Can’t catch your Zzz’s? Stop chasing them and ask why you’re having trouble sleeping.
The causes for insomnia, a sleep disorder that affects 10 percent of Americans, can vary widely from person to person. Fortunately, sleep medicine experts note that knowledge is power. Understanding the cause of your insomnia — we list several common ones below — can help you find the best way to overcome it.
Making targeted changes to your habits today may be all you need to get the shut-eye you’re dreaming of tonight.
1. Anxiety-Related Insomnia: You’re Too Worried About Sleep to Get to Sleep
Rest easy knowing that your body will sleep when it needs to — even if it doesn’t feel that way.
Dire, overblown health predictions about getting too little sleep can serve to heighten our anxiety around sleep and keep us up, says Mathew Ebben, PhD, associate professor at Weill Cornell Medical College Center for Sleep Medicine. “There are studies that say if you have insomnia, you’re at increased risk for Type 2 diabetes or high blood pressure. But when we actually look at the data, it is not clear that all or even most insomniacs are at risk.”
Dr. Ebben works with patients to put their fears to rest. “Insomnia causes tiredness. That’s it. When people realize that, they’re not as afraid. They feel better after finding out the facts.”
Busting through unrealistic fears about sleep is a big part of a research-backed treatment strategy called cognitive-behavioral therapy for insomnia. Also known as CBTI, this psychological framework helps you identify and get past dysfunctional beliefs about sleep to help you doze better.
“It’s been shown to be more effective than medication long-term,” says Dr. Ebben. (To find a psychologist near you who can teach you CBTI methods, try the American Psychological Association’s psychologist locator.)
Relaxation techniques can be an important component of CBTI as well. “We find CBTI tends to work even better when it’s paired with meditation,” says Robert Rosenberg, M.D., board-certified sleep medicine physician and author of "The Doctor's Guide to Sleep Solutions for Stress & Anxiety."
“Meditation actually changes the structure of the brain,” Dr. Rosenberg explains. “After several months, patients are less stressed. Tai chi and yoga are good choices, too.”
2. Rebound Insomnia: You Quit Sleeping Pills Too Quickly
Some 80 percent of insomnia cases can be resolved without medication, says Dr. Rosenberg. That having been said, sometimes medication can be appropriate.
Short-term stress-related sleeplessness after a divorce, death, job change or natural disaster may respond to short-term meds under a doctor’s supervision. But if use exceeds a month or two, question it. “Doing so can keep an acute insomnia episode from becoming something entrenched,” Rosenberg adds.
If you have taken sleep medication for more than a month or two and it’s become a habit, your insomnia can become worse than ever for a week or two if you stop taken them suddenly, Dr. Rosenberg notes.
To avoid this phenomenon, known as extreme rebound-wakefulness, he recommends tapering your dose with a physician’s guidance. Generally, this involves halving your current dose for two weeks, then halving the half-dose for the next week or so, and so on until you’re off them completely.
The process can take anything from a few weeks to a few months, depending on the dose and how long you’ve taken the pills. And remember: Dr. Rosenberg says that even if you do find yourself staring at the ceiling temporarily, know it won’t last.
3. Backfire Insomnia: You Go to Bed Too Early
Isn’t it ironic? You could actually be causing your own insomnia by trying to get too much sleep.
“If you’re going to bed early because you didn’t sleep well the night before and you think you need a certain number of hours… you can start spending too much time in bed and turn a short-term episode into something chronic,” says W. Christopher Winter, M.D., head of Charlottesville Neurology and Sleep Center.
Eight hours is an average, not an ideal, Dr. Winter adds. “If you go to bed at 9 p.m. and it takes you two hours to fall asleep, don’t go to bed at 9 p.m. Pick your Jimmy — whether it’s Fallon or Kimmel — and stay up a little longer."
“It’s kind of like going to lunch at 10 a.m. and sitting there for two hours until you’re hungry,” he explains.
4. Faux Insomnia: You’re Not Really Sleepy (Even Though You’re Drained)
There’s a big difference between being sleepy and feeling fatigued, Dr. Winter says. “Fatigue is the feeling you have right after you work out. It’s having no bodily energy. A marathon runner doesn’t fall asleep at the next mile marker. She’s fatigued, not sleepy.”
Feeling sleepy, on the other hand, is a sensation that originates in the brain. Eventually, it becomes a struggle to remain awake.
The distinction is important, says Dr. Winter. “You can’t act on fatigue with sleep.”
In short, if you’re consistently out of energy, you might need to get more vitamin D or B12, drink more water or get some exercise. If you’re consistently tired during the day, however, you may have a sleep issue that needs attention.
5. Inconsistent-Schedule Insomnia: You Lack Routine
Our brains thrive on habit, says Dr. Winter. If you’re having trouble sleeping, try keeping a routine for mealtimes, exercise, going to sleep and waking up. “If you don’t, your brain may respond, ‘Hey, I’m not really sure what you want me to do right now.’”
He adds that if your insomnia-du-jour is waking too early, don’t add fuel to the flambé. “Get up, go to a low-light area and do something calm like read. If you hit the Stairmaster at 6 a.m. because you’re awake at 5:45, your brain is going to start waking you up earlier because it’s time to go to the gym.”
To optimize your body’s rhythms, daily activity — especially in sunlight earlier in the day — can help you sleep better. How? It raises your body temperature, which enhances production of the sleep-regulating hormone melatonin at bedtime.
“One of melatonin’s main functions is to lower body temperature. The steeper the body temperature decrease when you hit the pillow, the more likely you are to fall asleep,” Dr. Rosenberg explains.
None of the Above? Maybe It’s Not Insomnia
If none of the above resonates for you, you may suffer from something other than insomnia. Conditions such as acid reflux, anxiety, bipolar disorder, chronic pain, depression, restless leg syndrome and sleep apnea can keep you up. So can certain medications, including those for high blood pressure, ADHD, depression, thyroid conditions and pain.
If you’ve tried everything you can think of for several months and you’re still not sleeping, or if you’re extremely tired throughout the day, bring it up to your primary care physician. He or she can refer you to a sleep specialist if necessary. Once the underlying issue is dealt with, you’ll almost assuredly be on your way to a better night’s rest.
Working through a sleep issue — particularly one that involves changing your schedule — will likely cause you to feel worse until you even out. Just like you won’t die of insomnia, however, “You won’t die of tiredness,” says Dr. Rosenberg.