Why Am I Having Trouble Sleeping at Night?

13 Reasons why you're not sleeping

5 Different types of insomnia and the causes may differ according to the type of Insomnia.

Having repeated difficulty with sleep initiation, maintenance, or poor quality of sleep that occurs despite adequate time and opportunity for sleep, resulting in some form of daytime impairment is called insomnia.

Acute insomnia is the most common type of insomnia. It is also commonly called adjustment insomnia because it is usually caused by a change in environment or stressful events. There are thirteen common causes of acute insomnia.  

What are the causes of insomnia?

There are five types of insomnia, and the causes may differ according to the type of insomnia.

Acute insomnia:
Acute insomnia is the most common type of insomnia. It is short term and lasts for a few days up to a month. It’s the most common type of insomnia. It is also commonly called adjustment insomnia because it is usually caused by a change in environment or stressful events. Thirteen common causes of acute insomnia are as follows:

  • New environment and unfamiliarity
  • Excessive noise or light
  • Extremes of temperature
  • Uncomfortable bed or mattress
  • New job or school
  • Relocation to a new place
  • Jet lag
  • Work deadlines or examinations
  • Deaths of relatives or close friends
  • Difficulties in a relationship
  • Physical discomfort like pain 
  • Certain medications
  • Acute illness and allergies

Chronic insomnia:
Insomnia is usually a transient or short-term condition. In some cases, insomnia can become chronic or long term. It may occur due to other underlying medical conditions (comorbidities).
Common causes of chronic insomnia include:

Onset insomnia:

Onset insomnia is difficulty initiating sleep. The common causes are as follows:

Maintenance insomnia:
Maintenance insomnia is when the patient has difficulty staying asleep or waking up too early and difficulty going back to sleep. Some medical conditions that may cause maintenance insomnia are as follows:

Behavioral insomnia of childhood:
Behavioral insomnia of childhood (BIC) usually occurs due to negative associations with sleep such as needing to go to sleep by being rocked or nursed or watching TV while going to bed or a child’s refusal to go to bed.

What are the signs and symptoms of insomnia?

  • Difficulty falling asleep at night
  • Disturbed sleep
  • Waking up early
  • Irritability
  • Poor concentration, focus and memory problems
  • Problems in coordination
  • Frequent headache 
  • Gastrointestinal problems such as acid reflux
  • Excessive worrying
  • Depression and anxiety 
  • Daytime fatigue or sleepiness

What is the treatment of insomnia?

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

Cognitive-behavioral therapy:

  • Sleep hygiene education: It addresses behaviors that are incompatible with sleep such as caffeine or alcohol use, environmental noise, inappropriate room temperature, and watching TV in bed.
  • Cognitive therapy and relaxation therapy: It involves inculcating correct sleep beliefs, reducing stress and anxiety, relaxation exercises, and meditation. Acupressure and massage therapies can help in relaxation and reducing chronic pain.
  • Stimulus-control therapy: It works by associating the bed with only sleepiness and when it is time to sleep.
  • Sleep-restriction therapy: This is based on the fact that excessive time in bed can lead to insomnia. Hence, it is advised for adults to limit sleep time to around five to seven hours.

Medication to treat insomnia:
Sedative-hypnotic drugs, sedating antidepressants, antihistamines, and other drugs may be prescribed by a physician.

Devices: FDA-approved prescription devices can be used in patients with insomnia.

Diet and exercise:

  • Patients are advised the following:
  • To avoid caffeinated beverages in the late afternoon or evening
  • To avoid alcohol in the evening
  • To avoid large meals right before bedtime
  • To exercise in the late afternoon or early evening (six hours before bedtime) that can promote sleep


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