Having Difficulty Falling Asleep? Know the Reasons & Fall Asleep Faster

Long-term stress

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.

Lifestyle stress

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

Medications

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.

Physical illness

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:

• Depression
• Anxiety
• Post-traumatic stress disorder (PTSD)
• Bipolar disorder
• Schizophrenia
• Dementia

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 products like a CPAP (Continuous Positive Airway Pressure) machine, which allows the patient to experience much better sleep almost immediately.

Insomnia disorder

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.

Depression

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.

Rarity: Common

Top Symptoms: fatigue, depressed mood, headache, anxiety, irritability

Symptoms that always occur with depression: depressed mood

Urgency: Primary care doctor

Medical treatments

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.