Neend Na Aana (Insomnia) in Pakistan: Causes and Treatment That Isn't a Pill

Insomnia is one of the most common complaints in any Pakistani clinic and one of the most poorly treated, because the usual response is a sleeping tablet — a class of drug that is widely available across a pharmacy counter, works for a fortnight, and creates a dependence that then needs its own treatment. The best-evidenced treatment for chronic insomnia is not a drug at all: it is cognitive behavioural therapy for insomnia (CBT-I), recommended as first-line by the US National Heart, Lung, and Blood Institute and by NICE.

At a glance

• Chronic insomnia = difficulty sleeping ≥3 nights a week for ≥3 months, with daytime consequences
• CBT-I is first-line — more effective than sleeping pills, and it lasts
• Sleeping tablets are for short-term use; tolerance and dependence develop quickly
• Insomnia is often a symptom: anxiety, depression, pain, reflux, thyroid disease or sleep apnoea
• Loud snoring with pauses in breathing is not insomnia — it is possible sleep apnoea, and it needs a different investigation
• Lying in bed trying harder to sleep makes insomnia worse. This is the central paradox

Neend kyun nahi aati — the causes worth finding

• Stress aur fikr — paise, kaam, khandan; dimagh raat ko chalna shuru kar deta hai
• Anxiety aur depression — subah bohat jaldi aankh khul jana aur phir neend na aana depression ki khaas alamat hai
• Bay-qaida auqat — shift work, raat ko mobile, har roz alag waqt par sona
• Caffeine — chai, coffee, energy drinks. Caffeine ka asar 6–8 ghante rehta hai; shaam ki chai raat ki neend kharab karti hai
• Nicotine — cigarette, naswar, sheesha
• Dard — kamar dard, ghutnon ka dard
• Acid reflux — lait-te hi jalan
• Thyroid ki zyadti; menopause ki garmi; raat ko baar baar peshab (sugar ya prostate)
• Sleep apnoea — tez kharatay, saans rukna, din bhar neend aana
• Restless legs — pairon mein bay-chaini jo hilane se kam ho
• Garmi aur load-shedding — a real and underrated factor in Pakistani summers
• Kuch dawaiyan: steroids, kuch blood pressure aur asthma ki dawaiyan, decongestants

Sleep hygiene — the basics, done properly

• Fixed wake-up time, every single day — including Sunday. This anchors the body clock more powerfully than bedtime does
• Bed is for sleep only. No phone, no laptop, no eating, no working, no arguing
• If you're awake beyond ~20 minutes, get up. Leave the room, do something dull in dim light, return only when sleepy. Lying there trains the brain to associate bed with frustration
• No caffeine after early afternoon
• No heavy meal within 2–3 hours of bed
• Dark, quiet, cool room. Blackout curtain; fan for both cooling and steady white noise
• Screens off an hour before bed, or at minimum on night mode
• No daytime naps if you sleep badly at night — especially not the long afternoon qailulah, which is pleasant and, for an insomniac, counterproductive
• Exercise regularly, but not intensely in the last two or three hours
• Get bright light in the morning
• Write tomorrow's worries down before bed, so the list is on paper instead of running at midnight

CBT-I: what actually treats chronic insomnia

CBT-I is a short, structured programme — typically four to eight sessions — and it outperforms sleeping tablets in long-term outcomes. Its components:

• Sleep restriction — deliberately limiting time in bed to the hours you actually sleep, then extending as efficiency improves. Counter-intuitive, uncomfortable for the first week, and the most powerful single element
• Stimulus control — rebuilding the bed–sleep association
• Cognitive work — dismantling the catastrophic thinking ("if I don't sleep now, tomorrow is ruined") that keeps you awake
• Relaxation training — breathing, progressive muscle relaxation
• A sleep diary to measure rather than guess

A clinical psychologist or therapist delivers this, and it can be done over video. You can find psychologists on DoctorOS and filter by city.

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About sleeping pills

Benzodiazepines and "Z-drugs" work — briefly. Tolerance builds within weeks, so the dose creeps; stopping causes rebound insomnia worse than the original, which feels like proof the drug was needed; and in older adults they raise the risk of falls, fractures and confusion. In Pakistan they are frequently sold without a prescription and taken for years. If you are already on them, do not stop abruptly — abrupt withdrawal from benzodiazepines can be dangerous. Ask a doctor for a tapering plan, ideally alongside starting CBT-I. See our guide to self-medication.

When to see a doctor

See someone if insomnia has lasted more than three months, if it is affecting work, driving or mood, if you snore loudly with witnessed pauses in breathing, if you feel sleepy during the day despite adequate time in bed, or if you are relying on tablets to sleep at all.

Frequently asked questions

Kya neend ki goli rozana khana theek hai?

Nahi. Yeh dawaiyan chand haftay ke liye banayi gayi hain, saalon ke liye nahi. Kuch arse baad jism aadi ho jata hai, phir wahi goli kaam nahi karti aur khuraak barhani parti hai — aur achanak chhorne par neend pehle se bhi ziyada kharab hoti hai. Agar aap pehle se le rahe hain to achanak band na karen — doctor se ahista ahista kam karne ka tareeqa poochein.

Raat ko neend nahi aati aur dopahar ko so jata hoon. Kya yeh theek hai?

Yeh masla barha deta hai. Dopahar ki lambi neend raat ki neend ka "dabao" khatam kar deti hai, is liye raat ko phir neend nahi aati — aur yeh chakkar chalta rehta hai. Kuch haftay ke liye dopahar ki neend bilkul chhor kar dekhen, aur subah uthne ka waqt rozana ek hi rakhen.

I sleep eight hours but wake up exhausted. Is that insomnia?

Probably not — that pattern points more towards a sleep quality problem, most commonly obstructive sleep apnoea, especially with loud snoring, witnessed pauses, morning headache or a large neck. That needs a sleep study, not a sleeping tablet, which would make it worse.

Does warm milk or a herbal remedy help?

A calming pre-sleep routine genuinely helps, and if warm milk is part of yours, keep it. What the evidence does not support is any herbal preparation reliably treating chronic insomnia — and unlabelled sleep mixtures sometimes contain undeclared sedatives, which is the thing you were trying to avoid.

Sources

• US National Heart, Lung, and Blood Institute — Insomnia treatment (CBT-I as first-line)
• NHS — Insomnia
• "Self-Medication with Antibiotics: Prevalence, Practices and Related Factors among the Pakistani Public" (PMC) — context on non-prescribed medicine use in Pakistan

For practitioners: if you're a psychologist, psychiatrist or sleep specialist in Pakistan, list your practice free on DoctorOS and start taking bookings from patients who are searching for exactly this kind of care.

Cover image: The alarm clock by Szift, licensed under CC BY 2.0.