want to feel like myself again. How do people recover from this without becoming dependent on pills?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

I understand that you are having trouble waking up multiple times each night. I understand how frustrating this can be. We hope to help. As I understand it, you are experiencing increasing fatigue. I did see that you have tried sleep‑hygiene tips, melatonin, and meditation without benefit.

Based on your description of waking up with racing thoughts, it seems that anxiety is the most likely cause of your insomnia. I strongly recommend that you see a general practitioner and ask them to screen you for anxiety using a tool such as the GAD‑7 (generalized anxiety disorder assessment).

In the meantime, consider dietary changes that may help reduce anxiety until you are evaluated by your provider. Suggested changes include reducing caffeine, especially in the afternoon and evening, drinking less alcohol (gradually limiting to one drink per day if you do drink, and further reducing if anxiety persists), and keeping a food log to track any correlation between anxiety and sugary or fatty foods.

Exercise may also help, especially high‑intensity aerobic activity, but you should discuss a new exercise program with your doctor before starting. First, see a general practitioner and obtain anxiety screening. If you are experiencing stressors or life events contributing to your stress, consider discussing these with your doctor if you feel comfortable doing so. I hope this helps. Please follow up with us three to four days after you have been screened for anxiety.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.