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Many people have trouble sleeping.

Typically this isn’t a sign of a major issue. But, missed or interrupted sleep can have many negative side effects – especially when it happens often.

Trouble sleeping is subjective, meaning that it is based on an individual’s point of view. A person may report:

  • Difficulty falling asleep

  • Difficulty staying asleep

  • Waking up too early

  • Not feeling rested

And, sleep problems can impact every hour of an individual’s life. In the daytime, people with sleep troubles may report:

  • Feeling tired or sleepy

  • Trouble paying attention, concentrating, or remembering things

  • Having difficulty with work, school, or social situations

  • Feeling irritable or moody

  • Having less energy or desire to do things

  • Making errors while driving or managing tasks like home finances

  • Experiencing concerns or worries about sleep

  • Having physical issues like tension, headaches, or gastrointestinal (GI) complaints

In any year about 4 out of 10 people have symptoms of short-term insomnia.

At least 1 out of 10 people have an actual diagnosis of insomnia disorder.

Insomnia is more common in women after menopause.

As people get older, getting enough sleep tends to be more difficult.

This page has been reviewed by the GoodPath medical team. Medical Writer: Beth Holloway, RN, M. Ed; Medical Reviewer: Roukoz Abou-Karam, MD; Updated: January 2020.

TYPES & CAUSES

There are several types of sleep problems.

Sometimes, trouble sleeping may be a condition all on its own. In other cases, it’s a symptom of something else happening in a person’s body. One of the most common diagnoses is insomnia.

Acute Insomnia

(Short-Term)

Short-term sleep difficulty (acute insomnia) is a problem that occurs at least 3 nights a week but for less than 3 months. 

A person may have trouble falling asleep, staying asleep, or may wake too early. As a result, they do not feel rested. In some cases, it results from family or work problems or an upsetting event.

Chronic Insomnia

(Long-Term)

Long-term sleep difficulty (chronic insomnia) is a problem that occurs at least 3 nights a week and lasts more than 3 months.

Like acute insomnia, a person may have trouble falling asleep, staying asleep, or may wake too early. As a result, they do not feel rested. Chronic insomnia is often secondary insomnia, meaning it occurs with other conditions.

Other Sleep Issues

(Other than insomnia)

Other types of sleep problems beyond insomnia also interfere with sleep, but have a different cause. These sleep issues are usually treated by a person’s doctor or a sleep specialist.

One example of a non-insomnia sleep issue is restless leg syndrome. This causes uncontrollable leg movements interfere with sleep. Another example is obstructive sleep apnea, a condition that causes a person to briefly stop breathing during periods of sleep.

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And, there are many possible causes.

The cause of a person’s sleeping problem may be unknown. Often, the cause may be many factors instead of just one. Below, we have outlined several common causes of sleep issues.

Behavioral Causes

Some specific behaviors that may cause troubled sleep or insomnia include:

STRESS AND ANXIETY

When a person feels stress or anxiety, they may have trouble relaxing and falling asleep. Or, they may wake up after sleeping and still feel stressed or anxious.

NAPS

Sleeping or dozing off during during the day, especially later in the day, may interfere with sleeping at night. For some people, a brief nap doesn’t cause any problems. In fact, napping can be helpful when an individual is struggling to sleep at night. In those cases, doctors recommend napping before 3:00 PM and for 20 minutes or less.

EXERCISE HABITS

People that don’t exercise may have difficulty sleeping. Regular exercise can help with sleep as well as overall health. It is best to exercise 4 to 8 hours before going to sleep, but closer to bedtime is usually okay.

CONSUMPTION HABITS

Foods

Eating large meals or foods that cause indigestion or heartburn close to bedtime may interfere with sleep. 

Caffeine

Caffeine is a stimulant, which means that it increases alertness. Having caffeinated drinks later in the day may cause difficulty sleeping. These drinks also increase urination, which may cause someone to wake up. 

Tobacco

Nicotine, too, is a stimulant. Smoking overall, and especially close to bedtime, may interfere with sleep.

Alcohol

Many people have an alcoholic drink to help with sleep. Although alcohol is a sedative (it has a calming effect), it can negatively affect the quality of sleep.

Environmental Causes

Environmental or lifestyle elements can affect sleep, such as:

ELECTRONIC DEVICES

Light from phones, computers, and televisions can make it difficult to fall asleep. According to the National Center on Sleep Disorders Research (NCSDR), “light at night from LED bulbs, tablets, and TV can confuse the brain and make it more difficult to sleep.”

Viewing stressful or exciting content can also create difficulty relaxing.

DISTURBANCES OR DISCOMFORT

Factors like room temperature, lighting, noise levels, or bed comfort all play a role in how well an individual sleeps.

BED PARTNERS

Anything from a partner’s snoring, a child’s kicking, or a pet’s whimpering can wake a person from sleep.

LACK OF TIME AND OPPORTUNITY

Things like jet lag or new parenthood can make it difficult to sleep. Although these situations are very challenging and they do interfere with sleep, doctors don’t include these as causes of insomnia.

Medical Conditions

Some medical conditions are likely to cause sleep problems, including:

LONG-TERM (CHRONIC) PAIN

The pain associated with arthritis or fibromyalgia may make it difficult to sleep. Additionally, the pain, heartburn, and indigestion associated with gastroesophageal reflux (GERD) may also interfere with sleep.

BREATHING PROBLEMS

Asthma, chronic obstructive pulmonary disease (COPD), heart failure, and other conditions can cause difficulty breathing. Individuals with these issues may also have trouble with sleep.

MENTAL HEALTH DISORDERS

Trouble sleeping may be a symptom – or even a cause – of depression, anxiety disorders, or substance abuse.

Medicines

There are certain types of medicines that are likely to affect sleep or cause troubled sleep:

STIMULANTS

For example, medicines used to treat attention deficit hyperactivity disorder (ADHD).

OPIOIDS

These strong narcotics are used to treat pain. Although they cause sleepiness, they may also cause sleep disruptions.

STEROIDS

Commonly used to treat medical problems. For example, they may be part of the treatment program for individuals with asthma or chronic obstructive pulmonary disease (COPD).

ANTIDEPRESSENTS

Some of the most commonly prescribed medicines for depression may interrupt sleep. The sleep disturbances may go away once a person adjusts to the drug they are taking.

DIURETICS

These medicines are used to treat some heart problems. They are often called water pills. Because they remove extra fluid from the body, they increase urination. People taking diuretics often have to get up at night to urinate.

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TREATMENT

There are many paths to feeling better.

Treating sleep problems depends on a number of different factors. For example, the length of time that a person has had trouble sleeping. An individual’s environment, medical history, and lifestyle also play a role.

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Treatment options vary based on need.

Depending on an individual’s sleep problems, their treatment program might include medicines, lifestyle changes, or other approaches. Once a person gets treatment for their sleep problem, they may need to keep up with healthy changes to help prevent it from recurring.

Treatment for Short-Term Sleep Problems

A person who has a short-term sleep problem may take an over-the-counter (OTC) product or natural supplement to help with sleep. And, they may learn about sleep hygiene, stimulus control, or lifestyle changes that can help with sleep. As they make some of the changes they may find that their sleep problems improve.

Treatment for Long-Term Sleep Problems

A person with long-term sleep problems may receive cognitive behavioral therapy-insomnia (CBT-I). And, they may begin other parts of a sleep treatment program, like sleep hygiene, stimulus control, or lifestyle changes. 

Until these take effect, a person may need to take medicine for sleep. If the therapy, sleep hygiene, stimulus control, or lifestyle changes help with their sleep problem, the person may be able to stop taking or reduce the amount of medicine they take.

Treatment for Sleep Problems due to Underlying Conditions

Sleep problems caused by underlying conditions (comorbid insomnia) may go away with proper treatment for those conditions. For example, a person who has trouble sleeping due to depression may have improved sleep if depression is well-managed.

Treatment for Sleep Problems Other than Insomnia

Sleep problems other than insomnia may also go away if the problem is treated. For example, a person with obstructive sleep apnea (periods when they briefly stop breathing during sleep) may begin using a continuous positive airway pressure therapy (CPAP) machine while sleeping. The CPAP keeps the throat open and prevents the apnea. This allows for more restful sleep.

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There are various treatments that can fit a person's symptoms:

Oral Treatments

Over-The-Counter (OTC) Medicine

Prescription Medicine

Natural Remedies & Supplements

Other Natural Remedies

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Sleep Hygiene & Lifestyle

Sleep Hygiene

Stimulus Control

Lifestyle Changes

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Therapy & Training

Therapy or Counseling

Relaxation Training

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PREVENTION

Some sleep problems are preventable.

When a person has sleep problems or has had them in the past, they may be wondering how to prevent them in the future. 

Fortunately, there are several common options available to avoid ongoing sleep problems. In more serious cases, visiting a doctor may be necessary where exams, tests, and possible referrals can share more information.

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Common questions about troubled sleep.

Tips for Preventing Troubled Sleep

Simple approaches to avoiding troubled sleep include:

  • Following a sleep treatment program

  • Going to sleep and wake up around the same time every day

  • Avoiding electronic screens, or using blue light blockers when screens are inevitable

  • Staying away from caffeine, nicotine, alcohol, and heavy meals in the evening

  • Exercising every day, though not 2 hours before bed, as that may contribute to troubled sleeping

  • Speaking with a doctor about prescription and over-the-counter (OTC) medicines that may cause problems with sleep

How Sleep Problems Are Diagnosed

Individuals may or may not need to see a doctor when they’re experiencing sleep problems. If they decide to see a doctor, the doctor will ask questions and perform a physical exam. They may also order tests or suggest seeing a specialist. In order to make a diagnosis, doctors often ask questions, perform an exam, and may order tests.

QUESTIONS

Because the symptoms of trouble sleeping are subjective, the doctor will ask many questions about an individual’s sleep. 

Other questions will involve their medical history, including prescription and over-the-counter medicine use. The doctor will also want to know about the person’s stress levels, exercise habits, and other daily activities. 

They may also ask if the patient has pain that interferes with sleep, if they use alcohol or drugs, and what their bedtime habits are.

EXAMS

As with other medical problems, the doctor might complete an exam. The exam may include may include measuring the person’s weight and vital signs (temperature, pulse, breathing rate, and blood pressure) to check overall health.

TESTS

The doctor may order tests to check on the medical causes of sleep problems. Sometimes, a person is asked to keep a sleep diary, writing down details about their sleep each evening. Some individuals can join special studies that check for sleep disorders.

REFERRALS

The doctor may suggest that the person see a sleep specialist for testing. Or, they may refer the patient to other specialists for further help.

When To See A Doctor

When sleep trouble happens just once in awhile, it is usually only a small issue. But, there are times when it’s important to get professional care. A person should call the doctor right away if they have trouble sleeping and any of the following:

RISK FACTORS

  • Serious depression

  • Anxiety or panic disorder

  • Substance abuse disorder

  • Unstable heart or lung problem

SYMPTOMS

  • Trouble staying awake or functioning during the day due to lack of sleep

  • Falling asleep while driving or taking part in another dangerous activity (such as operating a machine at work)

  • Suddenly falling asleep during the day

  • Experiencing breathing interruptions while sleeping

  • Showing unusual sleep behavior (such as sleepwalking)

Additionally, a person should call their doctor if they have symptoms of a previously diagnosed sleep disorder. For example, someone who was diagnosed with sleep apnea who experiences snoring or tiredness during the day.

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