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Overview: Why Can't I Sleep? 

What is Insomnia?

Insomnia is the most common sleep disorder. It affects about 1 in 4 adults in the United States. People with insomnia have trouble sleeping well and getting a good night’s sleep. These sleep difficulties include difficulty falling asleep and/or staying asleep. 

If you have insomnia, you may find it hard to fall asleep when you go to bed, or you may wake up in the middle of the night and find it difficult to go back to sleep. Insomnia symptoms can also cause daytime impairments such as sleepiness, trouble concentrating, and irritability. 

Getting less sleep than recommended can lead to a number of health problems as well as problems with functioning in daily life. However, throughout our lives, we experience changes in the number of hours we sleep each day.

Common Reasons for Trouble Falling Asleep: Why Am I Suddenly Unable To Sleep?

• Lifestyle factors, such as an inconsistent sleep schedule, use of electronic devices at bedtime, poor sleep environment, and dietary choices (caffeine, alcohol, heavy meals) before bedtime.

• Mental disorders such as stress, anxiety, and post-traumatic stress disorder.

• Other sleep disorders that can disrupt sleep, such as obstructive sleep apnea and restless leg syndrome. 

• Medical conditions, such as chronic pain, acid reflux or GERD, diabetes, asthma, heart disease, overactive thyroid, substance use disorder, and neurological disorders such as Alzheimer’s disease and Parkinson’s disease.

• Certain medications, including over-the-counter and prescription drugs used to treat high blood pressure, asthma, colds and allergies, and weight loss drugs.

Learn about “What Medications Can Cause Fatigue?”

Insomnia Symptoms

• Having difficulty falling asleep at bedtime.

• Waking up in the middle of the night and being unable to get back to sleep.

• Waking up too early in the morning.

• Feeling sleepy or tired in the daytime.

• Having trouble focusing, paying attention, concentrating, and remembering.

• Experiencing crankiness, irritability, anxiety, or depression.

• Making more errors or having more accidents.

• Worrying about your sleep routine.

Effects of Poor Sleep Hygiene

Almost everyone has had the occasional sleepless night. But when sleep difficulties continue for a few days or weeks, it is called acute or short-term insomnia. This usually occurs as a result of external stressors such as life events (divorce, the death of a loved one), financial difficulties, or receiving a medical diagnosis. If a person continues to have a hard time falling asleep and staying asleep for more than a few months, it is called chronic insomnia. The National Sleep Foundation estimates that 10-15% of people in the US have chronic insomnia.

Experts recommend adults get no less than 7-9 hours of sleep per night. Untreated insomnia (not getting enough quality sleep at night) can affect your ability to function in daily life. It can also lead to chronic sleep deprivation, which is linked to an increased risk of many chronic health conditions, including obesity, high blood pressure, heart disease, and diabetes.

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Common Sleep Disorders: Why Can’t I Sleep Even If I Try?

Obstructive Sleep Apnea

Obstructive sleep apnea is a sleep disorder in which breathing repeatedly stops or becomes shallow while sleeping. This reduces the amount of oxygen your brain and body get. People with obstructive sleep apnea wake up multiple times during the night, gasping for breath. Loud snoring is another common symptom. Learn Hypopnea vs Apnea: Know the Difference.

Circadian Rhythm Disorders (Sleep-Wake Cycle) 

Circadian rhythm sleep disorders affect your body’s natural wake-sleep cycle and sleep patterns. Examples include: 

• Jet lag after traveling to a different time zone.

• Shift work sleep disorder with trouble adjusting to work timings outside the usual 9-5 hours.

• Delayed sleep-wake phase disorder, where you fall asleep much later than most people.

• Advanced sleep-wake phase disorder where you go to bed and wake up earlier than most people.

• Irregular sleep-wake rhythm disorder where you have an erratic and unpredictable sleep schedule.

• Non-24-hour sleep-wake rhythm disorder where your circadian rhythm is longer or shorter than 24 hours.

Restless Legs Syndrome

Restless leg syndrome (RLS) is a disorder in which there is an uncomfortable feeling in the legs and a strong, uncontrollable urge to move them. These symptoms of RLS can disrupt sleep and cause trouble falling asleep and staying asleep.

Parasomnias

A parasomnias is a sleep disorder that can disrupt sleep. Examples include sleepwalking (somnambulism), sleep terrors, confusional arousals, and sleep-related eating disorders. Find out why you can’t wake a sleepwalker.

Lifestyle and Environmental Factors

Lifestyle and environmental factors can play a role in your ability to fall asleep and stay asleep. Things that can affect your sleep quality and duration include:

• An irregular sleep schedule (going to bed and waking up at different types every day).

• Use of electronic devices before going to bed.

• An uncomfortable sleep environment such as noise, lights, or too cold or too hot bedroom temperature, which can affect your body temperature.

• Dietary choices such as drinking alcohol, consuming caffeine, or eating a heavy meal shortly before bedtime. 

Mental Health Conditions: Why Am I So Tired But Can't Sleep?

Insomnia is a symptom of mental health disorders such as anxiety, depression, post-traumatic stress disorder (PTSD), schizophrenia, and bipolar disorder. For example, anxiety can cause racing thoughts and worries that cause you to lay awake at night. PTSD can cause flashbacks, nightmares, or night terrors that prevent you from getting a good night’s rest. 

But insomnia and mental health conditions have a complex, bidirectional relationship. Insomnia can be a symptom of mental disorders, but mental disorders can also cause insomnia, tiredness, and other symptoms. Further complicating the picture is the fact that some medications used to treat these disorders can cause insomnia and tiredness as side effects.

Physical Health Conditions: Why Am I Struggling To Sleep So Much?

Certain health conditions can cause or worsen insomnia symptoms. Examples include:

• Chronic pain

• Heartburn or gastroesophageal reflux disease (GERD) 

• Asthma

• Diabetes

• Heart disease

• Hyperthyroidism (overactive thyroid)

• Neurological disorders such as Alzheimer’s disease and Parkinson’s disease

• Depression

• Substance use disorder

Medications

Several over-the-counter and prescription drugs can cause insomnia as a side effect, including: 

• Antidepressant and anti-anxiety drugs

• Antihypertensives prescribed for high blood pressure, for example, beta blockers and alpha agonists

• Corticosteroids, such as prednisone and prednisolone

• Alzheimer's drugs, such as cholinesterase inhibitors

• Over-the-counter medications, such as decongestants, cold and allergy medicines, and weight loss agents (appetite suppressants)

• Diuretics (water pills)

• Medications containing caffeine

Learn more about prednisone and insomnia.

Sleep Tips for Falling Asleep and Staying Asleep

Stick to a Consistent Sleep Schedule

Try to stick to a sleep schedule by going to bed and waking up at the same time every day, including weekends. Ensure you get at least 7-9 hours of sleep every night. 

Establish a Relaxing Bedtime Routine

Wind down with relaxing activities such as reading, listening to soft music, or taking a warm bath before going to bed. Limit or avoid using electronic devices like phones, tablets, and computers for 1-2 hours before bed. Blue light from these devices can disrupt sleep. 

Create a Sleep-Conducive Environment

Create a good sleeping environment by making sure your bedroom is dark, quiet, and at a comfortable temperature. 

Diet and Exercise for Better Sleep

Get Daily Exercise

Studies have shown that regular physical activity can lead to improved sleep quality and a reduction in symptoms of sleep disorders like insomnia. 

Make Dietary Changes

Avoid caffeine and nicotine, which can stay in your system for several hours and prevent you from getting quality sleep. Also, avoid alcohol and large meals before bed, which can cause sleep disruptions.

Consider Taking Supplements

Short-term use of dietary supplements, such as melatonin, can help in managing insomnia and sleep disruptions related to sleep disorders such as jet lag. Find out how much melatonin is safe to take.

Managing Stress and Mental Health

Practice Relaxation Techniques

A relaxation technique such as deep breathing, body scan meditation, light stretching, or progressive muscle relaxation can help you relax, feel sleepy at bedtime, and get a good night’s rest.

Medical Treatments for Insomnia

Over-the-Counter Sleep Aids and Supplements

• Sedating antihistamines such as diphenhydramine (Benadryl) and doxylamine (Unisom). 

• Supplements such as melatonin.

• Herbal remedies such as valerian.

Read more: “Best Sleep Aids: Prescription Vs. Over-The-Counter”

Prescription Medications

Some of the prescription medications to treat insomnia include:

When to Talk to a Healthcare Practitioner

Symptoms of Severe Sleep Disturbances

• Trouble falling asleep, waking up during the night, waking up too early, or lying awake for long periods at night.

• Daytime symptoms such as feeling tired, drowsy, irritable, lacking energy, or having difficulty concentrating or remembering.

• Mood changes such as feeling irritable, cranky, anxious, or depressed.

• Performance issues, such as making more mistakes or having more accidents.

• Ongoing worries about your sleep issues.

Diagnostic Procedures and Tests

If you continue to experience insomnia after working on your sleep hygiene (sleep habits) and trying natural remedies, make an appointment to see your healthcare provider. Your doctor can make a diagnosis of insomnia based on your symptoms, medical history, and physical exam. Healthcare professionals use the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) to diagnose mental health disorders.

You might have a condition such as sleep apnea or restless legs syndrome that needs to be diagnosed and treated by a sleep specialist. To this end, you may need to be referred to clinical sleep medicine for further testing.

Treatment Plans and Long-Term Management

Do not take over-the-counter sleeping pills for more than 2-4 weeks without your health care provider’s approval. Some of these sleep medications can be habit-forming and cause serious side effects. They are not meant to be used long-term for treating insomnia. 

Your doctor can not only treat insomnia but also the underlying cause of insomnia. For example, if stress and anxiety are the underlying cause of your insomnia, you may benefit from a non-drug treatment approach such as cognitive behavioral therapy (CBT), a type of talk therapy.