Have you ever gone to bed feeling completely drained, only to find yourself wide awake at the start of your bed time? Perhaps you fall asleep quickly, but struggle to stay asleep?
If this happens occasionally, you probably have no need to worry. But if it happens repeatedly, it is completely normal to be concerned and want to figure out what is going on.
Insomnia can be caused by a variety of different factors ranging from stress and lifestyle to different medications, and even underlying medical conditions and other sleep disorders. Several factors can contribute at the same time.
It is important to understand what is causing your insomnia in order to take the right approach to fixing it.
In this article, we will look into the different common causes of insomnia, the role that our habits and routines play in causing sleep difficulties, the reason that some people may continue to have sleep problems even after the original cause is resolved, and when to see a doctor.
Medical Disclaimer: This article is for informational purposes only and does not diagnose, treat or cure insomnia. Consult a qualified healthcare professional about persistent or long-term sleep problems.
What Is the Main Cause of Insomnia?
The National Heart, Lung, and Blood Institute (NHLBI) states that stress, changes in routine, and your environment can all affect your sleep.
Factors that can contribute to insomnia include:
- Stress, anxiety, and worries
- Changes in your sleeping and waking times
- Use of stimulants (i.e. caffeine and nicotine) and depressants (i.e. alcohol)
- Use of certain prescription and over the counter medications
- Changes in your health, especially if you have a chronic illness
- Hormonal changes (i.e. in women during their menstrual cycle, or during pregnancy)
- Sleep disorders
- A painful or uncomfortable environment while you are sleeping
It is possible for insomnia to continue after the initial cause is no longer there. Concern for your sleep can affect your routine and behaviors, and lead to you spending a lot of time in bed and not sleeping.
Now, we will discuss the initial causes in more detail:
1. Stress and Overthinking
Stress can keep you thinking and active for a long time after the day is over. You may be tired and just want to rest, but your mind pulls you back thinking about everything you still have to do or about everything you still can’t figure out.
If you have a lot of stressful things happening to you, it can lead to a state where you are unable to relax enough to fall asleep.
According to the Mayo Clinic, stress and distressing events can cause or worsen your insomnia.
What may help: Make a short wind-down routine before going to bed. This can help clear your mind and relax. If stress is continuously affecting your life, and is beyond your control, then you should seek professional support.
2. Anxiety About Not Being Able to Sleep
Sometimes the issue isn’t just the inability to fall asleep. It’s about the anxiety you get from thinking about whether or not you’ll be able to fall asleep.
During a series of restless nights, bedtime can start to feel stressful. You may start to calculate how many hours there are until your alarm goes off. You may start to think about how tired you’ll be the next day.
This can cause a vicious cycle. The more anxious you get, the more alert you become and the harder it becomes to fall asleep.
Over a period of time, your bedroom can start to feel frustrating and stressful rather than a relaxing place to finally get some rest.
There are many behavioral treatments to address the thoughts and behaviors that can contribute to and maintain the cycle of poor sleep and anxiety. Read the NHLBI’s insomnia treatment guide for more info.
3. An Irregular Sleep Schedule
Your body follows a circadian rhythm. It’s an internal timing system that helps regulate your sleep-wake cycle and influences when you feel naturally sleepy and alert.
If you frequently change your bedtime and wake-up time, you can make your body’s circadian rhythm Desynchronize, and it can make it harder to fall and stay asleep. For example, you may be in bed by 10:30 p.m. on weekdays, but don’t go to bed at all on weekends until 2 a.m.
The NHLBI explains how changing your schedule can cause and contribute to insomnia.
What may help:Try to stick to a consistent weekday/weekend schedule as much as possible.
4. Caffeine and Nicotine
Stimulants like caffeine and nicotine can make it hard to fall and stay asleep.
Caffeine is in coffee, tea, energy drinks, soda, chocolate and other products. Because its effects can last several hours, a drink consumed in the afternoon or evening may affect your ability to sleep at night.
Nicotine also disrupts sleep and can cause awakenings.
How sensitive you are to caffeine’s effects varies, so the same amount of caffeine does not affect everyone the same way.
What may help: If you can’t sleep, try eliminating caffeine and nicotine use in the evening.
The NHLBI insomnia treatment recommendations suggest avoiding caffeine and nicotine use near bedtime as a part of their recommended sleep habits.
5. Alcohol and Sleep Disruption
Alcohol, like caffeine, can interfere with sleep and disrupt normal sleep patterns.
If you regularly wake up after falling asleep, alcohol may be the reason.
Alcohol does not help to treat insomnia. Using alcohol with other sedative substances may be dangerous.
6. Excessive Use of Electronic Devices Before Bed
Using a lot of technology at bedtime can keep you mentally stimulated.
It may delay bedtime, and make relaxing or falling asleep more difficult.
Although too much screen time doesn’t cause insomnia, it can displace sleep time and consolidate irregular sleep habits.
Exposure to light in the evening can negatively affect the body’s sleep-wake timing.
What may help: Set aside some time before bed to relax without using a screen. Reading or listening to quiet music can help relax the mind and body for sleep.
The Mayo Clinic’s website offers more tips for improving your sleep.
7. Long or Late Daytime Naps
Taking a long or late nap may reduce your sleepiness for the night, especially if you are already having issues falling asleep. This can be extremely infuriating.
It’s a good idea to keep a sleep log to see how long you are sleeping during the day and how it may be affecting your sleep at night.
The NHLBI recommends avoiding naps to help with insomnia.
The best approach to dealing with daytime sleepiness to not take naps. However, if you are having chronic issues with naps affecting your nighttime sleep, it may be a good idea to consult a sleep specialist to be evaluated for a possible underlying condition.
8. An Uncomfortable Sleeping Environment
How comfortable is your bedroom? Is it quiet? Is it too cold or too hot? Is your mattress and pillow comfortable? Your bedroom can negatively impact your quality of sleep.
Distractions that can lead to poor quality and little sleep include:
- Street noise and other outside noises
- Bright lights
- Not the right temperature
- Pillows and mattress not comfortable
- Frequent interruptions
- Working or watching TV in bed
These can not necessarily cause chronic insomnia, but can lead to poor or no quality sleep.
To help: Make your bedroom dark, quiet and comfortable. Keep your schedule consistent. Avoid activities that promote wakefulness in bed.
9. Eating Too Much or Too Late
Larger meals can lead to indigestion and/or acid reflux. These can make it hard to fall asleep and may cause you to wake up.
You may also be uncomfortable if you go to bed hungry, but a good night’s sleep should not be dependent on large meals.
To find what works for you, try not to go to bed starving or stuffed.
If you regularly get heartburn, you should consult a doctor or healthcare professional.
10. Sleep Affecting Medicines
There are various medicines that can cause and worsen insomnia. These can include:
- Antidepressants
- Medicines to help with asthma
- Cold and allergy medicines
- Decongestants
- Steroids
- Stimulant medicines
- Blood pressure medicines
Various things can cause insomnia and make it hard to get a good night’s sleep. If your sleep has recently gotten worse due to medicine, talk to your doctor or pharmacist. Do not stop or change your medicine without talking to a doctor or pharmacist.
According to The Mayo Clinic, there are a variety of reasons why an individual might experience insomnia. One reason may be the use of certain medications. The following information will examine some of the medical conditions as potential contributors to insomnia.
11. Chronic Pain and Other Medical Conditions
Sometimes the symptoms of a medical condition can manifest as insomnia.
Examples of medical conditions that can impact sleep include but are not limited to:
- Chronic pain
- Asthma
- GERD
- Thyroid Disorders
- Neurological Conditions
Pain can certainly impact the ability to find and maintain a comfortable position for sleep. Breathing difficulties and reflux can also disrupt sleep. Other medical conditions may cause symptoms that disrupt and/or prevent the individual from falling and/or staying asleep.
Addressing the medical condition can also address the insomnia.
12. Anxiety and Depression and Other Mental Health Conditions
Anxiety can be associated with an inability to shut off the mind and/or body at the end of the day. Depression can be associated with difficulty falling and/or staying asleep as well as sleeping too much.
The relationship can also work in the opposite order where the inability to get quality and/or sufficient sleep can worsen an individual’s mental health.
Just because someone is experiencing insomnia, it does not necessarily mean that person has anxiety and/or depression.
However, if an individual is experiencing insomnia as well as other emotional symptoms such as low mood and/or anxiety, it would be prudent to reach out for professional assistance.
13. Hormonal Changes
Pregnancy and some of the impacts of menopause can certainly contribute to symptoms of insomnia.
Hot flashes and night sweats are some of the symptoms of menopause that can disrupt sleep.
Poor sleep may be due to other causes aside from hormonal changes, and in light of that, symptoms should be assessed accordingly.
The NHLBI mentions insomnia and its association with the hormonal changes of pregnancy and menopause.
14. Other Sleep Disorders
Sometimes, what appears to be insomnia is actually another sleep disorder.
Sleep apnea
Sleep apnea is characterized by repeated stopping of the breath during sleep, and may be accompanied by snoring and excessive sleepiness during the day.
Restless legs syndrome
This is a disorder characterized by restlessness and the irresistible urge to move the legs, and may be accompanied by unpleasant sensations in the legs.
Circadian rhythm sleep-wake disorders
These disorders occur when there is misalignment between the body's internal sleep-wake rhythm and what is desired or required by the external world.
Different approaches are required to manage these disorders in comparison to insomnia.
If you regularly feel unrefreshed upon waking, have breathing-related issues during sleep, experience recurring unusual sensations in your legs at night, talk with your healthcare professional.
For additional information see the Mayo Clinic's webpage on sleep disorders.
15. Age, Family History and Individual Differences
It is a common misconception that sleep problems occur only in the elderly, when in fact people of all ages may experience sleep problems.
Factors such as a person's health, use of medications, and family history may contribute to sleep problems.
These are risk factors, not guarantees. For instance, having a family member with sleep problems does not mean you will get it as well.
Why Can Insomnia Persist Even if the Original Cause Improves?
This is a common situation.
Let’s say your sleep issues started because of a stressful month at work. The month is over, but you still can’t sleep. Now you’re worried about not sleeping and go to bed earlier in an attempt to catch up on sleep. You may also spend time lying in bed awake. These things may become a pattern. Eventually bedtime becomes stressful.
This is one reason why insomnia may persist even after a stressor is removed.
There are effective behavioral treatments available for chronic insomnia. These treatments address the ways people think and act which may maintain sleep difficulties.
Learn more by reading the NHLBI's guide to insomnia treatment.
How do you figure out What’s Causing your Sleep Problems?
Generally speaking you won’t have to consider every potential cause.
Keep a sleep diary
Pay attention to your sleep patterns and what happens before and after.
- One thing you can do is keep a sleep diary.
- For one to two weeks write down:
- What time you go to bed
- How long it takes you to fall asleep
- How many times you wake up during the night and what time you wake up
- If you take a daytime nap and what time you went to bed
- When you drink caffeine and alcohol
- Your physical activity and work schedule
- How sleepy you feel during the day
A sleep diary can be very useful for finding patterns and for a doctor’s appointment.
To learn more about the use of sleep diaries and other resources to help assess sleep problems, review the NHLBI’s guide to evaluation of insomnia.
Review changes
Has anything in your life changed that might affect your sleep? Have you started a new job with different hours? Have you experienced a stressful event, or taken new medication, gotten sick, or changed your normal routine?
Avoid self diagnosis
Because the body and brain work together to support sleep, the presence of certain symptoms may suggest the presence of one or more sleep disorders. Each of those symptoms may overlap with other disorders. A healthcare professional can help determine if your symptoms may be caused by another condition that is unrelated to insomnia.
When Should You Seek Medical Advice?
You may want to talk to a healthcare professional if you struggle to fall asleep or stay asleep. You may also want to talk to a healthcare professional if you feel your inability to sleep is impacting your work, school, or normal activities.
You may want to seek help from a healthcare professional if you feel excessively sleepy during the day. You may want to seek help from a healthcare professional if you feel unrefreshed when you wake up.
You may want to seek help from a healthcare professional if you feel medication you are taking is affecting your sleep.
You may want to seek help from a healthcare professional if you feel you have a sleep disorder.
You may want to seek help from a healthcare professional if you feel you have chronic insomnia. Chronic insomnia is sleep difficulties that occur at least three times a week for at least three months. You do not have to wait three months to get help if symptoms are negatively impacting your quality of life.
Frequently Asked Questions
What is the most common cause of insomnia?
There are many causes. This may depend on the individual.
Can stress alone cause insomnia?
Yes. Short term stress can cause temporary sleep problems. Long term stress can cause chronic sleep problems. However, there are other contributing factors that can cause insomnia.
Will caffeine consumed in the afternoon still cause insomnia?
Caffeine can cause insomnia, as it can stay active for many hours in the body, and sensitivity to it is individualized. So, caffeine consumed in the afternoon can still affect your ability to fall asleep.
Why am I not able to fall asleep even when I am very tired?
You may be physically tired, but not always mentally ready to fall asleep. Disruptive schedules, stress, caffeine consumption, medication effects, discomfort and other things can make you mentally not ready to fall asleep.
Can an underlying medical condition cause insomnia?
Yes, insomnia can be caused by many medical conditions such as chronic pain, neurological conditions, hormonal conditions, respiratory conditions, reflux conditions and many more.
Can natural supplements help with insomnia?
Not necessarily, and there is not enough evidence to show effectiveness. Taking natural supplements for persistent insomnia can still cause side effects and interact with other medications.
Studies on cannabinoids and sleep are still preliminary and results vary by compound, formulation, and study. CBD and THC should not be broadly generalized as cures for insomnia. Individuals considering these products should be informed about potential risks, interactions, and the legal status.
Final Thoughts
Insomnia is rarely caused by a single factor. Stress, irregular sleep, caffeine, alcohol, and other medications, health conditions, and sleep disorders can all contribute. In some cases, many of these factors can co-exist and interact to maintain insomnia, even when the contributing factors improve.
Instead of focusing on how to achieve a faster onset of sleep, assess what is disrupting your sleep.
If symptoms are persistent and/or impede your daily life, it is best to consult a physician or other qualified health professional. Many times, the reason you are not able to get a good night’s sleep can be better understood when you take into account underlying health conditions.
This article is not a substitute for professional medical diagnosis, treatment or advice and should be used for general information purposes only.
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