Top 5 Reasons You Can't Get To Sleep

And why trying harder and going to bed earlier is rarely the answer.

You bought the blackout curtains, lowered the thermostat, and sipped chamomile tea. Yet at 2:17 a.m., you are tossing and turning and wide awake.

Sleep problems rarely come from not trying hard enough, “not being a good sleeper” or even bad bedtime habits. Biological, behavioral, environmental, and emotional factors often reinforce one another, making it hard to sleep. When evaluating patients with complaints of insomnia or less than restful sleep, the following list captures the top 5 causes we see at our practice.

1. You Have Developed Sleep Anxiety

After a few difficult nights, bedtime can feel like a performance review. You watch the clock, calculate tomorrow's damage, and think, "Oh no, what is wrong with me. If I don’t sleep now, I will not be able to function tomorrow." But sleep does not respond well to pressure, and sleep is not a performance.

Having worried thoughts heightens the sense of alertness, which interrupts sleep further and reinforces the fears about not sleeping. Eventually, anxiety about not sleeping may be worse than the original trigger. Insomnia treatment reduces the emotional experience of worry, the related anxious thoughts, and the resulting restlessness, muscle tension, and wakefulness, plaguing most patients struggling to get good sleep.

2. Your Screens Are Working Hard To Keep You Awake

Your phone may be small, but it is talented at keeping a brain awake. Bright evening light from any type of screen can disrupt sleep-wake timing and keep the nervous system engage=wide awake!!

At least one hour before bedtime, start to dim the lights in your home, avoid engagement with activating content, and create a screen-free wind-down, and once you are in the bed avoid screens. If your phone stays nearby, silence notifications and keep it out of reach.

3. Adults Need Regular Bedtimes Too (And Wake Times)

Ever-changing bedtimes, sleeping late to catch up on sleep, or shift work can confuse your circadian system. A consistent bedtime and wake time helps to anchor a healthy functional circadian rhythm. As in a restaurant, when the staff knows what time the restaurant closes, they can begin some of the tasks of shutting down long before the posted closing time. The brain and body does the same thing in preparation for sleep. This improves the odds that all tasks associated with closing or falling asleep are already engaged when you close your eyes at bedtime, or lock the door of your restaurant.

4. Spending Too Much Time In Bed and Trying to Sleep

Extra time in bed, including going to bed early or napping, can weaken your natural sleep drive and reduce sleep pressure. These two forces help the body ease into sleep without any effort on your part.

Also, the bed becomes associated with worrying, scrolling, frustration, and effort, while naps reduce nighttime sleep pressure. Evidence-based treatments for insomnia help you consolidate sleep and rebuild the connection between bed and sleep.

5. Something Else Is Affecting Sleep

Not every sleep problem is about sleep hygiene or behavioral modifications. Sleep may be impacted by sleep disorders, mental health conditions, medical problems, pain, menopause, medications, caffeine, and other substances. Speaking with a psychiatrist, can help determine if other factors need treatment, if referrals to other doctors are needed, or a combination of interventions to help you get back to restful sleep. Sleep apnea, restless legs syndrome, and circadian disorders need specific treatment from a sleep doctor.

Instead of "How do I make myself sleep?" ask, "How can I allow sleep to naturally occur?"

How We Help

At Gray MD Psychiatry, we use Cognitive Behavioral Therapy for Insomnia (CBT-I) to change the patterns that keep sleep problems going. Evaluation of insomnia is not one size fits all. It may require a referral for a sleep study. Treatment may also include medications. Amongst the many patients we have treated for insomnia, we find common behavioral patterns that are typically amenable to therapeutic interventions. The goal is to help your mind and body sleep without turning bedtime into a nightly battle.