Difficulty falling asleep

What is important to know

Difficulty falling asleep can be part of insomnia, but not any prolonged period of falling asleep means you have a sleep disorder.

It is important to consider whether it is associated with a disturbing event, how often it occurs, how long it takes to fall asleep, whether there is sufficient opportunity for sleep, and how the person feels the next day.

Sometimes the problem is fueled by anxiety around the dream itself. The more a person tries to “be sure to fall asleep now,” watches the time, or worries about the consequences of lack of sleep, the higher internal tension can become.

Difficulty falling asleep can also accompany anxiety and depression, chronic stress, pain, restless leg syndrome and some other conditions.

Possible reasons

Sleep may be affected by:

severe stress or emotional tension;

anxious thoughts and constant thinking about problems before going to bed;

irregular sleep patterns;

late afternoon nap;

use of caffeine, nicotine, alcohol or other substances;

bright light and activity just before bedtime;

chronic pain or physical discomfort;

discomfort and the need to move your legs;

some medications;

anxiety, depression and other mental conditions.

Sometimes several factors act simultaneously.

What to pay attention to

How long has it been difficult to fall asleep and how many nights a week does this happen?

How long does it usually take from the moment you lie down to sleep?

Does drowsiness occur by the time you go to bed?

Is there anxiety, internal tension or a flow of thoughts that is difficult to stop before going to bed?

Do you also wake up at night or too early in the morning.

Do you feel tired, sleepy, irritable, or have decreased concentration the next day?

Does bedtime and wake-up time vary on different days?

Is there napping during the day?

Do you consume coffee, energy drinks, alcohol, nicotine or other substances in the evening?

Did the problem begin after a new medication was prescribed or its dosage changed?

Is there pain, snoring, sleep apnea, or discomfort in the legs?

What can help

It's helpful to keep a relatively consistent wake-up time and go to bed when you really feel sleepy.

If sleep does not come for a long time, it is usually better to get up briefly, go to another quiet place and do an inactive activity in dim lighting, and return to bed when drowsiness returns.

You should avoid constantly checking the time and trying to force yourself to fall asleep. You should also limit your intake of caffeine and other stimulants in the afternoon.

For persistent difficulty falling asleep, one of the most studied non-pharmacological approaches is cognitive behavioural therapy for insomnia (CBT-I).

When to ask for help

Contact your doctor if your difficulty falling asleep lasts several weeks, occurs regularly, or results in severe daytime fatigue, drowsiness, irritability, or decreased performance.

Consultation is especially important if sleep problems are accompanied by severe anxiety, depressed mood, chronic pain, discomfort in the legs, severe snoring or sleep apnea.

If your need for sleep has suddenly decreased and you are experiencing unusually high energy, increased activity, faster speech or thinking, impulsivity, or noticeable changes in behaviour, you should be evaluated by a professional.