Can't Fall Asleep? 3 Sleep Disorders That Might Be the Cause

Tossing and turning, watching the time crawl by and desperately wishing for sleep — many people are all too familiar with this unwanted bedtime routine. While occasional sleepless nights are common, they take a serious toll on our well-being when they become the norm. If it’s increasingly difficult for you to fall asleep, Dr. James Meyer, DO, UnityPoint Health, explains what might be happening.

Why Can't I Fall Asleep at Night?

Simple habits, often related to poor sleep hygiene, could be the reason you're struggling to effortlessly doze off.

Here’s what to try if you can’t sleep:

• Avoid exercising too late in the day: While daily activity is critical for quality sleep, consider the timing. This is especially true for intense workouts. You can trigger a stress response in your body that makes it tough to feel sleepy. Dr. Meyer suggests ending your workout at least two hours before bed.
• Don’t snack after dinner: Try not to eat after supper. Sleep is when your body recovers, and eating too close to bedtime stops that from happening.
• Get daily movement: Most people can find ways to be more active. Daily activity helps you sleep better at night.
• Keep your room cool: For good sleep, make sure your bedroom is dark, quiet and cool. An optimal sleep temperature is between 60-67 degrees Fahrenheit.
• Keep consistent rhythms: Figuring out consistent bed and wake-up times that make you feel your best is important.
• Move back your bedtime: If you're still staring at the ceiling after 15-20 minutes, consider a later bedtime. You can also try getting out of bed to do something that’s not overly stimulating, like journaling.
• Pass on the nightcap: Drinking alcohol too close to bedtime should be avoided. While a few beverages might help you fall asleep faster, it messes with your deep sleep and makes you wake up more often.
• Pick up a book: Consider reading to wind down. It’s most effective at least 20-30 minutes before your planned bedtime. If you use a tablet, dim the light.
• Put down screens: To promote better sleep, reduce your exposure to the light emitted from TVs, smartphones, computers, tablets, etc.
• Skip the stimulants: Steer clear of things like nicotine and caffeine — especially later in the afternoon and evening.
• Soak in morning sunlight: Morning sunlight helps regulate your circadian rhythm (your body's internal clock) and that promotes better sleep at night. Thirty minutes outside in the morning can make a noticeable difference in your sleep quality. Blue light therapy may be beneficial for overcast days.
• Stick to power naps: A 20- to 40-minute nap gives you a second wind, but anything longer than an hour or two interferes with nighttime sleep.

Why Can’t I Stay Asleep at Night?

The tips for falling asleep are helpful for staying asleep, too. However, if you struggle with the latter, Dr. Meyer says a personalized approach is most successful.

"I think people often discover what works best for them. I like to understand what my patients find helpful for sleep. If their approach seems beneficial, I encourage them to continue. If not, we look at other options together."

Cognitive behavioral therapy for insomnia (CBT-I) is a highly effective tool for people with sleep struggles. It’s a specialized treatment that gets to the root cause of your sleep issues. Dr. Meyer recommends it as a long-term solution, since sleep medication provides short-term relief and can be habit-forming.

“Because CBT-I is so specialized, consider accessible alternatives if you don’t have a therapist in your area, like mental health apps and online resources that offer valuable support for people with sleep struggles,” he says.

If you're having trouble falling back asleep, try getting out of bed for a bit. Reading with a dim light, like on a Kindle, can help.

If you use supplements to fall back asleep, that’s OK if they’re effective and don’t cause harmful side effects.

"We generally prefer a natural substance, like melatonin, over something like Benadryl, which can really slow down the brain,” Dr. Meyer says. “Of course, I use sleep medications like Ambien for short bouts of insomnia, but my goal is always to get people sleeping well without them.”

What is Sleep Deprivation?

Sleep deprivation means not getting enough good sleep — including how long and how well you snoozed.

Common sleep deprivation symptoms include irritability, mood changes and errors in judgment.

Lack of sleep causes a slew of health problems, such as high blood pressure, headaches, dizziness and weight gain. It’s common for sleep deprivation and sleep disorders to overlap with other health conditions, too, like cardiac disease, lung disease, brain disease and mental health issues.

If obesity or being overweight is contributing to sleep deprivation due to obstructive sleep apnea, GLP-1 weight loss medications are helpful.

“Previously, I would refer patients with morbid obesity for bariatric surgery and sometimes, with weight loss, they could come off their CPAP or BiPAP (devices used to treat sleep apnea). Now, with these medications, I believe we'll see a noticeable improvement in sleep-disordered breathing for people,” Dr. Meyer says.

Common Sleep Disorders

Sleep Apnea

Obstructive sleep apnea is the sleep disorder Dr. Meyer sees most in his practice.

“It involves loud snoring and repetitive episodes of snorting, followed by brief pauses in breathing as the tongue blocks the airway. This cyclic process leads to poor sleep quality and may result in breathless upon wakening,” he says.

During the day, sleep apnea symptoms look like excessive sleepiness, morning headaches, trouble concentrating, mood changes or irritability, feeling unusually fatigued or nodding off during activities.

“Some patients aren’t aware of their sleep disturbances, so it's helpful if they bring their partner to the appointment. They can provide valuable insights into snoring and other symptoms. A partner can also record snoring sounds over the phone to help with the diagnosis,” Dr. Meyer says.

Your doctor conducts a physical exam and looks at your neck circumference and inside your mouth to identify tissue obstructions and how much airway space you have.

Several factors increase the risk of sleep apnea, such as:

• Age
• Chronic nasal congestion
• Family history of the condition
• Gender (men are typically higher risk, although women’s risk increases after menopause)
• Larger neck circumference
• Narrowed airway due to enlarged tonsils or adenoids or other inherited traits
• Obesity
• Smoking

Like other sleep disorders, numerous health issues are linked to sleep apnea, including high blood pressure, diabetes, depression, dementia, stroke, heart attack, congestive heart failure and cardiac arrhythmias like atrial fibrillation.

"Central sleep apnea, though less common, is also a concern,” Dr. Meyer says.

“Unlike obstructive sleep apnea, where the airway is physically blocked, central sleep apnea is when the brain fails to tell the body to breathe, even with an open airway. It may be associated with serious heart and neurological diseases. Certain medications, especially chronic opioid use, is another cause. Home or lab sleep studies are valuable in diagnosing these sleep disorders.”

Sleep apnea is also linked to frequent nighttime urination (nocturia), especially for older men.

“Waking up due to pauses in breathing during sleep can trigger the urge to urinate,” Dr. Meyer says. “If we keep the airway open, patients don't have breathing interruptions and need fewer bathroom breaks at night.”

This connection is so strong that Dr. Meyer has received patients from urologists when other causes are ruled out.

Restless Leg Syndrome

Restless legs syndrome (RLS) affects roughly 5-10% of the patients Dr. Meyer treats. It’s described as an urge to move the legs, accompanied by unpleasant sensations like pins and needles. It's worse with inactivity and relieved by movement. It occasionally affects the arms as well. Certain medications (antihistamines, antidepressants, antipsychotics) can make RLS worse.

It’s more common in women than men, often due to iron deficiency.

“Whenever someone has restless legs, we carefully review their records to confirm they've had iron blood tests, especially serum ferritin,” Dr. Meyer says.

If your doctor determines your RLS is, in fact, due an iron deficiency, getting more iron in your diet through food or supplements can get you feeling better, faster.

Before making a diagnosis, your doctor will likely do tests to rule out other things that cause leg discomfort, such as leg cramps or sciatica. While it’s also associated with serious conditions like Parkinson's and multiple sclerosis, experiencing RLS doesn’t mean you have these diseases.

Medication is an option for treating RLS, although many patients find relief with at-home remedies like warm baths, stretching and leg massages.

Insomnia

To know if you have insomnia, consider if you regularly have trouble falling or staying asleep, even when you've given yourself plenty of time to doze off. That’s a key sign.

Insomnia is triggered by things like stress, worry, poor sleep hygiene, temporary or chronic health problems, genetics, some medicines and substances like caffeine or alcohol. Along with struggling to fall and stay asleep, common signs of insomnia include waking up too early, excessive daytime sleepiness, irritability and trouble staying focused.

To treat insomnia, Dr. Meyer suggests a combination of strategies: improving your sleep routine, getting mental health support, such as CBT-I, and occasionally using short-term sleep medication.

Uncommon Sleep Disorders

Circadian Rhythm Sleep Disorder

Your body runs on a 24-hour internal clock that tells you when it's time to sleep and wake up. It’s called your circadian rhythm and is heavily influenced by light and darkness. When your internal clock gets out of sync with your daily schedule, circadian rhythm sleep disorder results.

Several factors disrupt your circadian rhythm, making it difficult to sleep or stay awake at the right times, such as:

• Advanced sleep phase syndrome (ASPS), when your body's natural sleep time is much earlier than normal
• Delayed sleep phase syndrome (DSPS), when your body's natural sleep time is much later than what’s typical
• Irregular sleep-wake rhythm disorder, which results in highly variable sleep patterns with no consistent bed or wake-up time
• Lack of sunlight exposure, which is especially important in the morning or for people who are blind
• Traveling across time zones (jet lag)
• Working night or rotating shifts

To diagnose a circadian rhythm sleep disorder, doctors gather information about sleep habits through questionnaires, sleep diaries and wearable monitoring devices. They also consider light exposure, your natural sleep preferences and other health conditions, sometimes using lab sleep studies.

Narcolepsy

Narcolepsy makes people feel extremely sleepy during the day, even after a good night's rest. Sometimes, people fall asleep suddenly, which can be dangerous.

If you have sleep apnea, and you’re still tired after it’s treated, or if you’re constantly sleepy for no clear reason, narcolepsy should be ruled out. To make a diagnosis, doctors do a special sleep test called multiple sleep latency test (MSLT). It involves a series of five naps, spaced two hours apart, to measure how quickly a person falls asleep.

“If someone falls asleep in less than eight minutes, or even faster, in five minutes or less, and they have rapid eye movement (REM) sleep during two of their naps, that suggests narcolepsy,” Dr Meyer says.

Narcolepsy often presents with additional symptoms, too, such as:

• Involuntary loss of muscle tone
• Sleep hallucinations upon falling sleep that are visual or auditory
• Sleep paralysis, where you awaken from sleep but can’t move

Experts aren't sure what causes narcolepsy, but they believe it could be due to low levels of orexin, a chemical in the brain. Fortunately, medications are available to manage narcolepsy.

REM Sleep Behavior Disorder

REM sleep is when your brain is actively dreaming. Your eyes move quickly, and your body is deeply relaxed. It’s critical for your brain health and memory.

REM behavior disorder, or RBD, is when people act out their dreams during sleep, sometimes doing odd or even dangerous things. Unlike sleepwalking, which happens during any stage of sleep, RBD occurs specifically during REM sleep. Usually, a provider diagnoses it by talking to the person and their family about what happens at night, rather than conducting a sleep study.

However, if sleep apnea is also suspected, then testing is recommended.

People with RBD do things like sleepwalking, sleep talking, sleep eating or even sleep driving without being aware of it. Because of this, it's important to make the bedroom safe. This means removing sharp objects or anything potentially harmful.

“I recently read an article where someone was afraid their sleepwalking partner might hurt them, and that's a real concern. So, taking safety precautions is crucial to prevent injuries,” Dr. Meyer says.

What is a Sleep Study?

A sleep study monitors your bodily functions while you sleep. You’re hooked up to sensors that record your breathing, heart rate, brain waves and muscle movements. These recordings give doctors a picture of how you sleep and whether you have a sleep disorder. By understanding your sleep patterns, your doctor can recommend the right treatment to improve your sleep and overall well-being.

While typically performed in a lab setting, you can do a sleep study at home, too. You take home a portable device that uses sensors to record your breathing, oxygen levels and chest movements in your own bed.

A healthcare professional then analyzes the data to check for sleep-related breathing problems, like sleep apnea. While convenient, this type of study mainly focuses on breathing and doesn't track brain activity like a lab-based sleep study.

What if I Can’t Sleep During a Sleep Study?

“People who come for sleep studies are in a strange bed and hooked up to a lot of wires and sensors. This makes it hard to sleep, and the worst sleep study is one where you don't sleep at all,” Dr. Meyer says.

“I give patients a short-acting sleep aid, like zolpidem, to help. If someone’s coming back because they still don’t sleep well, I give a longer lasting sleep medication but ensure they have someone to drive them home. I can still get the information I need for the study, even if the patient takes a sleep aid.”

When to See a Doctor if You Can’t Sleep

Good sleep isn't just about how long you sleep, but how well you sleep. While occasional bad nights are normal, talk to your doctor if sleep problems frequently disrupt your focus, mood or daily life. They can help figure out what's going on and get you back to snoozing soundly. Don't wait until you're totally exhausted – getting help sooner makes a big difference.

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