Q. I could not sleep for 24 hours due to chronic lack of sleep. Kindly help.

Answered by
Dr. Saraswat Kumarshri Shriniwas
and medically reviewed by Dr. K Shobana
This is a premium question & answer published on Jul 30, 2021

Hi doctor,

I have a chronic lack of sleep. I cannot sleep for 24 hours. I have tried everything. Kindly help.



Welcome to

There are various causes of chronic insomnia. Every cause has its specific management. To rule out the cause, it is necessary to have a detailed history, examination, and relevant investigations are required. The common causes of insomnia are depression, anxiety, obstructive sleep apnea, and primary insomnia.

Depression is the common cause of having difficulty in falling asleep and staying asleep. Even if you sleep, you may not feel refreshed and you will have a feeling of not slept. Depression is diagnosed when you have a low mood or lack of enthusiasm or interest in doing things. There is guilty, low self-confidence, and a negative outlook towards life. It is treated by taking anti-depressants and taking hypnotics (sleeping pills) will not help.

During anxiety, there are worries and a general sense of edginess. It keeps you from relaxing to fall asleep. It is treated by taking anti-anxiety medicines. In obstructive sleep apnea, there are frequent arousals in sleep at night and during daytime sleepiness. For primary insomnia, there are no other identifiable causes for sleep loss. The treatment for each cause is different. It will be helpful if you wear a watch to measure your sleep and its phases. It helps in objectively analyzing and arriving at the exact cause of sleep. Kindly provide further details regarding the duration of the issue along with your accompanying symptoms and so I can help you better.

Thank you doctor,

I have a problem initiating and maintaining sleep. This is a chronic issue for the past ten years. It is getting worse for the past few months. I could not fall asleep for consecutive days. I feel sleepy but when I go to bed, I can no longer fall asleep and I am fully alert. Today I feel unbalanced and slow to respond. I tried taking 5 mg of Zolpidem which helped me to sleep for 5 to 6 hours but I am not fully recovered. I have researched and tried many approaches but there is no success. Is it possible to schedule a chat to give you further details?



Welcome back to

As you have not mentioned any cause, I am assuming that you do not have mood or anxiety symptoms along with insomnia. Please mention whether you have any reason for not taking Zolpidem 10 mg which is the standard adult dose. Please mention whether you have tried taking Melatonin along with it. Please mention whether you take caffeine in the evening. It can make you alert at night. Please mention whether you have any history of sleep issues in the family. Please mention whether you are able to work well with five hours of sleep while taking Zolpidem. Regards.

Thank you doctor,

I have anxiety as a working mom but it is not something beyond usual. Sometimes, I become worried and think a lot. I have been like this for few days and I was able to sleep. But lately, sleep seems almost impossible. I do not like to take sleeping pills and so I tried to minimize the dose. I am worried about the side effects. I had a headache and dizziness on the second day. I can able to function with five hours of sleep and I hope for more. I can able to concentrate. For now, I am not able to focus without sleep. I have never tried taking Melatonin. How long should I take it? I want to know whether it is a good option for the long term. I use to drink a second cup of coffee around 5 pm but for now, I drink one cup around 12 pm. My mom has sleep issues. She still sleeps late but she gets it for full hours.



Welcome back to

Your mom seems to be suffering from delayed sleep phase syndrome (DSPS) in which the sleep is normal but its onset is delayed. In this condition, patients wake up late and it can be inherited. If you fall asleep very late at night and prefer to wake up late, you can also have it. But you are forced to wake up early due to responsibility. It is treated with 15 minutes of sunlight exposure as early in the morning as possible. Take Melatonin before three hours of falling asleep. Melatonin is quite safe. It can be taken long-term. The exact timing and dosage need to be figured out with trial and error. It helps in regular insomnia (non-dsps) also.

Ramelteon is a melatonin agonist which can be taken an hour before sleep if melatonin causes daytime somnolence in some people. If anxiety is keeping you awake, taking an anxiolytic-like Etizolam is safe and effective. You can start taking 0.25 mg an hour before sleep and titrate upwards. It does not cause daytime hangover (headache and dizziness) like Zolpidem. It is non-addictive as well. You can try taking light coffee instead of strong ones. Even taking coffee at 2 pm stays in the body till early morning as it is slowly metabolized.

Also ensure that there is no caffeine in any other drink, supplement, weight loss formula, or anything else that you are taking. Also, I hope that you do not use screens like a phone or laptop on your bed. The blue light from them messes with melatonin release. It is advisable to keep them away two hours before the scheduled bedtime. I suggest you follow sleep hygiene and start following it daily. It helps a lot of people with sleep issues. Some simple mistakes that we make harm our night sleep in a big way. Correcting them benefits sleep. Hope this helps.

Thank you doctor,

Thank you for all of your advice. Today I started getting some sunlight as soon as I wake up and I also had a decaf coffee instead of regular coffee. I forgot to mention. I usually have the worst insomnia right before menstruation for almost five days before my cycle starts. I am not sure if this information helps. I want to know whether there is some sort of hormonal imbalance associated with my insomnia. I would like to know your opinion about Zolpidem. Is it safe? How long to be taken? Regarding melatonin, what is the good dose to start? Thanks for your help.



Welcome back to

Early morning sun and reducing caffeine helps you. When you do it regularly, the effects are shown within a week. Your insomnia is worse in the premenstrual period. I assume that you do not have any other symptoms of pre-menstrual dysphoric disorder like irritability, depression, body ache, or weakness. If you have these symptoms in the premenstrual period along with insomnia, an SSRI (selective serotonin reuptake inhibitor) class of medicine like Paroxetine could help you with it. Zolpidem could cause a bit of daytime dullness in some people and thus it makes them prone to depression. But this does not happen with everyone. Apart from this, it is a fairly safe drug. I have a couple of patients who are taking Zolpidem for more than five years now without any issue. It is non-habit forming. 3 mg Melatonin is a decent dose to begin. You can go from there to 5 mg and then 10 mg when you do not experience any daytime dullness. Regards.

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