Why Can't I Fall Asleep at Night?

You’re tired in a bone-deep way. You get into bed at 10:30 and your body finally agrees to power down. Then your brain boots up. The email you didn’t answer. The thing you said in 2011. The grocery list.

How much sleep you need

The CDC² says adults ages 18 to 60 need 7 or more hours a night, 61 to 64 need 7 to 9, and 65 and older need 7 to 8.

What’s keeping you up

The NHS¹ describes insomnia as finding it hard to go to sleep, waking several times in the night, or still feeling tired after waking up. Its list of causes:

• Psychological: stress, anxiety or depression
• Environment: noise or an uncomfortable bedroom
• Substances: alcohol, caffeine or nicotine
• Work: shift work
• Hormonal changes: such as menopause
• Medicines: some can trigger it

The NHLBI³ says short-term insomnia lasts days to weeks, and chronic insomnia means trouble sleeping 3 or more nights a week for more than 3 months. It also says insomnia can affect memory and concentration, and raises the risk of high blood pressure, heart disease, diabetes and cancer, which is a reason to treat it and not tough it out.

If menopause is part of it, our articles on hot flashes and mood changes explain how those feed into sleep. If your legs are the problem, see restless legs. If you wake at night, see 3 a.m. waking.

The wind-down that works for most people

Keep the same hours. The NHS⁴ says going to bed and getting up at similar times each day helps your body know when it’s time to sleep. The CDC² says the same: the same time every day.

Cut the screens. The NHS⁴ says to avoid screens for an hour before bed, because blue light can make it harder to fall asleep. The CDC² says to turn off electronics at least 30 minutes before bedtime. Read, meditate or play calming music instead, the NHS suggests.

Get the room right. The NHS⁴ says quiet, dark and cool, with earplugs, blackout curtains or an eye mask if you need them. The CDC² says quiet, relaxing and cool.

Watch what goes in. The NHS¹ says to avoid caffeine, large meals, alcohol and nicotine close to bedtime. The CDC² says to skip caffeine in the afternoon or evening and large meals and alcohol before bed.

Move during the day. Regular exercise helps sleep, the NHS¹ says, but not within 4 hours of bedtime.

Park the worries. The NHS⁴ says writing down your worries can help you manage them, and that a to-do list before bed clears your mind.

Don’t force it. If you’re still awake after about 20 minutes, the NHS⁴ says to get up, sit somewhere comfortable and do something relaxing before returning to bed.

The play

Try this: a seven-night wind-down

Pick a wake-up time and keep it every day, weekends included.

An hour before bed, put your phone down and write your to-do list and any worries on paper.

If you’re awake after 20 minutes, get up, sit somewhere comfortable and do something calm until you feel sleepy. Jot down how long it took you to fall asleep each night.

When it doesn’t resolve

The NHS¹ says that if lifestyle changes don’t work after months, see your GP, who may suggest cognitive behavioural therapy, CBT. The NHLBI³ lists CBT for insomnia, called CBT-I, a regular sleep schedule and medicine when appropriate. The NHS notes that sleeping pills are rarely prescribed because of dependence risks, and only briefly when insomnia is severe.

When to get checked

The CDC² says to talk with your provider if you regularly have problems sleeping or notice signs of common sleep disorders. A provider may order tests, including a sleep study, and ask you to keep a sleep diary. The NHLBI³ says providers review sleep habits and may request a diary too.

Book an appointment if any of these fit:

• Trouble sleeping most nights for several months
• You’re exhausted, foggy or irritable during the day
• Self-help hasn’t changed anything after a few weeks
• You snore loudly, gasp or pause your breathing in your sleep
• Alcohol or a sleeping pill has become your way to fall asleep
• Anxiety or low mood is part of the picture

Tonight, the grocery list can go on paper. Your brain doesn’t have to hold it.