Insomnia Causes and Cures
What to Do When You Can't Sleep
Do you struggle to get to sleep no matter how tired you are? Or do you wake up in the middle of the night and lie awake for hours, anxiously watching the clock? Insomnia is a very common problem that takes a toll on your energy, mood, and ability to function during the day. Chronic insomnia can even contribute to serious health problems. But you don’t have to resign yourself to sleepless nights. Addressing the underlying causes and making changes to your lifestyle, daily habits, and sleep environment can put a stop to the frustration of insomnia and help you to finally get a good night’s sleep.
What is insomnia?
Insomnia is the inability to fall asleep or stay asleep at night, resulting in unrefreshing or non-restorative sleep. Anyone who’s laid awake at night knows how frustrating and upsetting it can be to spend hours in bed willing sleep to come—and knowing just how bad you’re going to feel in the morning if it doesn’t. Insomnia can adversely impact all aspects of your health and well-being, leaving you feeling fatigued, drowsy, and low on energy during the day, affecting your mood and concentration levels, and damaging your productivity at work or school. Insomnia can also pressure you into relying on sleeping pills, sleep aids, or alcohol to help you sleep—which in the long-run only makes your sleep problems worse. Chronic insomnia can even take a serious toll on your physical and mental health, increasing your risk of health problems such as stroke, diabetes, obesity, high blood pressure, heart disease, Alzheimer's disease, and certain cancers.
No matter how long you’ve been suffering from insomnia or how frequently you struggle to sleep, don’t despair. While it can take time to correct the habits that contribute to your sleep problems, there are plenty of things you can do to help overcome insomnia and enjoy a full and restful night’s sleep. The first step is to identify the type of insomnia you’re struggling with.
Types of insomnia
Short-term or acute insomnia is a temporary problem stemming from changes in your normal routine due to illness, travel, grief, hormone fluctuations, or stress. Most of us experience this type of insomnia at some point in our lives and while it usually resolves itself when your routine returns to normal, addressing the problem early can ensure your insomnia doesn’t persist.
Long-term or chronic insomnia occurs when you regularly experience trouble sleeping (three or more nights a week) over an extended period of time (three months or more). Since chronic insomnia has been ingrained over months, changing the unhealthy habits or thought patterns that fuel your insomnia can sometimes take time, perseverance, and a willingness to experiment with different solutions.
Insomnia can be further categorized as:
Sleep onset insomnia - This is when you have difficulty falling asleep despite feeling tired. While good sleepers are able to fall asleep with 15 to 20 minutes of going to bed, if you have sleep onset insomnia you may toss and turn for hours before sleep finally comes.
Sleep maintenance insomnia - A condition where you find it difficult to stay asleep. While it's normal to wake up briefly during the night, good sleepers usually don't remember. But if you have sleep maintenance insomnia, you may lay awake for hours in the middle of the night struggling to get back to sleep, and/or you wake up too early in the morning. The result is the same: you get out of bed not feeling refreshed.
Why can't I sleep?
While short-term insomnia is usually due to a temporary interruption of your routine, long-term or chronic insomnia is more likely caused by unhealthy daytime and bedtime habits, shift work, a less than ideal sleep environment, or underlying medical or psychological issues—or a combination of these factors.
Psychological and medical causes of insomnia
Anxiety, stress, and depression are some of the most common causes of chronic insomnia. Having difficulty sleeping can also make anxiety, stress, and depression symptoms worse. Other common emotional and psychological causes include anger, worry, grief, bipolar disorder, and trauma. Treating these underlying problems is essential to resolving your insomnia.
Medical problems or illness. Many medical conditions and diseases can contribute to insomnia, including asthma, allergies, Parkinson’s disease, hyperthyroidism, acid reflux, kidney disease, and cancer. Chronic pain is also a common cause of insomnia.
Medications. Many prescription drugs can interfere with sleep, including antidepressants, stimulants for ADHD, corticosteroids, thyroid hormone, high blood pressure medications, and some contraceptives. Common over-the-counter culprits include cold and flu medications that contain alcohol, pain relievers that contain caffeine (Midol, Excedrin), diuretics, and slimming pills.
Sleep disorders. Insomnia is itself a sleep disorder, but it can also be a symptom of other sleep disorders, including sleep apnea, restless legs syndrome, and circadian rhythm disturbances tied to jet lag or late-night shift work.
Daytime habits that cause insomnia
Having an irregular sleep schedule, napping, drinking caffeinated beverages late in the day, eating sugary foods or heavy meals too close to bedtime, and not getting enough exercise are all examples of daytime habits that can impact your ability to sleep at night.
Not only can poor daytime habits contribute to insomnia, but a poor night's sleep can make these habits harder to correct, creating a vicious cycle of unrefreshing sleep:
Another common habit linked to insomnia is overstimulating the brain during the day, making it harder to clear your head at night. Many of us overstress our brains during the day by repeatedly interrupting tasks to check the phone, email, or social media. The brain becomes so conditioned to constantly seeking fresh stimulation that when it comes time to unwind at night your brain is still looking for the next information fix.
As well as avoiding screens in the hours before bedtime, try to set aside specific times during the day for checking messages and social media, allowing your brain to spend more time focusing on one task at a time. Taking short breaks from technology during the day and doing non-stimulating activities can also help to recondition your brain’s habit of constantly looking for new stimulus.
If you're having trouble identifying insomnia-inducing habits
Some habits are so ingrained that you may overlook them as a possible contributor to your insomnia. Maybe your Starbucks habit affects your sleep more than you realize. Or maybe you’ve never made the connection between that late-night glass of wine and your sleep difficulties. Keeping a sleep diary is a helpful way to pinpoint habits and behaviors contributing to your insomnia.
Sleep environment and bedtime routines that cause insomnia
Noise, light seeping through the window, a bedroom that’s too hot or cold, or an uncomfortable mattress or pillow can all contribute to both sleep onset and sleep maintenance insomnia. To ensure that your sleeping environment is quiet, dark, and comfortable, mask noise with a fan or sound machine, use blackout shades or wear an eye mask, and experiment with different levels of mattress firmness, foam toppers, and pillows that provide more or less support.
Creating a peaceful bedtime routine sends a powerful signal to your brain that it’s time to wind down and let go of the day’s stresses. Electronic screens emit a blue light that disrupts your body’s production of melatonin that helps regulate your sleep-wake cycle. So, instead of watching TV in bed or using a computer, tablet, or smartphone in the two hours before bed, try listening to soft music or an audiobook, taking a hot bath, or practicing a relaxation technique such as deep breathing or meditation to help you unwind.
For more tips on improving your sleep habits and routines...
Read: Getting Better Sleep
What to do when you can't fall asleep
One of the most common causes of sleep onset insomnia is anxiety or chronic worry. You get into bed at night but can’t fall asleep because your mind is racing with anxious thoughts about what you didn’t get done today, about what tomorrow might hold, or simply feeling overwhelmed by daily responsibilities.
As well as addressing daytime habits that contribute to sleep onset insomnia—such as avoiding caffeine late in the day and exercising in the morning or afternoon—there are steps you can take to learn how to stop worrying at bedtime and look at life from a more positive perspective. To help calm your mind and prepare for sleep, you can also try:
Using the bedroom only for sleeping and sex. Don’t work, watch TV, or use your computer in bed or the bedroom. The goal is to associate the bedroom with sleep alone, so that your brain and body get a strong signal that it’s time to nod off when you get in bed.
Turning off all screens at least an hour before bed, dimming the lights, and focusing on quiet, soothing activities, such as reading, knitting, or listening to soft music.
Avoiding stimulating activity and stressful situations before bedtime. This includes big discussions or arguments with your spouse or family, or catching up on work. Postpone these things until the morning.
Moving bedroom clocks out of view. Anxiously watching the minutes tick by when you can’t sleep—knowing that you’re going to be exhausted when the alarm goes off—is a surefire recipe for insomnia. You can use an alarm, but make sure you can’t see the time when you’re in bed.
Getting out of bed when you can't sleep. Don’t try to force yourself to sleep. Tossing and turning only amps up the anxiety. Get up, leave the bedroom, and do something relaxing, such as reading, drinking a cup of herbal tea, or taking a bath. When you’re sleepy, go back to bed.
Harnessing your body's relaxation response. Relaxation techniques such as meditation, yoga, and deep breathing not only help you quiet your mind and relieve tension in the body, but they also help you fall asleep faster. It takes regular practice to learn these techniques and harness their stress-relieving power. But the benefits can be huge. You can do them as part of your bedtime routine or when you are lying down preparing for sleep. A variety of smartphone apps can guide you through the different relaxation methods, or you can follow these techniques:
Relaxation techniques for insomnia
Abdominal breathing. Breathing deeply and fully, involving not only the chest, but also the belly, lower back, and ribcage, can help relaxation. Close your eyes and take deep, slow breaths, making each breath even deeper than the last. Breathe in through your nose and out through your mouth.
Progressive muscle relaxation. Make yourself comfortable. Starting with your feet, tense the muscles as tightly as you can. Hold for a count of 10, and then relax. Continue to do this for every muscle group in your body, working your way up from your feet to the top of your head.
Mindfulness meditation. Sit or lie quietly and focus on your natural breathing and how your body feels in the moment. Allow thoughts and emotions to come and go without judgment, always returning to focus on breath and your body.
What to do when you can't stay asleep
One of the keys to countering sleep maintenance insomnia is to figure out why you’re waking up in the night or too early in the morning. If light from streetlamps or noise from traffic, neighbors, or roommates is disturbing your sleep, for example, the answer could be as simple as wearing an eye mask or ear plugs. If you’re awake at 2 a.m. worrying, you need to take steps to get your anxiety under control.
Things to avoid before bed:
Drinking too many liquids in the evening. Waking up at night to go to the bathroom becomes a bigger problem as we age. By not drinking anything an hour before sleep and going to the bathroom several times as you get ready for bed, you can reduce the frequency you’ll wake up to go during the night.
Alcohol before bed. While a nightcap may help you to relax and fall asleep, it interferes with your sleep cycle once you’re out, causing you to wake up during the night.
Big meals at night. Try to make dinnertime earlier in the evening, and avoid heavy, rich foods within two hours of bed. Spicy or acidic foods can cause stomach trouble and heartburn which can wake you during the night.
What to do when you wake up at night:
Stay out of your head. Hard as it may be, try not to stress over your inability to fall asleep again, because that stress only encourages your body to stay awake. To stay out of your head, focus on the feelings in your body or practice breathing exercises. Take a breath in, then breathe out slowly while saying or thinking the word, “Ahhh.” Take another breath and repeat.
Make relaxation your goal, not sleep. If you find it hard to fall back asleep, try a relaxation technique such as visualization, progressive muscle relaxation, or meditation, which can be done without even getting out of bed. Even though it’s not a replacement for sleep, relaxation can still help rejuvenate your mind and body.
Do a quiet, non-stimulating activity. If you’ve been awake for more than 20 minutes, get out of bed and do a quiet, non-stimulating activity, such as reading a book. Keep the lights dim and avoid screens so as not to cue your body that it’s time to wake up.
Postpone worrying and brainstorming. If you wake during the night feeling anxious about something, make a brief note of it on paper and postpone worrying about it until the next day when it will be easier to resolve. Similarly, if a great idea is keeping you awake, make a note of it on paper and fall back to sleep knowing you'll be much more productive after a good night's rest.
Cure insomnia by tackling daytime stress and worries
For many of us, our sleeping problems can be traced back to residual stress, worry, or anger from the day that makes it difficult to wind down and sleep well at night. The worse we sleep at night, the more stressed, worried, and angry we become. To break the pattern:
Get help with stress management. If the stress of managing work, family, or school is keeping you awake at night, learning how to handle stress in a productive way and to maintain a calm, positive outlook can help you sleep better at night.
Talk over your worries with a friend or loved one during the day. Talking face-to-face with someone who cares about you is a one of the best ways to relieve stress and put an end to bedtime worrying. The person you talk to doesn’t need to be able to fix your problems, but just needs to be an attentive, nonjudgmental listener.
Get enough exercise. Regular exercise not only relieves stress but improves the symptoms of insomnia, increases the amount of time you spend in the deep, restorative stages of sleep, and helps you to feel less sleepy during the day. To maximize sleep benefits, try to exercise vigorously for 30 minutes on most days—but not too close to bedtime.
Watch what you eat and drink. Caffeine can cause sleep problems 10 to 12 hours after drinking it, and your diet can also play a role in how well you sleep. Some people find that cutting back on sugary food and drinks and refined carbohydrates during the day makes it easier to sleep at night.
When to see a doctor about insomnia
If you’ve tried a variety of self-help techniques without success, schedule an appointment with a sleep specialist, especially if insomnia is taking a heavy toll on your mood and health. Provide the doctor with as much supporting information as possible, including information from your sleep diary.
Therapy vs. sleeping pills for insomnia
In general, sleeping pills and sleep aids are most effective when used sparingly for short-term situations, such as traveling across time zones or recovering from a medical procedure. Your insomnia won’t be cured by sleeping pills—in fact, over the long-term they can actually make insomnia worse.
Since many people complain that frustrating, negative thoughts and worries prevent them from sleeping at night, cognitive-behavioral therapy (CBT) can be much more effective in addressing insomnia. CBT is a form of psychotherapy that treats problems by modifying negative thoughts, emotions, and patterns of behavior. It can be conducted individually, in a group, or even online. A study at Harvard Medical School found that CBT was more effective at treating chronic insomnia than prescription sleep medication—but without the risks or side effects.
For more on how CBT can treat insomnia...
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Resources and references
Facts About Insomnia (PDF) – Fact sheet describes the symptoms and common causes of insomnia, as well as proven treatments and cures. (National Institutes of Health)
Insomnia: What it is, How it Affects You, and How to Help You Get Back Your Restful Nights – An overview of insomnia including common causes, signs, symptoms, and what to do (National Sleep Foundation)
Insomnia (PDF) – Discusses insomnia symptoms, types, causes, and treatments, including what you can do to stop sleepless nights. (University of Cambridge)
Twelve Simple Tips to Improve Your Sleep – Explore simple tips for making the sleep of your dreams a nightly reality. (Healthy Sleep, Harvard Medical School)
Insomnia – A series of articles covering different types of insomnia, the causes of transient and chronic insomnia, self-help cures, and professional treatment. (University of Maryland Medical Center)
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