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Insomnia
What to Do When You Can't Fall Asleep or Stay Asleep
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. 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, longterm 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 (/articles/depression/depression-symptoms-and-warning-signs.htm) worse.
Other common emotional and psychological causes include anger (/articles/relationshipscommunication/anger-management.htm), 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 (/harvard/medicalcauses-of-sleep-problems.htm) 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 (/articles/sleep/sleep-disorders-and-problems.htm), including sleep
apnea, restless legs syndrome, and circadian rhythm disturbances tied to jet lag or latenight 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 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 (/misc/sleep-diary.pdf) 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 (/articles/sleep/getting-better-sleep.htm) 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 (/articles/stress/
relaxation-techniques-for-stress-relief.htm) such as deep breathing or meditation to help
you unwind.
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 (/articles/anxiety/how-to-stopworrying.htm) at bedtime and look at life from a more positive perspective. To help calm
your mind and prepare for sleep:
Use 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 into
bed.
Turn off all screens at least an hour before bed. Dim the lights, and focus on quiet,
soothing activities, such as reading, knitting, or listening to soft music.
Avoid 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.
Move 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.
Get 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.
Harness 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 (/articles/anxiety/how-to-stopworrying.htm).
Things to avoid before bed:
Drinking too many liquids. 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. 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 evening meals. 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 back
to sleep, 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 to sleep, 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.
Promote relaxation by rubbing your ears or rolling your eyes. Rubbing the Shen
Men acupressure point at the top of the ear can promote calmness and relaxation. Another
simple way to promote sleep is to close your eyes and slowly roll them upwards a few
times.
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 (/articles/stress/stressmanagement.htm) 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 (/articles/healthy-living/how-to-start-exercisingand-stick-to-it.htm) 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 (/articles/healthy-eating/healthy-eating.htm) in
how well you sleep. Some people find that cutting back on sugary food and drinks and
refined carbohydrates (/articles/healthy-eating/choosing-healthy-carbs.htm) 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 (/articles/sleep/sleep-disorders-andproblems.htm#tracking).
Therapy vs. sleeping pills for insomnia
In general, sleeping pills and sleep aids are most effective when used sparingly for shortterm 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) (/articles/sleep/therapy-forsleep-disorders.htm#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.
More help for insomnia
Sleeping Well: (/articles/sleep/getting-better-sleep.htm) How to Create Habits
that Help You Sleep Better
Sleep Disorders and Problems: (/articles/sleep/sleep-disorders-andproblems.htm ) Symptoms, Treatment, and Self-Help
Sleeping Pills & Natural Sleep Aids: (/articles/sleep/sleeping-pills-and-naturalsleep-aids.htm ) Prescription and Over-the-Counter Products
Authors: Lawrence Robinson, Melinda Smith, M.A., and Robert Segal,
M.A. Last updated: June 2017.
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