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5 most common causes
Difficulty falling asleep symptoms
Lying awake for hours when trying to fall asleep, even when very tired, is a common symptom. Some consider it a by-product of living a fast-paced, modern life. Even if you can stay asleep once you do finally fall asleep, taking too long to fall asleep can yield too few hours of sleep altogether. This can have a profound effect on a person's quality of life if it continues.
"Difficulty falling asleep" is also called "difficulty with sleep onset." It is a form of insomnia.
Common characteristics of difficulty falling asleep
Symptoms that are commonly associated with difficulty falling asleep include the following.
- "Racing mind": After lying down to sleep, you still worry and think about things you must accomplish the next day or in the days to come.
- Daytime fatigue and drowsiness
- Difficulty concentrating
- Emotional symptoms: You may experience worsening anxiety, depression, and irritability due to lack of sleep.
- Relationship difficulty: Marriages especially can be negatively affected when partners have different sleep schedules.
Difficulty falling asleep may be a short- or long-term condition.
- Acute insomnia: This involves a few nights of difficulty falling asleep that resolves on its own.
- Chronic insomnia: This is a long-term difficulty falling asleep that lasts a few times per week for three months or more.
Who is most often affected?
People who are most likely to experience difficulty falling asleep include:
- Women: This includes women under the age of about 30 or who are pregnant.
- Parents: Especially those with a young child in the house.
- Older people: Including anyone over 50.
- Traumatic brain injury (TBI) sufferers
Is difficulty falling asleep serious?
Difficulty falling asleep is usually not serious unless it is chronic or related to an underlying illness or injury.
- Not serious: Anyone can temporarily have trouble falling asleep.
- Moderately serious: Relationships, especially marriages, can suffer when one partner has chronic sleep difficulty. The body particularly the brain needs restorative sleep each night in order to function properly the next day.
- Serious: Going without proper sleep for weeks or months leads to severe lack of concentration and dozing off during the day, resulting in poor job performance, increased susceptibility to injury or illness, and a high risk of traffic accidents.
Difficulty falling asleep causes
Many conditions can cause the symptom of difficulty falling asleep. We've listed several different causes here, in approximate order from most to least common.
Short-term instances of stress can be defined by but are not limited to the following:
- Work or school: These may cause short-term deadline pressures.
- Holidays or vacations: The excitement and change of routine, even when enjoyable, can be stressful.
- Moving: Having to pack and move to a new home is almost always difficult.
- Pregnancy: Pregnant women are coping with the discomforts of an enlarged abdomen as well as the anticipation of a new baby.
Long-term instances of stress can be defined by but are not limited to the following:
- Shift work: This means sometimes you work nights and sometimes you work days. It is virtually impossible to adjust to a schedule like this and most people find it extremely disruptive.
- Relationships: Living for a long time with a troubled marriage or other difficult relationship is very stressful.
This type of stress can be defined as:
- Poor sleep habits
- Poor diet
- Little to no exercise
- Caffeine use
- Nicotine (tobacco) use
- Alcohol or drug abuse
Many medications cause sleep disturbance, especially when taken in certain combinations. Medications that can commonly lead to insomnia include those for blood pressure or heart rhythm problems, corticosteroids, certain antihistamines (although some have sedative effects) and SSRIs for depression and anxiety, among others.
Certain physical illnesses can lead to difficulty falling asleep.
- Chronic pain This can be the result of an injury or illness, such as fibromyalgia.
- Autoimmune disease There are many types, and all can cause chronic pain and sleep disruption.
- Heartburn: This is also called gastroesophageal reflux disorder, or GERD.
Mental or emotional illness
Certain mental or emotional illnesses can lead to difficulty falling asleep, such as:
- Post-traumatic stress disorder (PTSD)
- Bipolar disorder
Rare and unusual causes
Traumatic brain injury can cause severe and ongoing sleep disturbances.
We've listed some specific conditions that can cause difficulty falling asleep, along with how to identify each of them.
This list does not constitute medical advice and may not accurately represent what you have.
Restless legs syndrome (RLS)
Restless Legs Syndrome, also called RLS or Willis-Ekbom Disease, is a neurologic and sensory disorder. It causes uncomfortable sensations in the legs that are only relieved by walking or by moving the legs.
The cause is not in the legs but in the brain. One theory is low levels of iron in the brain.
RLS may be hereditary. It is more common in women than in men, especially in middle age. It may get more severe as the person gets older.
Symptoms may happen only a few times a week and are usually worse at night.
There will be an irresistible urge to move the legs in order to relieve the uncomfortable sensations; difficulty sleeping, with daytime exhaustion and inability to concentrate; and sometimes depression and anxiety due to the effect on quality of life.
Diagnosis is made through patient history and physical examination. Blood tests and sleep studies may be done.
Treatment involves first addressing any underlying medical condition, such as iron deficiency. In some cases, anti-seizure medications can be helpful.
Periodic limb movement disorder
Periodic limb movement disorder is a sleep disease that causes random limb movements during sleep. There is no known cause.
You should visit your primary care physician to discuss these symptoms.
Obstructive sleep apnea
Sleep apnea means "sleeping without breathing." It means the person briefly stops breathing during sleep and then abruptly wakes up due to lack of oxygen.
In obstructive sleep apnea, the airway becomes relaxed and collapses during sleep. In central sleep apnea, the part of the brain which controls breathing may fail to send out signals during sleep. In both cases, breathing is cut off and the patient is forced to wake up – sometimes hundreds of times per night.
Older, overweight people are most susceptible, as is anyone with enlarged tonsils.
Symptoms include loud snoring; constant rousing during sleep; and constant daytime sleepiness.
Ongoing sleep apnea leads to very poor sleep quality with little REM sleep. This is very stressful and can lead to high blood pressure, stroke, and heart arrhythmias. The daytime drowsiness can lead to car accidents.
Diagnosis is made through physical examination and a sleep study.
Treatment consists of lifestyle changes and usually a CPAP (Continuous Positive Airway Pressure) machine, which allows the patient to experience much better sleep almost immediately.
Insomnia disorder means being unable to fall asleep, or to stay asleep long enough to get the normal seven to eight hours of sleep per night.
Common causes are pain; sleep apnea; depression; stress and worry over life events; circadian rhythm disorders such as jet lag; aging; and certain medications.
Many medical conditions, such as diabetes and heart disease, cause poor sleep. Women who are pregnant or menopausal may experience insomnia due to hormone shifts.
Symptoms include waking up during the night; feeling tired in the morning; daytime sleepiness and irritability; and increased errors and accidents through inability to concentrate.
Diagnosis is made through physical examination, patient history, and sometimes testing at a sleep study center.
Treatment consists of addressing underlying medical conditions, along with managing stress and checking all medications and supplements.
Improving "sleep hygiene" means establishing a routine of lying down in a dark room at the same time each night, with no television, computer, or phone. Avoiding food and caffeine before bedtime will prevent heartburn and wakefulness while trying to sleep.
Moderate depression, also called dysthymia or dysthymic disorder, is one of the three general forms of : mild, moderate, or severe. About half of all people suffering from have the moderate form.
The causes of any depression are not known for sure. Some may be situational, such as grief or other difficult life events. Others may be due to physiological causes such as chemical or hormonal imbalances.
Symptoms include loss of interest in normal activities; neglect of activities of daily living; and loss of productivity, though the person will continue going through the motions of attending work or school.
If not treated, moderate depression can worsen into major depression.
Diagnosis begins with physical examination and blood tests to rule out any physical causes. A mental health professional will talk to the patient to learn about any difficult situational factors.
Treatment may or may not involve antidepressant medication, since antidepressants generally work best for severe depression. Psychotherapy, exercise, relaxation techniques, and lifestyle improvements are usually tried first for moderate depression, and are often very effective.
Top Symptoms: fatigue, depressed mood, headache, anxiety, irritability
Symptoms that always occur with depression: depressed mood
Urgency: Primary care doctor
Difficulty falling asleep treatments and relief
Difficulty falling asleep is something that can be possibly solved at home. However, if your restlessness persists, you should consult your physician.
Various at-home remedies may be helpful in getting you to sleep.
- Avoid shift work: This means you're required to constantly switch between working days and working nights look for resources with advice on how to manage this.
- Avoid naps: Do not take a nap during the day if you suffer insomnia.
- Sunlight: Getting direct sunlight on your face each day helps to "reset" your inner sleep schedule.
- Establish a routine: Go to bed and get up at the same times every day.
- Extra pillows: Pregnant women can try lying on one side with a pillow between the knees to ease back strain.
- Diet: Avoid caffeine and sugar within a few hours of bedtime. A lighter meal may also be beneficial.
- Unwind: Allow time to relax before trying to sleep. You can try taking a warm bath, reading, or listening to calming music.
- Have a peaceful sleep environment: You should try to sleep in a cool, quiet, dark room, without a television and with limited access to electronics.
- Make lists: For "racing mind," try briefly writing down the tasks you must accomplish the next day. This often allows the mind to stop worrying about them.
- Improve overall health: Make improvements in diet, exercise, and stress management.
If conservative methods do not provide relief and you are still having trouble sleeping, you should consult your physician for further recommendations.
- Discussion of medications: Your medical provider may be able to adjust the doses or prescribe different medicines.
- Discussion of other symptoms: These would include anxiety, depression, or chronic pain.
- Referral to a sleep specialist: A sleep study can be arranged in order to further investigate the cause of your difficulties.
Seek immediate treatment in the emergency room or call 911 for the following
If it becomes impossible to fall asleep at all, this can actually be a life-threatening condition and you should seek immediate treatment.
Are over-the-counter sleep aids effective in getting to sleep?
Some are effective for the short term. However, they all have side effects, including interacting with other medications and leaving you feeling groggy and "hung over" the next day. They cannot be used in the long term because you will only build up a tolerance. Long-term lifestyle changes are far better for curing sleep problems.
Is taking melatonin a good idea for help in getting to sleep?
Melatonin is a hormone secreted by the brain. Its job is to prepare the body for sleep. It is largely triggered by darkness and dissipates in bright light. Synthetic, over-the-counter melatonin is also effective at producing sleep, but the body quickly builds up a tolerance.
Can I drink alcohol before bedtime to help me get to sleep?
Drinking wine, or other alcohol, just before bed may be effective in the short term; however, alcohol interferes with normal sleep.
Is it really harmful to go without enough sleep for months or years?
Sleep is one of the primary methods that the body and the brain use to heal and restore itself. If a person forces themselves to get by on a bare minimum of sleep for long periods, the stress can greatly worsen any illness such as heart disease, diabetes, and depression, or more easily allow new illnesses to develop. See your medical provider for help in managing and overcoming sleep deprivation.
What does it mean if someone can fall asleep, but constantly wakes up during the night?
This may be sleep apnea. Right after falling asleep, the muscles of the throat relax and block the airway. This causes the person to snore loudly and suddenly wake up sometimes hundreds of times per night. This is extremely stressful and makes it impossible to sleep properly. Your medical provider can arrange for testing and appropriate treatment.
Questions your doctor may ask about difficulty falling asleep
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Are you feeling irritable (easily made upset)?
- Are you having difficulty concentrating or thinking through daily activities?
- Are you sleepy during the day?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
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- How Insomnia Differs From Occasional Sleeplessness. National Sleep Foundation: Sleep.org. Sleep.org Link
- How Medications May Affect Sleep. National Sleep Foundation. National Sleep Foundation Link
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- National Sleep Foundation. National Sleep Foundation Link
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