When sleep isn’t easy

Technologies used in research, such as brain imaging and electrical mapping, have revealed many factors that affect your ability to fall asleep and continue sleeping throughout the night. Sleep problems can be temporary, caused by changes in your physical health, short-term stressors or environmental factors. Long-term sleep problems may be caused by significant life events–such as the loss of a loved one, going through a divorce or ongoing work-related stress–or can be a sign of an emerging medical condition.

Common sleep problems and possible causes are listed below. In many cases, simple lifestyle changes can have an enormous positive impact on your ability to fall asleep, stay asleep and wake up refreshed. Visit the 5 Keys to better sleep to learn good sleep habits and achieve healthy sleep. Chronic sleep issues, however, may require seeking help from a medical professional.

Trouble falling asleep

When you find it hard to fall asleep at night, there may be an identifiable cause:

  • Overscheduling activities

  • Consuming caffeine too late in the day or eating a large meal just before bedtime

  • Exercising in the evening

  • Skipping “wind down” time without exposure to television or electronic screens

  • Taking decongestants, steroids and medicines that relieve headaches

Difficulty staying asleep

If you are able to fall asleep but find yourself waking up frequently, it could be due to:

  • Discomfort from your mattress, pillow or room temperature

  • Distractions such as noises, bright lights, television, a cell phone or computer

  • Alcohol - though it’s a sedative that makes it easier to fall asleep - prevents deep sleep and REM sleep

  • Nicotine use, which leads to lighter-than-normal sleep

  • Heart and blood pressure medications known as beta blockers

  • Nocturia, the need to get up frequently to go to the bathroom

  • Breathing difficulties from a common cold or chronic condition such as asthma

  • Heartburn, pain from injuries or uncomfortable conditions like arthritis

Struggling to wake up

If falling and/or staying asleep is hard for you, waking up refreshed is likely to be a challenge too. However, if you feel like you’ve slept well and still struggle to feel awake and alert in the morning, it may be from:

  • Disruptions from shift work or seasonal changes

  • Medications such as beta-blockers, muscle relaxants and some antidepressants

  • Stress and anxiety

  • Depression

  • Sleep disorders such as insomnia, sleep apnea or restless legs syndrome

Snoring

Snoring is the hoarse breathing sound that occurs when air flows past relaxed tissues in your throat while you sleep. Nearly everyone snores now and then, but it can be a chronic problem caused by:

  • The anatomy of your head, nose and/or throat

  • Sleeping on your back

  • Drinking alcohol close to bedtime

  • Weight gain or obesity

  • A medical condition or sleep disorder

Sleep issues for women

Hormone cycles can affect how well women sleep. Progesterone is known to induce sleep and circulates in greater concentrations in the second half of the menstrual cycle. For this reason, women may sleep better during this phase of their menstrual cycle. On the other hand, many women report trouble sleeping the night before their period begins, which may be related to the abrupt drop in progesterone levels that occurs just before menstruation.

Pregnancy, especially during the first and third trimesters, can cause women to feel extremely fatigued. The physical and emotional demands of pregnancy increase the prevalence of sleep disorders among pregnant women.

Women in their late forties and early fifties, however, report more difficulties sleeping than younger women. These difficulties may be linked to menopause when concentrations of progesterone begin to lower. Hot flashes in women of this age also may cause sleep disruption and difficulties.

Medical & mental health issues

Common conditions often associated with sleep problems include heartburn, diabetes, cardiovascular disease, musculoskeletal disorders, kidney disease, neurological disorders, respiratory problems and thyroid disease. People who have chronic asthma or bronchitis also have more problems falling asleep and staying asleep due to breathing difficulties or the effects of medicines. Some psychological disorders are well known for disrupting sleep, including anxiety disorders, bipolar disorder and schizophrenia.

Sleep disorders are treatable

Sleep disorders can significantly affect your health, safety and wellbeing. The most common sleep disorders are:

  • Insomnia: short-term or chronic trouble falling and/or staying asleep. Insomnia is chronic when it occurs at least three nights a week for three months or more. Insomnia affects women more than men and is more prevalent as people age. Young and middle-aged African Americans also have a higher risk. Depression often leads to insomnia, and insomnia can cause depression. Chronic insomnia may also be associated with medical conditions or the use of certain drugs.

  • Sleep Apnea: a potentially serious sleep disorder in which breathing repeatedly stops and starts. Obstructive sleep apnea is the more common form, happening when throat muscles relax. Central sleep apnea occurs when your brain doesn't send proper signals to the muscles that control breathing. Complex sleep apnea syndrome is diagnosed when someone has both obstructive sleep apnea and central sleep apnea.

  • Restless Legs Syndrome (RLS): a condition that causes an uncontrollable urge to move your legs, usually because of an uncomfortable sensation. Moving eases the unpleasant feeling temporarily. Also known as Willis-Ekbom disease, RLS can begin at any age and generally worsens with age.

  • Narcolepsy: a chronic sleep disorder characterized by overwhelming daytime drowsiness and sudden attacks of sleep. People with narcolepsy often find it difficult to stay awake for long periods of time, regardless of the circumstances.

Scientific understanding and treatment of these and other sleep disorders are consistently improving.

When it’s time to visit your doctor

If you continue to have trouble sleeping, consistently find it difficult to fall or stay asleep and/or feel tired or not well rested during the day, you may have a sleep disorder. Your family doctor or a sleep specialist should be able to help you, and it is important to rule out other health or psychiatric problems that may be disturbing your sleep.

Below are some helpful questions to ask your doctor to open the conversation regarding sleep:

1.       Why am I more tired during the day and more awake at night?

2.       Should I see a sleep specialist?

3.       Should I consider a medication for sleep aid?

4.       Do I need a sleep study?

5.       What resources can you provide me for improved sleep hygiene?  

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