Mental health and sleep
Insomnia & sleep problems
For trouble falling asleep or waking during the night
with a medical interpreter
24 hours a day, 365 days a year
OK to consult together
payment information
About
About Insomnia & sleep problems
We help with sleep problems such as trouble falling asleep, waking during the night and sleep rhythms disrupted by time differences.
Why it happens
Sleep is regulated by the body clock (circadian rhythm) and by sleepiness that builds the longer you're awake. When this balance is upset by time differences, an irregular routine, not getting morning light, using a smartphone before bed, caffeine or alcohol, or stress and anxiety, trouble falling asleep and waking during the night become more likely. Mental health problems or breathing problems during sleep (sleep apnea) may also be behind it.
What's happening in the body
Sleep is thought to be regulated by two systems: the body clock, and sleep pressure that builds the longer you're awake. The body clock is reset by morning light, and at night a hormone that promotes sleep is released. Exposure to bright light late at night delays the release of this hormone and makes it harder to fall asleep. The other system is that the more active you are during the day, the more sleepiness builds. If you're not very active during the day, you won't feel sleepy enough at night. On top of this, under severe stress the body tries to stay alert, making it harder to fall asleep and easier to wake during the night. When poor sleep continues, worry that you won't sleep again tonight can develop, and that worry itself can start a vicious circle that keeps you awake.
Main symptoms
- Taking a long time to fall asleep
- Waking up many times during the night
- Waking up early and unable to get back to sleep
- Not feeling rested after sleep
- Strong daytime sleepiness, poor concentration
- Told you snore or stop breathing during sleep
- Feeling anxious about sleeping when night comes
When you can wait and see
What you can do yourself
- Get up at the same time each day and get morning light
- Avoid smartphone and computer screens for 1 hour before bed
- Avoid caffeine from the evening onward, and alcohol before bed
- If you can't sleep, don't force yourself to stay in bed; get up for a while
- Get moderate exercise during the day
Please consult us
If any of the following apply
- It takes you a long time to fall asleep
- You wake in the night or early morning
- Daytime sleepiness is a problem
Seek care right away
If any of the following apply
- Overwhelming daytime sleepiness, with lapses of awareness while driving or working
- Told you stop breathing during sleep, with morning headaches or high blood pressure
- Trouble sleeping along with thoughts of wanting to die
- Unable to sleep without alcohol or sleeping pills, and needing more and more
Don't wait for a Cotovia consultation; call the emergency number in your country.
See the emergency guide for each countryIf you're not sure, ask us on LINE
Differential
Telling it apart from similar conditions
Symptoms that look the same may need different care depending on the cause. Use this as a guide to find what's closest to your situation.
Trouble falling asleep
It takes a long time to fall asleep after going to bed
We start with your light exposure before bed and ways to relax
Waking during the night
Waking several times in the night and not getting back to sleep
We check factors such as alcohol, toilet trips, room temperature and stress
Waking too early
Waking earlier than planned, with low mood
A mental health problem may be behind it, so we assess that too
Sleep apnea
Loud snoring, being told you stop breathing, and strong daytime sleepiness
It needs to be assessed with tests. Left untreated, it can affect the whole body
Restless legs
Uncomfortable legs in the evening and at night, with an urge to keep moving them
We assess it, including your iron levels
Physical illnesses such as thyroid disease
With a racing heart, sweating and weight changes
This can be assessed with a blood test
* This is not a complete list. If you're not sure, please consult us.
When it might be something else
Course
Typical course
This is the general course. Actual progress varies from person to person.
- A few days to 2 weeks
Temporary disruption from a change in environment or time difference
Getting morning light and waking at the same time each day help it settle
- 2 weeks to 1 month
If it continues past this point, a vicious circle may be starting
Consider whether pressure to fall asleep is keeping you awake
- 1–3 months
It tends to become long-term at this stage, and daytime problems become noticeable
Don't try to handle it on your own; please consider consulting us
- 3 months or more
Insomnia 3 or more times a week for more than 3 months needs treatment
We look into the causes and assess treatment options
Local Insight
For people living in Southeast Asia
The climate, healthcare and access to medication differ from Japan. Here are points specific to this region.
Many countries here have only a small time difference from Japan (1 hour for Singapore, Malaysia, the Philippines and Hong Kong, and 2 hours for Thailand), so the time difference itself has little effect. However, meetings with head offices in Japan sometimes fall early in the morning or late at night and break up sleep.
In a climate that is summer all year, daylight changes little between morning and evening, which can make the body clock less distinct. Making a point of getting outdoor light in the morning helps.
Setting the air conditioning too cold or having it blow directly on you can lower sleep quality. It's worth adjusting the room temperature and airflow at bedtime.
In many countries sleeping pills are strictly regulated, and bringing them from Japan may require an advance application or documents. The same medication may not be prescribable locally, so consulting early is recommended.
Care
What Cotovia can do
- Assessing your sleep through a consultation
- Lifestyle advice for better sleep
- Discussing medication if needed (prescribing is at the doctor's discretion)
Tests you may have
Not knowing what will happen can make people hesitate to seek care, so here's what actually takes place.
Consultation and sleep diary
Recording bedtimes, wake-up times, waking during the night and daytime sleepiness
Questionnaire assessment
Gauging how severe the insomnia and daytime sleepiness are
Blood test
Checking thyroid function, anemia and iron levels
Sleep apnea test
Assessing your breathing during sleep
Treatment options
Rebuilding sleep habits
Resets the body clock and natural sleepiness
The basics are waking at the same time each day and getting morning light
Adjusting thoughts and behavior
Breaks the vicious circle of worrying about not sleeping
Techniques include going to bed only when sleepy and not spending long periods in bed
Medication
Helps sleep temporarily
It isn't continued indefinitely but adjusted as things progress. Prescribing is at the doctor's discretion
Treating the underlying condition
Care when something such as sleep apnea is behind it
If tests identify a cause, treating it takes priority
* Tests, procedures and prescriptions are decided by the doctor after a consultation. Services may vary by country and location.
Preparation
Before your visit
When seeing a doctor abroad, simply organizing what you need to say makes a big difference.
What to bring
- Passport or residence card
- Insurance card and your insurer's contact details
- Your medication record and the medication you take
- A sleep diary for 1–2 weeks, if possible
What to tell us
- Whether the main problem is falling asleep, waking in the night or waking too early
- Roughly how long it has been going on
- Your bedtime and wake-up time, and how they differ on days off
- Alcohol, caffeine and smartphone use before bed
- How sleepy you are during the day, and whether you've been told you snore
Self Care
What you can do yourself
Along with seeing a doctor, here are things to keep in mind in daily life.
Prevention
- Don't change your sleep and wake times much on days off
- Keep your bedroom dark and quiet at a comfortable temperature
- Before and after trips home or business travel, adjust when you get light
- Don't let stress build up; consult us early
How to Consult
How to be seen
Choose from 3 ways to be seen, depending on your symptoms and schedule. If you're not sure, we'll guide you on LINE.
Online consultations
See a doctor by video call from home or the office. Medication delivered or from a pharmacy.
Available for this symptom
In-person care
In-person consultations at our clinics and partner hospitals, including tests and procedures.
Ask us about this symptom
Cotovia Counter
Support with an interpreter for visits to general hospitals.
Available for this symptom
If an online consultation finds that tests or procedures are needed, we'll guide you to in-person care or Cotovia Counter.
From consultation to receiving medication
Add us on LINE and consult
Tell us your symptoms, and we'll recommend the right way to be seen.
Book and be seen
See a doctor online or at the nearest location, with an interpreter present.
Receive your medication
Have it delivered or pick it up at a pharmacy or the clinic (varies by country).
Follow-up
You can also consult us on LINE about how you're doing afterward.
Special Care
People who need extra care
Children
Screen use before bed and irregular wake-up times tend to have an effect
Older adults
Lighter sleep is also a normal part of aging. If you're fine during the day, there may be nothing to worry about
Pregnant women
Some medications can't be used. Be sure to tell us if you could be pregnant
People with low mood
Insomnia with early waking can have a mental health problem behind it. Please tell us about that too
FAQ
FAQ
Common questions before a visit, and common assumptions that lead people to judge for themselves.
QI don't want to rely on sleeping pills.
We can start by working on lifestyle changes together. The doctor carefully considers medication only when it's needed.
QCan I bring sleeping pills from Japan?
Regulations differ by country, and you may need to apply in advance or bring documents showing your prescription. It's recommended to check before you travel.
QIs my trouble sleeping caused by stress?
Stress is one major factor, but daily rhythm, environment and physical factors may also be involved. We'll sort it out as we hear how things have developed.
Common misconceptions
Myth A drink before bed helps you sleep well
Fact You may fall asleep faster, but sleep becomes lighter and you're more likely to wake during the night
Myth You must sleep 8 hours
Fact How much sleep people need varies. If you're fine during the day, shorter sleep isn't a problem
Myth If you can't sleep, just lie in bed longer
Fact Lying awake in bed makes it easier to link your bed with not being able to sleep
Myth You can catch up on sleep on days off
Fact Shifting your wake-up time a lot disrupts the body clock and actually makes things harder to fix
Myth Once you take sleeping pills, you can't stop
Fact Medication is adjusted as things progress, in consultation with the doctor
Feel free to ask us on LINE first
It's fine to contact us even if you're not sure you need to see a doctor. We're available in Japanese 24 hours a day, 365 days a year.
- Symptoms
- When it started
- Your country of residence
- How you'd like to be seen
Sending these 4 things helps us respond faster. It's fine if you don't have them all.
Ask us on LINE