Suddenly Can’t Sleep? Here’s What May Be Causing Your Insomnia

Temporary vs. chronic insomnia

Insomnia is considered chronic when it occurs three nights a week for three months. Fewer nights of disrupted sleep would be indicative of short-term, or temporary, insomnia.

“When people have these unhappy moments in their life, there’s probably a little bit of difficulty sleeping and we shouldn’t get too hung up on that,” says Watson, who is codirector of the University of Washington Medicine Sleep Center. “If somebody’s having a short-term insomnia issue related to something happening in their life, I would caution people from catastrophizing around that and think of that as the normal experience of human emotion.”

What causes insomnia?

1. Age

Age, alone, can be to blame for your sleep troubles. For one, older adults are more susceptible to health issues that can disrupt sleep. Plus, as you age, your circadian rhythm changes, which is why you might notice wanting to go to bed earlier and, likewise, waking up earlier. For women in perimenopause and menopause, sleep disturbances often manifest hot flashes and night sweats.

Adding to these difficulties, as we age our brain makes less melatonin, a hormone that tells us night is approaching and prepares us for sleep, says Pelayo.

“It’s not chiseled in stone that as we get older that we’re going to have problematic sleep,” says Watson. “When we look at epidemiology, we do see that sleep difficulties do become more prevalent as we age, but it’s not necessarily predetermined.”

If you’re battling age-related insomnia, it’s important to keep a consistent sleep schedule so you don’t skimp on the recommended seven hours a night. Try to go to bed at the same time every night to avoid those late-night, early-morning days.

2. Blue-lights

You’ve heard time and again to turn off electronics an hour or so before bed because these devices emit a blue light that suppresses melatonin. However, glaring blue light even three or four hours earlier — like watching TV during or shortly after dinner — is enough to delay melatonin production, says Karl Doghramji, M.D., director of the Jefferson Sleep Disorders Center in Philadelphia. You don’t have to turn off the tube, though.

He recommends wearing eyeglasses that block blue light (available from a variety of online retailers) until you tuck in (and when you wake up at night too). That way, you’ll have no problems winding down with the TV on.

3. Menopause

Declining estrogen can prompt disturbances — including hot flashes — in the middle of the night. Research indicates that about a quarter of menopausal women have sleep problems severe enough to impact their ability to function during the day.

Head off hot, sweaty wakeups by using sheets and pajamas that wick moisture, and sleeping on a buckwheat pillow, which is more cooling than traditional latex or down, advises Harris, who wrote The Women’s Guide to Overcoming Insomnia. If your partner likes it warmer, consider having a separate comforter for each side of the bed.

4. Caffeine

While it may be intuitive that drinking coffee for an afternoon pick-me-up could interfere with your sleep later, “people often have no idea that they’re consuming caffeine in other forms, like iced tea or chocolate,” says Beth Ann Malow, M.D., director of the sleep disorders division of the Vanderbilt University Medical Center in Nashville, Tennessee. Everyone metabolizes it at a different rate, so you may be surprised at what time of day you should be cutting off caffeine. “If you’re having trouble falling asleep, eliminate it after lunch,” she says.

5. Lack of a routine

Humans like routines because they’re predictable and monotony tends to make people sleepy, Pelayo says.

However, there is no one-size-fits all approach, since different things comfort different people. What’s most important is that your sleep routine signals relaxation, whether it’s a bath, meditation, prayer or even changing into clothes worn only for sleep.

Routines aren’t just helpful before sleep either; they can also help you get out of bed and reinforce a consistent sleep schedule. Plan to do something you really enjoy first thing in the morning to encourage you to get out of bed and stick with a consistent wake-up time to help maintain a regular sleep schedule.

6. Poor sleep environment

A good sleep environment starts with feeling safe, Pelayo says. “We want people to go to bed feeling safe, comfortable and loved.”

Temperature is crucial; your bedroom should be between 65 and 68 °F, according to the Sleep Foundation. Cooling sheets may also help. 

Dark rooms help stimulate melatonin production, so in addition to shades that keep out light, make sure to douse lights from any electronic devices. Exposure to bright light, especially in the morning, can also help you sleep at night, because it can help keep our circadian clocks on track. 

In fact, multiple studies show that cataract surgery, which increases light entering the eye, can improve melatonin production by intensifying daytime light exposure, strengthening the signal that night is approaching.

For noise, if you prefer silence, embrace it. But, if it comforts you, use it — whether its a podcast, fan or a sound machine. Make sure the sound is continuous and non-looping to avoid disruptions and set a timer for a podcast so the continued talk doesn’t wake you back up.

“The brain is very active when it’s sleeping. It’s doing maintenance. It also has background monitoring,” says Pelayo. Therefore, sudden noises or interruptions can disturb sleep.

Lastly, if keeping your phone nearby makes you feel safe, keep it within reach, Pelayo says. But, if it becomes something you obsess over, consider placing it in another room.

Know that you can put your phone in ‘do not disturb’ mode to prevent notifications or configure it to only accept calls from specific contacts during sleeping hours.

7. Long naps

“Many adults don’t nap voluntarily or intentionally, but often fall asleep when not busy or watching TV,” says Doghramji. Either way, your brain sees it as sleep. The most common time of the day when people get sleepy is between 2 and 3 in the afternoon, when we experience a natural dip in energy, he says. This may prevent you from feeling tired at bedtime; then spending too much time lying awake can contribute to insomnia. If your afternoon energy tends to be low, try scheduling something active for that time instead of napping. It will help you feel refreshed, and research shows that exercisers have better sleep quality too — so it’s a double bang for your buck.

If a nap calls your name, Pelayo suggests sleeping no longer than 40 minutes to avoid feeling groggy later. Rest your head where you normally sleep so you remain accustomed to the same sleep environment.

8. Spending too much time in bed

Reading may be a relaxing activity but you should take your book to an armchair — not your bed, Harris advises. “I prefer that the bed is only used for sleep and sex,” she says. Even calm activities like puzzles or an adult coloring book can cause your brain to associate the bed with activities that you pursue while awake, which can affect your ability to drift off at night.

9. Alcohol

Yep, a glass of vino can simmer you down and make it easier to fall asleep. However, research shows that while it may help you conk out, there’s also a rebound effect that causes lighter and more fragmented sleep in the second half of the night; that’s why you’re up at 3 a.m. It also decreases sleep quality — so you rise less refreshed.

Limit alcohol to three hours before bedtime and imbibe moderately (one drink for women and two for men, as recommended by the Centers for Disease Control and Prevention).

10. Medications

Sleep can also be interrupted by poor timing of your medications. Some, like diuretics for blood pressure, can make you have to urinate more often. More than one or two bathroom breaks at night is abnormal, Doghramji says.

Antidepressant SSRIs, can either be energizing or sedating, depending what type you’re on. Steroids like prednisone, beta blockers like propranolol and certain asthma medications are best taken in the morning to avoid sleep disruptions. Always consult your doctor before changing the timing of your medication. See "Common Medications That Can Affect Sleep" for more details.

11. Stress

Dealing with stress can make falling asleep difficult, leading to light, fragmented sleep. However, there are tools to help alleviate stress-related insomnia.

For example, if you’re stressed over bills, avoid reviewing or addressing them in your bedroom. “Put it in a separate room so when you go to your room, it’s a different world,” says Pelayo who also wrote How to Sleep: The New Science-Based Solutions for Sleeping Through the Night.

If you have persistent thoughts that trap you in a cycle of negative feelings, schedule a dedicated time to think or worry. Consider journaling or writing a simple list, whether it’s what you need from the grocery store or even jotting down short- and long-term goals.

“Say it and believe it, then put that aside,” says Pelayo. "Now do something that you enjoy. Reach for pleasure, a warm bath or time with your spouse.” These activities can be incorporated into your sleep routine to signal to your body that you are transitioning into sleep mode and the day is over.

Problems may seem less intense in the morning than they do at night.

Finally, cognitive behavioral therapy for insomnia (CBT-I), can help you retrain your thoughts to calm your mind, Doghramji says. A specially trained CBT-I therapist can help, but there are also apps that teach you these important skills. “Don’t just use them at 3 a.m.; practice with these apps during the day.”

12. Forced-sleep

As you get older you may start going to bed earlier but you may want to consider pushing it back later.

 “You want a later bedtime, but a locked in wake-up time. That’s going to squeeze out those middle of the night awakening… and the body’s going to sleep deeper,” says Pelayo.

Lying in bed trying to force sleep to happen out of boredom backfires, Harris says. It can convince your brain that being awake in bed is normal. Instead, get up and go into a different room and do something relaxing and calm in dim light, she advises. (No screens allowed.) Having an accepting mindset about it can also help. “Sleep will come when it comes. If not tonight, don’t sleep in to compensate — and you’ll likely sleep better the next night,” she says.

13. Health condition affecting sleep

“Insomnia is both a symptom and a disease,” says Watson. If correcting your sleep habits hasn’t improved its quality, your insomnia may be a symptom of another condition.

There are over 80 sleep disorders, many which include insomnia as a symptom. These include sleep apnea, restless leg syndrome, parasomnia (such as sleepwalking, talking or eating) and narcolepsy. While a relatively rare condition, older adults in particular are susceptible to REM sleep behavior disorder (RBD), where individuals physically act out their dreams while asleep. This not only may cause injury to oneself or their bed partner but can be an early warning sign of Parkinson’s, Lewy body dementia or multiple system atrophy, a rare neurodegenerative disorder that affects the body's involuntary functions, and should be treated by a doctor.

Other non-sleep disorders that may cause insomnia include pain, arthritis, atrial fibrillation, PTSD and heartburn, according to Pelayo.

If you’ve tried the correcting your sleep on your own for a month and it still doesn’t feel adequate, see your doctor for an evaluation.

14. Exercising too close to bedtime

Exercise offers numerous benefits for better sleep, such as reducing anxiety and depression and realigning your circadian rhythm. But working out too close to bedtime may be counterproductive. Exercise can heat up your body or make you feel more alert which can make it harder to sleep. Instead, aim to exercise at least two hours before bed to allow these effects to wear off.

Treatment options for insomnia

Cognitive behavioral therapy for insomnia (CBT-I): This is typically recommended as the first-line treatment because it identifies and addresses habits, behaviors, thoughts and other factors that keep you awake during the night. Think of it as getting a toolbox for overcoming insomnia.

Medication: Those who opt for medication should know that there can be side effects and limitations for long term use. For older adults, sleeping pills can be especially dangerous due to the risk of mobility problems and falls. However, if you’re dealing with temporary insomnia, your doctor might give you a short-term prescription.

Alternatively, a relatively new category of medication called dual orexin receptor antagonist (DORA) has proven to be well tolerated in older adults with insomnia and can be a good alternative to traditional prescription sleeping pills.

Over-the-counter options: In general, it’s best to steer clear of over-the-counter options like melatonin, Tylenol PM or Advil PM.  They may not provide the most effective solution and could mask an underlying medical condition responsible for insomnia, which might require a doctor’s evaluation, says Watson. “If you’re just addressing the insomnia yourself over the counter, you might miss an opportunity to address the root cause.”

Alcohol: While alcohol may help you fall asleep initally, as it wears off, your sleep becomes more disrupted toward the last half of the night.

Cannabis: The role of cannabis in promoting sleep remains uncertain, and its potential effects are still being researched.

When to see a doctor

You should reach out to a doctor when insomnia begins to impact your daytime function or if you routinely have trouble with your sleep quality or quantity, multiple nights a week.

Working with a sleep specialist or other another health care professional is important for managing insomnia because you can identify the root causes of your sleeplessness and establish a personalized treatment plan that addresses your specific needs.

“Modern sleep medicine has reached a point where most sleep disorder will improve when addressed correctly,” Pelayo says. “So you shouldn’t suffer with a sleep disorder anymore.”