Insomnia: Why You Cannot Sleep and What Actually Helps

This article is general information published by the practice of Dr. Sholeh Toobaei, Specialist Psychiatrist, Dubai. It has not yet been individually reviewed by a clinician and is not a substitute for personal medical advice. Published: 1 September 2026.

Scope: This article is general information about insomnia. It is not a diagnosis and contains no medication or dosing advice. Persistent sleep problems deserve a proper clinical assessment.

What is the difference between a bad night's sleep and insomnia?

A bad night's sleep is common and harmless. You slept poorly, you feel tired the next day, and tomorrow you sleep fine. Insomnia is different. It is when difficulty falling asleep, staying asleep, or waking too early happens at least three nights a week for at least three months, and it causes daytime impairment — fatigue, poor concentration, irritability, reduced performance at work or school.

Chronic insomnia is one of the most common problems psychiatrists see. It is also one of the most treatable. The problem is not that people with insomnia cannot sleep — it is that their brain has learned to be awake in bed, and that learned pattern is harder to break than the original trigger that caused the sleeplessness.

How does insomnia develop?

Usually in three stages. Stage one is a trigger: stress at work, a move, a difficult relationship, a medical problem, jet lag, a new baby. Your sleep is disrupted, temporarily. That is normal.

Stage two is the reaction. You worry about not sleeping. You start counting hours. You lie in bed thinking "I need to sleep now or I will be terrible tomorrow." That anxiety activates your nervous system, which makes sleep even harder. The worry about sleep is now a second problem on top of the original trigger.

Stage three is the learning. Your brain associates the bed with being awake, worrying, and lying in the dark thinking. The bed is no longer a cue for sleep — it is a cue for wakefulness. No amount of willpower can break this association, because the association was built by the unconscious part of your brain. It requires behavioural retraining.

What keeps insomnia going?

The behaviours people adopt in response to poor sleep. These include: sleeping in on weekends (which disrupts your body clock), taking long naps (which reduces sleep pressure for the next night), spending more time in bed "trying" to sleep, drinking more alcohol to help you fall asleep (which fragments sleep later in the night), drinking more coffee to cope with fatigue (which makes sleep harder), and checking the clock repeatedly (which increases anxiety).

Each of these strategies feels helpful in the moment. All of them worsen insomnia in the long term. This is why the most effective treatment for chronic insomnia — Cognitive Behavioural Therapy for Insomnia, or CBT-I — focuses on undoing these behaviours systematically.

What does CBT-I actually involve?

Sleep restriction. This sounds counterintuitive but is one of the most effective techniques in psychiatry. You limit the amount of time you spend in bed to roughly the amount of time you actually sleep. If you sleep six hours out of eight in bed, you are allowed eight hours in bed but only six hours to sleep. This creates mild sleep deprivation, which builds enormous sleep pressure. As your sleep efficiency improves (you spend a higher percentage of time in bed actually sleeping), your time in bed is gradually increased.

Stimulus control. The bed is for sleep and sex only. If you are awake and frustrated for more than about twenty minutes, you get out of bed. You sit somewhere dim, do something quiet and boring, and return when sleepy. This may happen multiple times in a single night. It retrains the brain's association: bed = sleep, not bed = worry.

Cognitive therapy. This addresses the thoughts that maintain insomnia: "I need eight hours or I will crash," "If I don't sleep now, tomorrow is ruined," "I have not slept properly in weeks." These thoughts are often catastrophising — they amplify the anxiety that keeps you awake. A therapist helps you challenge these thoughts and replace them with more realistic ones.

Relaxation techniques. Progressive muscle relaxation, diaphragmatic breathing, and guided imagery can all help reduce the physiological arousal that prevents sleep. They are not cures on their own, but they are helpful adjuncts.

What about sleeping pills?

They have a role in some situations, but they are not a long-term fix for chronic insomnia. The most common types are benzodiazepines (which enhance GABA, the brain's main calming chemical) and non-benzodiazepine "Z-drugs" like zolpidem (which target the same system more selectively).

Both work in the short term. Both develop tolerance — you need more over time to get the same effect. Both can cause dependence. Both have side effects, including next-day drowsiness, memory problems, and in older people, increased fall risk. Most importantly, neither treats the underlying behavioural pattern that maintains insomnia. When the pills stop, the insomnia usually returns.

This is not to say sleeping pills are never appropriate. For short-term insomnia triggered by a specific event, they can be helpful. For severe insomnia that has not responded to CBT-I, they may be necessary. But for most people with chronic insomnia, CBT-I is more effective in the long run than any medication.

Does Dubai make insomnia worse?

Yes, in specific ways. The heat keeps people indoors and out of daylight — and daylight is the most powerful synchroniser of your body clock. The late-night social and dining culture disrupts sleep schedules. Shift work is common in many industries. For expatriates, late-night calls to family in distant time zones delay bedtime. Air conditioning creates a cool environment, which is good for sleep, but the combination of heat during the day and cool at night can confuse the body's thermal rhythm, which is part of the sleep signal.

Morning daylight is the single most underutilised sleep treatment. Ten minutes outside in the morning — even in the shade, even in the heat — is a genuine biological intervention, not a lifestyle suggestion.

When should I see a doctor?

If your sleep problems have lasted more than a month, if you are relying on alcohol or medication to sleep, or if your insomnia is coming with low mood, anxiety, or loss of function, seek a professional assessment. Your psychiatrist can help you determine whether there is an underlying condition (depression, anxiety, sleep apnoea, thyroid problems, restless legs syndrome) contributing to your insomnia and create a treatment plan.

Seek urgent help — call 999 (police) or 998 (ambulance) in the UAE, or go to the nearest emergency department — if you have gone several nights with almost no sleep and feel agitated, unreal, or are having thoughts of harming yourself. For non-urgent enquiries, use the appointment request form on this website. This practice does not operate a monitored telephone line, and a message sent through the form may not be read straight away.