What to Do When You Can’t Fall Asleep

Treatment for insomnia usually includes a combination of more than one treatment method and uses a multidisciplinary approach. Treatment options include the following:

Cognitive-behavioral therapy

• Sleep hygiene education: Addresses behavior or environmental factors that are incompatible with sleep, such as caffeine or alcohol intake, noise, comfortable room temperature and watching TV in bed.
• Cognitive therapy and relaxation therapy: Involves stress and anxiety reduction, relaxation exercises and meditation.
• Acupressure and massage therapies: Helps the body relax and reduces chronic pain.
• Stimulus-control therapy: Works by associating the bed with sleepiness and the practice of going to bed when it is time to sleep.
• Sleep-restriction therapy: Limits sleep time to around 5-7 hours, since excessive time in bed can lead to insomnia.

Medication

Medications prescribed for sleep disorders include:

• Sedative-hypnotic drugs
• Sedating antidepressants
• Antihistamines

Devices

FDA-approved prescription devices can be used to treat people with insomnia.

If you have trouble falling asleep even when you are tired, this is a sign that your circadian rhythm may be off. It more commonly affects young people or those with chronic insomnia and anxiety issues. 

Difficulty falling asleep can be short-term (acute) or long term (chronic):

Short-term causes

• Unfamiliarity with a new environment
• Excessive noise or light
• Extreme temperatures
• Uncomfortable bed or mattress
• New job or school
• Relocation to a new city
• Jet lag
• Work deadlines or exams
• Death of a relative or close friend
• Relationship difficulties
• Physical discomfort
• Certain medications
• Acute illnesses and allergies

Long-term causes

• Chronic medical conditions such as acid reflux disease, thyroid disease, diabetes, sleep apnea, neurological conditions such as Parkinson’s disease and chronic pain
• Psychological conditions such as depression, anxiety, bipolar disorder and stress
• Medications such as antihypertensives (blood pressure medication), respiratory medications, antihistamines, hormonal medication, seizure medication, antidepressants and chemotherapy
• Central nervous system (CNS) or brain stimulants such as nicotine or excessive caffeine
• Lifestyle factors such as frequent travel that causes jet lag, constantly rotating shift work, irregular naps and sleep timings
• Nasal block and sinus issues
• Age (insomnia becomes more common with age)
• Onset insomnia, which is difficulty initiating sleep (this type of insomnia may be short-term or chronic)
• Behavioral insomnia of childhood (BIC) often occurs because of poor sleep hygiene or nighttime routine. It can usually be managed with appropriate behavioral therapy. BIC has three subtypes.
  • BIC sleep-onset can usually be resolved with a few behavioral changes such as creating a healthy sleep routine or learning self-soothing or relaxation techniques. It occurs because of negative associations with sleep such as needing to go to sleep by being rocked or nursed or watching TV while going to bed.
  • BIC limit-setting occurs when a child refuses to get in bed or stay in bed.
  • BIC combined type is combination of both BIC subtypes.