Understand your difficulty falling asleep symptoms, including 4 causes and common questions.
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.
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.
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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
- 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.
Insomnia disorder is a short-term or chronic condition whereby individuals have difficulty
sleeping. Other common symptoms include fatigue, difficulty with concentration, social
dysfunction, reduced motivation, and behavioral changes. The short-term form of
the condition is usually ...
Restless leg syndrome (RLS) is a chronic condition characterized by uncomfortable sensations while lying down and a strong urge to move the legs. Leg movement relieves the unpleasant sensations temporarily, often resulting in poor quality sleep. RLS is co...
Obstructive sleep apnea (OSA) is a relatively common condition, especially in obese adults. It refers to obstruction (blockage) of the airway during sleep. This obstruction is usually caused by the back of the tongue and the muscles of the palate relaxing and falling ...
Depression is a mental disorder in which a person feels constantly sad, hopeless, discouraged, and loses interest in activities and life on more days than not. These symptoms interfere with daily life, work, and friendships.
Top Symptoms: fatigue, depressed mood, headache, anxiety, irritability
Symptoms that always occur with depression: depressed mood
Urgency: Primary care doctor
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Difficulty falling asleep treatments and relief
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.
- U.S. National Library of Medicine: MedlinePlus. Update March 7, 2018. MedlinePlus Link
- 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
- Sleep Disorders. National Alliance on Mental Illness. NAMI Link
- Sleep and Mental Health. Harvard Medical School: Harvard Health Publishing. Updated June 19, 2018. Harvard Health Publishing Link
- National Sleep Foundation. National Sleep Foundation Link
- How to Get to Sleep. NHS. Updated July 14, 2016. NHS Link
- Culpepper L, Wingertzahn MA. Over-the-Counter Agents for the Treatment of Occasional Disturbed Sleep or Transient Insomnia: A Systematic Review of Efficacy and Safety. The Primary Care Companion for CNS Disorders. 2015;17(6):10. NCBI Link
- Costello RB, Lentino CV, Boyd CC, et al. The Effectiveness of Melatonin for Promoting Healthy Sleep: A Rapid Evidence Assessment of the Literature. Nutrition Journal. 2014;13:106. NCBI Link