Why sleep stops working, and what an assessment covers

Most people who sleep badly have already tried the obvious fixes. An earlier bedtime, a darker room, less coffee after lunch. When none of it works, it is easy to decide you are simply a bad sleeper.

That is rarely the whole story. Broken sleep usually has several drivers running at once, and some of them can be measured. This article covers what broken sleep looks like in Australian adults, and what a practitioner looks at when you bring it to a consultation. It will not tell you what is happening with your sleep. Only an assessment of you can do that.

Sleep is also one of the foundations of healthspan. It is closely tied to metabolic health, mood and recovery, which is why it sits near the centre of any longevity assessment.

Why does sleep stop working for so many working adults?

Broken sleep is common in Australia, and it usually has more than one driver. Work hours, caffeine, alcohol, stress, breathing during sleep and an underlying condition can all be running at once. Most people who sleep badly have several of these together, which is why changing one thing often moves less than expected.

The scale is documented. The Sleep Health Foundation’s Chronic Insomnia Disorder in Australia report found that 14.8% of Australian adults meet the criteria for chronic insomnia disorder under the International Classification of Sleep Disorders, and that 59.4% experience at least one sleep symptom three or more times a week. Nearly half, 48.8%, said they do not have enough time available in the day for adequate sleep.

The economic reading is in the 2019 federal parliamentary report Bedtime Reading. Drawing on Deloitte Access Economics, it put the annual cost of inadequate sleep in Australia at $66.3 billion. That splits into $26.2 billion in financial costs and $40.1 billion in lost wellbeing.

Broken sleep is a symptom, not a diagnosis

Poor sleep describes what happens at night. It does not name the cause. Two conditions account for a large share of it in Australian adults: chronic insomnia and obstructive sleep apnoea. They are handled differently, and they often occur together. Working out which one is in play is the first job of an assessment.

The Royal Australian College of General Practitioners’ 2024 clinical resource article, Sleep health primary care clinical resource, describes both as the most common sleep disorders and frequent reasons for presentation in Australian general practice. It also reports that sleep disturbance has appeared among the most common presenting problems in the RACGP Health of the Nation survey for six consecutive years.

The same article notes that obstructive sleep apnoea is often unrecognised and underdiagnosed, and that an estimated 20% of the Australian general population has at least moderate obstructive sleep apnoea. That is the reason a consultation about tiredness asks about snoring and breathing, even when you came in to talk about waking at 3am.

What does a clinical sleep assessment look at?

It starts with a structured history. How long the problem has run. Whether you cannot fall asleep, cannot stay asleep, or wake too early. What your evenings, nights and mornings look like. How the days are affected. Validated questionnaires and a sleep diary then turn that account into something you can measure and re-check later.

The tools used in Australian primary care are named in the RACGP resource above and hosted at sleepprimarycareresources.org.au. For insomnia, the Insomnia Severity Index and the Sleep Condition Indicator give a score for how severe the problem is and how much it is affecting daytime function. For sleep apnoea risk, the Epworth Sleepiness Scale, the OSA50 and the STOP-Bang questionnaire score things like daytime sleepiness, snoring, witnessed pauses in breathing, neck size, age and blood pressure.

A sleep diary usually runs one to two weeks. You record bedtime, how long you took to fall asleep, night wakings, wake time, and a rating of the day. It is unglamorous. It also separates what actually happened from what you remember happening, which is why it is worth the fortnight.

What gets asked about your day, not only your night

Daytime patterns shape the night, so the history covers them. A practitioner asks about caffeine timing and quantity, alcohol timing, shift or rotating hours, evening light and screen use, exercise timing, any medicines you already take, and how your working week is structured. These are the variables that cost nothing to change, so they get examined before anything is ordered.

Alcohol is the one people are most often surprised by. The Sleep Health Foundation’s factsheet on caffeine, food, alcohol, smoking and sleep explains that alcohol can help you fall asleep while disturbing the quality of the sleep that follows, making it harder to stay asleep, and that it makes snoring and sleep apnoea worse. The Foundation suggests avoiding alcohol for at least four hours before bed. Its survey work found four in ten Australian adults had an alcoholic drink in the hour before sleep.

Which tests are worth ordering for a sleep concern?

Bloods are ordered when the history points at something specific. Iron studies are the clearest example, because low iron is linked with restless legs, and restless legs fragments sleep. Screening questions about mood, and a review of existing conditions, matter for the same reason. Each measure should have a question behind it.

On iron, the American Academy of Sleep Medicine’s 2025 clinical practice guideline for restless legs syndrome advises regular testing of serum iron studies, including ferritin and transferrin saturation, in people with clinically significant restless legs. The guideline sets thresholds for acting on the result, including a serum ferritin at or below 75 ng/mL, or a transferrin saturation under 20%. That is a specific measure attached to a specific finding, which is what a useful test looks like.

The RACGP resource makes a related point about context. It describes insomnia as something to view alongside other health and physical conditions rather than in isolation, which is why a sleep history asks about pain, breathing, mood and the medicines already in the picture.

Our position on testing is that a measure earns its place when the answer would change what happens next. That is why we tell you the scope and the cost of a consultation and any testing before you book.

What a consultation cannot tell you

A consultation cannot tell you what your breathing does while you are asleep. The questionnaires above estimate risk. They do not diagnose obstructive sleep apnoea. That requires a sleep study. Your practitioner arranges one through a referral pathway, and a referral is one of the more common outcomes of a first conversation about broken sleep.

The RACGP resource sets out when a sleep study or a referral is warranted, and covers the Medicare Benefits Schedule items involved. Some presentations are not suited to management outside a sleep service at all. If your history includes significant heart, lung or psychiatric conditions, the appropriate answer may be a sleep physician rather than any general consultation.

Some things need a doctor sooner than an article. See your GP promptly, or use urgent care, if you are falling asleep while driving or at work, if someone has seen you stop breathing or gasp during sleep, if you have chest pain, new palpitations or breathlessness at night, or if your mood has dropped. If you are having thoughts of harming yourself, call Lifeline on 13 11 14 at any hour, or 000 in an emergency.

When insomnia is the answer, what usually comes first?

Behavioural treatment comes first. The RACGP article states that cognitive behavioural therapy for insomnia is the recommended first-line treatment for insomnia, and that behavioural management improves insomnia severity and sleep parameters and frequently improves symptoms of co-occurring conditions. It is a structured course. A psychologist delivers it, or you work through a digital program.

That is worth knowing before you pay anyone for a consultation about sleep, because it means the first recommendation you get may be to work with someone else. A practitioner’s job is to identify what is driving the problem and point you at the right pathway, including when that pathway sits outside the clinic.

How BioLyfe approaches a sleep concern

You bring the concern. You speak with one of our practitioners in a live consultation. Before you book, you are told what the consultation covers, what would be measured, and what that comes to as a total. What follows depends on what the practitioner finds in your history and your results.

If deemed medically appropriate, the outcome may be advice, a referral, monitoring, a change to your routine, further investigation, or no treatment at all. With your consent, we work alongside your GP and any other practitioner you already see, and we tell you what gets shared with them.

A next step, if you want one

Start the diary. Two weeks of bedtime, wake time, night wakings and a note on the day. It costs nothing, it takes two minutes an evening, and it makes any appointment you eventually book more useful, whether that is with us or with your own GP.

When you want the concern looked at in a longer conversation, the Sleep & Circadian Health page sets out what a consultation covers and what gets reviewed.

Sources

• Sleep Health Foundation, Chronic Insomnia Disorder in Australia
• House of Representatives Standing Committee on Health, Aged Care and Sport, Bedtime Reading: Inquiry into Sleep Health Awareness in Australia, April 2019
• Soenen S, Sweetman A, Balzer M, et al. Sleep health primary care clinical resource. Australian Journal of General Practice, Vol 53, No 6, June 2024
• Sleep Health Primary Care Resources, Australian National Centre for Sleep Health Services Research
• Sleep Health Foundation, Caffeine, Food, Alcohol, Smoking and Sleep
• American Academy of Sleep Medicine, Treatment of restless legs syndrome and periodic limb movement disorder: an American Academy of Sleep Medicine clinical practice guideline