By Brandon Peters, MD
It seems like sleep should come naturally, but when it doesn't, you might quickly find yourself pleading, "Help me sleep!" It can be a frustrating, unnerving experience to have difficulty falling or staying asleep. When you awaken without feeling refreshed, this problem quickly becomes a drag on the rest of your life and health. What are reasons why you can't sleep? Are there tried and true ways to sleep better tonight? What should you do if you have tried everything and it just isn't working? Let's explore these issues and discover the help you need to sleep.
What Is Wrong with My Sleep?
We have an expectation of perfect sleep; that we will crawl into bed, fall asleep within minutes, sleep without interruption, and awaken fully refreshed and ready to start our day. But is this a reasonable standard?
Children are often hailed as a model of perfect sleep because (for the most part) they are able to do just what we've described. As we mature, our bodies change and our sleep seems to likewise deviate from the ideals of childhood. Life, in a sense, gets complicated. There are new time pressures, our sleep is disrupted by others (including bed partners and our own children), and other health problems (such as nocturia, heartburn, and even pain) compromise our sleep.
As a result, we may not enjoy the sleep we knew in your youth. Indeed, even the timing of our sleep may shift. Those who are in the twilight of their lives may more often find themselves waking early, unable to stay asleep as they once did.
Some of our expectations regarding our sleep may be slightly misguided. As an example, the thought that we will fall asleep almost immediately upon retiring to our beds may be improper. In fact, people who fall asleep in less than 5 minutes may be "pathologically sleepy". This means that they are so sleepy that they fall asleep quicker than might be normal. In some cases, this ability to fall asleep quickly -- and enter rapid eye movement (REM) sleep quickly -- can be seen in excessive daytime sleepiness that might occur in sleep deprivation or narcolepsy.
Some sleep researchers believe that it might be normal to be awake some during the night. The fact that you sleep straight through the night without budging may again be a sign of inadequate time spent sleeping. This phenomenon is called "quiet wakefulness" and is often observed when the sleep habits of other non-Western cultures are studied. When people sleep in a group in close quarters, there is more time spent awake during the night. This makes sleep a more fluid concept. Time may be spent chatting, eating a snack, or engaging others around you. In history, fragmented sleep with periods of wakefulness in the middle of the night were common, reflected in the midnight adventures seen in the plays of Shakespeare, for example.
When we find ourselves waking in the night, no matter the cause, we may conclude that something is wrong. If there are no consequences in daytime function, however, this may not be the case. (Waking to go to the bathroom is so common as we get older that you would be hard-pressed to call it "abnormal".) The problem begins when our poor sleep compromises our lives. If difficulty falling or staying asleep at night begins to have consequences, there is a motivation to seek the cause.
Common Causes of Difficulty Sleeping
When we find ourselves lying awake, watching the minutes tick past in the red light of our alarm clocks, the desperation to sleep quickly escalates. There are many reasons this could occur and getting to the bottom of it may require some reflection on your situation.
The most common reason why you can't sleep is also the most obvious: you are not tired. Your desire to sleep will be greatly diminished if you are trying to sleep at the wrong time. Imagine lying down three hours before your normal bedtime. The chance of you being able to fall right to sleep is pretty slim. This has to do with the circadian rhythm of our bodies. This system helps to coordinate our activities, including our desire for food and sleep, to the external environment. Problems with the timing of sleep may occur in the circadian rhythm sleep disorders as well as in temporary conditions like jet lag. If you spend more time in bed than required by your sleep needs, you will also be subject to long periods of wakefulness. Another reason you might be diminishing your desire to sleep at night is because of naps you take during the day.
A very common cause of difficulty sleeping relates to stress and the intrusion of stimulating substances and activities. You may have trouble falling asleep the night before a big test or presentation. In periods of emotional stress, such as after the death of a loved one, you may also have trouble sleeping. This is called acute insomnia. It usually passes when these stressors resolve. Similarly, stimulants such as caffeine and even nicotine can disrupt your sleep. You may be surprised to learn that exposure to light at night -- such as from a television or computer screen -- may make it difficult for some people to fall asleep. Additionally, late-night exercise may rev you up and provoke insomnia. For those who have chronic insomnia, the bedroom space may become a trigger for insomnia through conditioning.
The sleep environment is meant to be comfortable and facilitate sleep.
It should be cool, quiet, and free of distractions. Ideally you would not allow a television or pets in your bedroom. Bed partners may be disruptive and some people choose to maintain separate sleep spaces for this reason.
Another common cause of difficulty falling asleep is the activities that precede your bedtime. If you eat or drink too late, you may suffer from heartburn or frequent nighttime trips to the bathroom. There are general guidelines to improve sleep and many of these are meant to reinforce positive sleep habits. You should go to bed and get up the same time every day. Irregular sleep schedules may set you up for sleep disruption. You should follow a bedtime routine, including quiet, relaxing activities to help transition to sleep. If you fail to unwind prior to bed, you may find yourself struggling to drift off to sleep.
Finally, there are medical conditions that may keep you from sleeping well at night. These may be common problems such as heartburn or pain, but there are also multiple sleep disorders that might cause difficulty sleeping. Some of these include:
Insomnia
Sleep apnea
Restless legs syndrome
Circadian rhythm sleep disorders
Whether you suffer from one of these conditions or not, you may be interested in learning about some of the treatment options if you find yourself struggling to sleep at night.
Home Remedies When You Can't Sleep
The first task to sleep better at night is to improve your sleep hygiene, which refers to following the guidelines for better sleep. These steps may initially seem straightforward but because they involve modifying your behaviors in relation to your sleep, this can be challenging. If you have mastered these changes, you may be compelled to look at other options.
For those who have difficulty with insomnia, there are a handful of options to help you sleep. One treatment option is sleep restriction. This involves limiting the amount of time that you spend in bed, so that the time you are there you are more likely to spend asleep. It can also be useful to make a behavioral change called stimulus control. Stimulus control helps to break the association between not being able to sleep and your bedroom.
There are other non-medication options that might be helpful. Some people find benefit with the use of aromatherapy. Various relaxation techniques, including the use of biofeedback, may also establish a connection between your mind and body. This can be incorporated into your bedtime rituals and make it easier to relax and transition into sleep.
Finally, you may find yourself turning to over-the-counter medications to help your sleep. One of the most common is the naturally occurring hormone called melatonin. It is sold in many pharmacies and herbal supplement stores. It can be highly effective if you have insomnia related to a poorly timed circadian rhythm. As it has a low risk of major side effects (the most frequent is sleepiness), it might be an option to consider. Other herbal supplements (such as valerian root) do not have a lot of research supporting their efficacy.
If you still struggle to sleep, you may be compelled to look at other options.
Serious Help for Difficulty Sleeping
For those who still need help sleeping after exhausting changes in your sleep routine and at-home remedies, it may be necessary to turn to a professional. You may want to start by discussing the matter with your primary health care provider, but you may also choose a sleep doctor.
There are diagnostic tests that can be helpful for assessing your sleep problems, with special tests for insomnia. It may be helpful to keep a sleep log or use an actigraph to track your sleep patterns. Further testing with a home sleep apnea test or an overnight sleep study called a polysomnogram can also be helpful to identify sleep apnea or leg movements related to restless legs syndrome.
The other benefit of speaking with a health care professional is that you can discuss the use of sleeping pills. In addition, you can ask for a referral to a psychologist who might be able to teach you cognitive behavioral therapy for insomnia (CBTI) techniques to help your sleep.
This is a very serious matter, as the consequences of poor sleep can undermine your health and may even lead to your death. There are serious symptoms and physical effects of sleep deprivation, including hallucinations. For all these reasons – and more – it is absolutely worthwhile to get the help that you need in order to sleep well and wake refreshed.