Sleep Difficulties

Sleep difficulties are common and treatable—fix routines, address stress, screen for OSA; help’s available through Doccy on best sleep practices.

Dr. Louis J Sisk

BSc(Hons) MBChB MRCS(Glasg) MTrauma

Published: August 23, 2025

What You Need to Know – The Basics

• Sleep problems are common in Australia and linked with mood, heart, metabolic and injury risks—but effective help exists. ¹
• A U-shaped pattern is seen: short and long sleep are both associated with higher risks for diabetes, heart disease, obesity and mortality. ^{2 3}
• Insomnia is more common in women; obstructive sleep apnoea (OSA) is more common in men and increases with age and weight. ^{4 5}
• Quality, not just quantity: frequent awakenings, snoring, unrefreshing sleep, or daytime sleepiness signal a problem even if total hours look “okay”. ¹
• Costs & access: GP care and sleep studies are supported via Medicare (MBS); medicines may be subsidised under the PBS. ^{6 7}
• You deserve safe, restorative sleep—and support to get there.

Overview

“Sleep problems” include insomnia, OSA, restless legs, circadian rhythm disorders (e.g., shift work disorder), and poor sleep quality (long time to fall asleep, frequent waking, low sleep efficiency). They arise from the interplay of:

• Neurological/circadian mechanisms (brain networks that time sleep-wake cycles);
• Respiratory/anatomical factors (e.g., upper-airway collapse in OSA → intermittent hypoxia → fragmented sleep);
• Hormonal/metabolic signals (e.g., cortisol, melatonin);
• Behavioural & environmental contributors (caffeine, alcohol, late screens, noise/light, irregular schedules). ⁸

Why it matters: persistent poor sleep is associated with hypertension, CVD, type 2 diabetes, stroke, depression/anxiety, and accidents—and a substantial economic burden for Australia. ^{1 9 10}

Statistics and Prevalence in Australia

• Around 2 in 3 adults (66%) report at least one sleep problem; ~48% report two or more. ⁴
• Doctor‑diagnosed sleep disorders affect ~1 in 5 adults when OSA, insomnia and restless legs are combined. ⁹
• Age & sex: Short sleep is more common at 26–64; long sleep is more common 65+. Insomnia is up to 1.4× more common in women; OSA up to 3.5× more common in men. ^{4 5}
• Teens: On school nights, 27% of 12–13‑year‑olds and 52% of 16–17‑year‑olds do not meet sleep guidelines. ¹¹
• Shift work: ~16% of workers are shift workers; about 1 in 3 night workers meet criteria for shift work sleep disorder, with elevated accident risk. ^{12 13 14}

First Nations context: National data are limited. Some studies suggest more long sleep in Indigenous adults, higher OSA burden in some settings, and complex links with discrimination, remoteness and cardiometabolic risk. ^{15 16 17}

What the Research Says (Deep Dive)

1) The U-shaped curve (how much matters)

Large cohort meta-analyses consistently show a U-shaped association between nightly sleep duration and chronic disease risk:

• Compared with “normal” sleep, short or long sleep is linked to 8–46% higher incidence of conditions like type 2 diabetes, obesity, CHD/CVD, and hypertension. ^{2 3}
• Mortality: short sleep is associated with ~12% higher all-cause mortality; long sleep with ~39% higher mortality. ^{2 3}
• Who’s most affected? Effects vary by age/sex:
  • Short sleep → CVD risk mainly in people ≤65 years. ²
  • Long sleep → CVD risk mainly in people ≥65 years. ³
  • Diabetes with short sleep: significant in men; hypertension with short sleep: significant in women. ²
  • Obesity with long sleep: significant in women. ³
• Cancer: overall links between sleep duration and cancer are inconsistent; some pooled analyses show no clear association. ¹⁸

Why this happens (likely): short sleep may increase sympathetic tone, inflammation and insulin resistance; long sleep may capture underlying illness, depression, frailty or socioeconomic factors—hence careful interpretation and a focus on sleep quality + regularity, not just hours. ^{2 3}

2) Insomnia → mental health (direction and magnitude)

• Prospective evidence: insomnia predicts later depression and anxiety, beyond baseline symptoms and life events, in both young women and older men. ^{19 20}
• Suicidality: insomnia is a weak but significant predictor of suicidal thoughts/attempts/deaths across longitudinal studies—underscoring the need to screen for mood and suicide risk in chronic insomnia. ^{21 22}

Clinical takeaway: prioritise CBT-I and concurrent treatment of mood/anxiety; avoid long-term sedatives which don’t fix perpetuating factors. (See treatment section for details.) ²³

3) OSA & multimorbidity (who’s at risk; how big is the risk?)

• Multimorbidity: adults with OSA have ~8.8× higher odds of ≥2 chronic conditions (adjusted for age, sex, BMI, smoking, sleepiness). ²⁴
• Weight gradient: compared with normal BMI, overweight men have ~1.7× the odds of OSA; BMI ≥40 raises odds to ~10.3×. ²⁵
• Cardiometabolic links: OSA relates to hypertension, diabetes, dyslipidaemia and depressive/anxiety symptoms; effective CPAP improves sleepiness and blood pressure and reduces accident risk. ²⁶

Clinical takeaway: screen high-risk groups (snoring, witnessed apnoeas, obesity, resistant hypertension, sleepiness) with ESS/STOP-Bang, then confirm with polysomnography where indicated. ²⁷

4) Accidents & the economy (why safety matters)

• Road/work injuries: fatigue and sleep loss are major contributors. Shift workers have at least 60% higher accident risk than non-shift workers. ¹⁴
• National burden: inadequate sleep has been linked to >3,000 deaths (2016–17) and a combined ~$51 billion annual economic cost (2019–20) in Australia. ^{9 10}

Clinical takeaway: treat sleepiness as a safety issue (driving, heavy machinery). For shift workers, use anchor sleep, timed light, naps, and caffeine timing protocols. ²⁸

5) Measuring sleep (self-report vs wearables vs gold standard)

• Self-report is useful for screening but can misestimate true sleep duration and latency.
• Actigraphy/wearables: around ~82% accuracy for sleep/wake; newer wrist devices are more accurate for duration/efficiency, enabling long-term tracking—though access/use may vary by socioeconomic factors. ^{29 30}
• Polysomnography remains the gold standard when diagnosis changes management (e.g., suspected OSA, parasomnias). ⁸

6) The care gap (who’s missing out?)

• In national survey data, only ~16% of people reported being asked about sleep in a health visit over 12 months; among those with problems, only ~20% had a medical assessment. Many want help but don’t receive it. ³¹

System fix: normalise sleep-vital-signs in primary care (sleep hours, insomnia screen, snoring/ESS), provide CBT-I access (digital or therapist-led), and streamline sleep-study referrals where indicated. ^{8 23 6}

7) Practical implications (what to do with this evidence)

• Aim for regular, restorative sleep rather than chasing a perfect number; 7–9 h fits most adults, but quality and timing matter. ³²
• Treat insomnia early with CBT-I to reduce downstream mood/anxiety risks. ²³
• Identify OSA in at-risk patients (snoring, apnoeas, sleepiness, resistant hypertension, obesity); move to CPAP/MAD plus weight, alcohol and nasal management. ²⁶
• Protect safety in sleepy patients—especially drivers and shift workers. ²⁸
• Use objective tracking (where feasible) to augment history and guide behaviour change; rely on polysomnography when it will alter care. ^{29 8}

Symptoms and Clinical Presentation

Common patterns

• Taking >30 min to fall asleep, frequent night wakes, early morning waking; unrefreshing sleep.
• Daytime: fatigue, poor focus, headaches, mood change, microsleeps; risky use of caffeine/alcohol.
• Snoring/apnoeas (from a partner’s report), waking gasping/choking, nocturia, morning headaches (suggestive of OSA).
• Restless legs: uncomfortable urges to move legs at night, relief with movement.

Red flags – seek medical review promptly

• Loud habitual snoring plus witnessed apnoeas or gasping; excessive daytime sleepiness (do not drive).
• Major functional impairment, depression with sleep disturbance, or sleep attacks at work.
• In children: snoring, laboured breathing, behavioural or learning concerns. ⁸

Causes and Risk Factors

• Insomnia drivers: stress, anxiety, grief, pain, poor sleep routine, late screens/light, caffeine/alcohol; conditioned arousal in bed. ²³
• OSA drivers: ↑age, obesity, craniofacial anatomy, nasal obstruction, alcohol/sedatives, supine sleep. ^{8 26}
• Circadian/shift work: misalignment between work schedules and biological night; increased cardiometabolic and accident risk. ^{14 28}
• Sociodemographic & health: lower education, unemployment, remote residence, depression/anxiety, low physical activity, smoking. ^{33 34}

Diagnosis (Australia)

1. Primary care assessment (Doccy & GP): history, medications, substance use, sleep diary; screen for mental health and cardiometabolic risk. ⁸
2. Validated tools:
   • Insomnia: Sleep Condition Indicator (SCI).
   • OSA: Epworth Sleepiness Scale (ESS); consider STOP‑Bang for risk stratification. ²⁷
3. Investigations:
   • Polysomnography (lab or home) for suspected OSA (MBS‑supported when criteria met). ⁶
   • Iron studies if restless legs; thyroid and mood screening when indicated.
4. Differentials: circadian rhythm disorders, narcolepsy/idiopathic hypersomnia, periodic limb movement disorder, medication effects. ⁸

Treatment Options in Australia

1) Insomnia (first‑line is non‑drug)

• CBT‑I (gold standard): sleep restriction, stimulus control, cognitive strategies, relaxation, and circadian/schedule adjustments—superior to sedatives long‑term. ²³
• Digital CBT‑I can increase access; consider referral pathways under Better Access where indicated. ³⁵
• Short‑term medication (e.g., hypnotics) only when necessary and time‑limited; avoid in untreated OSA and high fall‑risk.

2) Obstructive Sleep Apnoea (OSA)

• CPAP is the standard therapy for moderate–severe OSA; improves sleepiness and blood pressure and can reduce accidents.
• Mandibular advancement devices for mild–moderate OSA or CPAP‑intolerant patients.
• Adjuncts: weight loss, alcohol/sedative reduction, side‑sleeping, treat nasal obstruction. ^{8 26}

3) Shift‑work / circadian issues

• Bright light timing, controlled naps, anchor sleep, caffeine timing, and, where appropriate, carefully timed melatonin. ²⁸

4) Children & teens

• Consistent schedules, screen limits, behavioural strategies; refer for snoring/OSA symptoms (ENT/sleep paediatrics). ³⁶

Costs & access

• MBS supports GP care and diagnostic sleep studies for eligible patients. ⁶
• PBS subsidises some relevant medicines (e.g., short‑term sedatives where clinically justified; certain wake‑promoting agents under criteria). ⁷

Living with Sleep Problems (Practical Tools)

• Regularity wins: fixed wake time, wind‑down routine, light snack if hungry; bed only when sleepy.
• Bedroom setup: dark, cool, quiet; remove clock‑watching; reserve bed for sleep/intimacy.
• Evening habits: no caffeine after midday; limit alcohol; screens off ≥60 min before bed (blue‑light mitigation).
• Day strategies: morning light exposure; move your body (even a brisk walk); keep naps short (less than 20–30 min, early afternoon).
• If you can’t sleep: get up after ~20–30 min; quiet activity; return when sleepy.
• Safety: if sleepy at the wheel, stop driving and rest.

Special Focus Sections

Shift workers

• Protect “anchor sleep”: keep a minimum protected sleep block (e.g., 4–5 hours) at the same clock time each day, even on days off, to stabilise your circadian rhythm. ²⁸
• Light is medicine: get bright light during the first half of a night shift (or on the way in); wear dark sunglasses on the commute home and use blackout curtains/eye mask to help daytime sleep. ²⁸
• Noise & temperature: use earplugs/white noise, keep the room cool, and put your phone on do-not-disturb.
• Strategic naps: a 10–20 min “maintenance” nap before nights can boost alertness; if you can nap during the shift, keep it short to avoid sleep inertia. ²⁸
• Caffeine timing: use small, early-shift doses; stop several hours before planned sleep and avoid caffeine on the drive home. ²⁸
• Rotation matters: where possible, prefer forward-rotating schedules (day → evening → night) and limit consecutive night shifts; advocate for fatigue-risk management at work. ¹⁴

Kids & teens

• Right amount for age: most 14–17 year-olds need 8–10 hours; younger children need more. Parent-set, consistent bedtimes are linked with better sleep. ^{32 11}
• Routines beat negotiations: predictable wind-down (bath, book, lights-out), regular wake time, and a tech-free hour before bed.
• Bedroom environment: dark, quiet, cool; no devices in the bedroom overnight (charging outside the room helps).
• Watch for symptoms: snoring, laboured breathing, bedwetting, hyperactivity/behaviour or learning problems may indicate sleep-disordered breathing—seek a GP/paediatric review.
• Teens’ body clocks run late: where possible, adjust morning light exposure (open blinds, breakfast outside) and limit evening bright light to help shift timing. ³²

First Nations peoples

• Culturally safe, community-led care: partner with Aboriginal Community Controlled Health Services, involve Aboriginal Health Workers, and use locally relevant education materials. ¹⁷
• Access & context: consider remoteness, transport, cost of diagnostics (e.g., sleep studies/CPAP), and housing factors that affect sleep (overcrowding, noise, temperature). ¹⁶
• Higher cardiometabolic burden: prioritise screening when symptoms are present (snoring, daytime sleepiness), given the intersection with cardiometabolic risk. ¹⁷
• Flexible pathways: leverage telehealth, home-sleep testing where suitable, and community-based follow-up to support adherence to therapy. ¹⁶

Prevention / Early Action

• Protect your circadian rhythm

  • Morning daylight within an hour of waking; dim lights in the last hour before bed.
  • Regular meals and activity aligned to daytime; avoid heavy late meals.
  • Consistent sleep window (aim for the same wake time daily).

• Tackle modifiable risks

  • Weight management, alcohol moderation, and smoking cessation lower OSA risk and improve sleep quality.
  • Address anxiety/depression early (CBT, lifestyle strategies, GP care).

• Job design & safety

  • Where possible: forward-rotating shifts, limit consecutive nights, plan on-shift naps, and ensure safe commute options after nights.
  • Engage with employers on Fatigue Risk Management Systems (education, rostering rules, rest facilities). ^{14 28}

Key Takeaways

• Sleep problems are common and treatable.
• CBT‑I helps insomnia best long‑term; CPAP is the standard for moderate–severe OSA.
• Short and long sleep are associated with cardiometabolic risks—aim for regular, restorative sleep.
• Medicare (MBS) and PBS reduce costs; your GP is the best first step.

Expert Medical Advice with Doccy

• Not sure where to start? We can help you screen your symptoms, choose the right next step (CBT‑I, sleep study, CPAP pathways), and optimise routines tailored to shift work, parenting or chronic illness.
• We can also help you prepare for your GP appointment (sleep diary templates, ESS/SCI questionnaires) and talk through access (MBS/PBS, telehealth).

Related Articles

• Depression and Low Mood
• Anxiety and Worry
• Stress

This page is for general information only and is not a substitute for professional medical advice.

References & Useful Links