What Is Actually Happening When We Can’t Sleep

Sleep is regulated by two interconnected systems: the circadian rhythm (the internal 24-hour clock) and the sleep drive (the accumulation of sleep pressure over time). When we are anxious or under chronic stress, a third system activates: the HPA axis, which governs the body’s stress response and releases cortisol.

Cortisol is meant to rise in the morning and decline through the day, reaching its lowest point at night. In people living under chronic stress, this pattern gets disrupted. Cortisol stays elevated in the evening, making it harder to fall asleep. Or it spikes in the early hours of the morning, 3am or 4am, pulling us out of sleep with that characteristic sense of alert dread.

This is not a character issue or a discipline failure. It is a physiological response to a nervous system that has been running on high alert for too long.

The South Asian Context

Chronic stress is not an individual failing. For many South Asians in Canada, it is structural. The pressures of navigating a professional environment that was not built with us in mind. The invisible labour of maintaining family relationships across cultures and sometimes continents. The weight of being the person everyone else is holding it together for. The unspoken cost of code-switching; being one thing at work and another at home and having no clear space to just be.

A 2026 study found that total daily working hours — including unpaid care and domestic work — are significantly associated with non-restorative sleep and poorer mental health in middle-aged women. South Asian women are disproportionately likely to be carrying both paid work and the majority of unpaid domestic and caregiving labour. That total load does not disappear at bedtime. It follows us in.

Hormonal factors add another layer. Women in perimenopause or dealing with PMOS (formerly PCOS) often experience significant sleep disruption driven by hormonal fluctuation. Insulin dysregulation — common in South Asian women, often present at lower BMIs than Western diagnostic tools are designed to catch — affects blood sugar regulation overnight and can be a driver of early morning waking.

Why “Just Relax” Doesn’t Work

Sleep hygiene advice — no screens before bed, cool dark room, consistent schedule — is real and useful. But it addresses the environment of sleep without addressing the internal state that is making sleep impossible. Telling an anxious nervous system to relax is a bit like telling a smoke alarm to stop beeping without addressing the smoke.

What actually moves the needle:

• Addressing the anxiety that is driving the sleep disruption — not just at bedtime, but as an ongoing practice. This is where therapy, particularly CBT for insomnia (CBT-I), has the strongest evidence base.
• Regulating blood sugar through the day: blood sugar crashes overnight are a common and underrecognised driver of early morning waking. Eating in a way that keeps glucose stable — pairing carbohydrates with protein and fat, not skipping meals, not eating very late — makes a measurable difference for many people.
• Moving the body: exercise is one of the most effective sleep interventions that exists. It does not need to be intense. A 20-minute walk after dinner, done consistently, changes sleep architecture in ways that most supplements cannot replicate.
• Processing the load, not just managing it: therapy that addresses the sources of chronic stress, not just the coping strategies, changes the baseline from which sleep has to happen.

The Sleep and Mental Health Loop

Here is what makes sleep disruption particularly serious as a mental health issue: poor sleep makes everything worse. Anxiety worsens. Emotional regulation deteriorates. Concentration drops. Irritability rises. The things that felt manageable when rested feel impossible when exhausted.

And then sleep becomes anxiety-provoking in itself. The dread of another bad night. The monitoring of sleep that paradoxically makes it harder to sleep. This is the insomnia loop — and it is genuinely difficult to break without support.

Harvard research from 2026 found that sleep difficulties are about twice as common in women as in men, and that this gap widens significantly during the perimenopause transition. For South Asian women dealing with hormonal shifts alongside structural chronic stress, sleep can become the thing that finally makes the accumulation visible.

A Different Way to Think About This

Sleep is not a reward we earn by finishing everything on the list. It is not something we get to when everything else is handled. It is a physiological necessity that is as fundamental to our functioning as food and water. Treating it as optional until the pressure lets up is treating our own biology as negotiable.

If sleep has been broken for months or years, that is information. It is the body’s way of indicating that something in the system — hormonal, psychological, structural — needs attention. It is worth taking seriously. Not because we are falling apart, but because we deserve to sleep.

At Sukoon Cares, we work with the whole picture: the anxiety, the hormonal health, the nutritional factors, the cultural context. If sleep is where the struggle is most visible right now, that is a meaningful starting point.

 Sources

• Harvard T.H. Chan — Sleep Patterns and Changes in Perimenopause (May 2026)
• Phys.org — The Hidden Workload Behind Burnout: Why Unpaid Work May Worsen Women’s Mental Health (April 2026)
• PMC — Impact of Sleep Disturbances on Health-Related Quality of Life in Postmenopausal Women
• NCBI — Knowledge, Attitude, and Practice Toward Sleep Disorders Among Perimenopausal Women