Having trouble sleeping: What to know

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Numerous factors can contribute to sleeping difficulty. A person’s lifestyle, sleeping habits, and health status may all play a role.

Age is also a factor in the amount of sleep a person needs and the quality of sleep they tend to get. The sections below discuss the factors that may lead to sleep loss or sleep difficulty in different age groups.

Adults

Adults require at least 7 hours of sleep per night. However, many adults have difficulty falling asleep or staying asleep through the night. In fact, up to 50% of older adults report sleeping difficulties.

As one 2018 review suggests, middle-aged and older adults spend less time in slow-wave and rapid eye movement (REM) sleep. Slow-wave sleep is important for regeneration, while REM sleep may be important for learning and memory. Spending less time in these stages results in less efficient sleep. This may explain why older adults are more likely to experience sleeping difficulty.

A range of lifestyle factors and underlying medical conditions can also contribute to sleeping difficulty in adults.

For example, some lifestyle factors that can cause sleeping difficulty include:

• overstimulation before bedtime, which could be due to exercising, using electronic devices, or using stimulants such as nicotine or caffeine
• eating a large meal or snacking late at night
• not being physically active during the day
• experiencing psychological stress
• having exposure to noise disturbances or light

Some medical conditions that can interfere with sleep include:

• sleep apnea
• chronic pain
• low back pain
• headaches and migraine
• allergies or upper respiratory infections
• gastrointestinal problems, such as acid reflux, nausea, or vomiting
• mental health conditions such as anxiety, depression, and chronic stress
• neurodegenerative conditions, such as Parkinson’s disease and Alzheimer’s disease

Children

The amount of sleep a child needs depends on their age. The Centers for Disease Control and Prevention (CDC) provide the following sleep recommendations for children of different age groups:

In 2015, the CDC conducted a survey of sleep duration in children and teenagers. They found that 57.8% of middle school students and 72.7% of high school students did not meet the CDC’s sleep recommendations on school nights.

The CDC also say that children and teenagers who experience a lack of sleep are at increased risk of:

• chronic health conditions, such as obesity and diabetes
• mental health conditions
• injuries
• focus and attention problems
• behavioral problems
• poor academic performance

The following factors can all increase the risk of sleeping difficulty in children:

• having irregular sleep patterns
• using personal electronic devices before bedtime
• not being physically active during the day
• consuming too much caffeine or sugar close to bedtime
• experiencing breathing problems, such as sleep apnea or upper airway resistance syndrome
• having a fever, headache, or other illness

Pregnant women

Some women might experience sleeping difficulties or develop sleep disorders while pregnant.

Changes in sleeping habits during pregnancy may occur as a result of hormonal changes. Levels of the hormones progesterone and estrogen increase during pregnancy. Progesterone blocks receptors in the brain that stimulate sleep, while higher estrogen levels reduce REM sleep.

Sleeping difficulty tends to peak around the second and third trimesters. Causes of sleeping difficulty during the end of a pregnancy include:

• back or leg pain
• a frequent need to urinate
• heartburn or indigestion
• nausea or vomiting
• snoring or nasal congestion

Sleep disorders are conditions that affect a person’s quality or duration of sleep. If a person does not seek treatment, sleep disorders can lead to the following health complications:

• memory problems
• difficulty concentrating
• a weakened immune system
• increased blood pressure
• increased risk of heart disease
• lower sex drive
• changes in appetite
• unexpected weight gain
• loss of balance and coordination

The sections below provide more detail on a number of different sleep conditions.

Insomnia

People with insomnia may have trouble falling asleep, staying asleep, or a combination of the two. Acute insomnia can last for a few days or weeks, while chronic insomnia can last for several months.

The exact cause of insomnia varies from person to person. Possible causes may include:

• certain medications
• chronic pain conditions
• headaches and migraine
• hormonal imbalances due to hypothyroidism
• gastrointestinal problems
• stress or emotional disturbances
• major life changes

Most cases of chronic insomnia develop due to medications or an underlying health condition. Treating the underlying condition or switching medications may help relieve insomnia.

Sleep apnea

Sleep apnea is a condition wherein the upper airways become blocked and impede a person’s breathing while they sleep. People with sleep apnea may wake up multiple times in the night due to snoring or a lack of oxygen.

Some symptoms of sleep apnea include:

• loud snoring
• gasping for breath while asleep
• weak or completely absent respiration

A healthcare professional might recommend making lifestyle changes that will help reduce the severity of sleep apnea symptoms. These changes may include:

• limiting alcohol intake
• being physically active
• losing weight
• eating a low fat, low sodium diet

People with sleep apnea may also need to use a continuous positive airway pressure (CPAP) device while they sleep. A CPAP device is a machine that works to keep the airways open.

Restless legs syndrome

Restless legs syndrome (RLS) occurs because tingling or aching sensations in the legs create an irresistible urge to move them. The symptoms of RLS tend to start late in the day and peak at night.

Some possible causes of RLS include:

• genetics
• iron deficiency
• alcohol, caffeine, or nicotine use
• certain cold medications
• selective serotonin reuptake inhibitors, which are a type of antidepressant
• nerve damage
• kidney disease

There is currently no cure for RLS. However, a healthcare professional may prescribe medications to help a person manage their symptoms and improve the quality of their sleep. They may also recommend trying the following:

• getting a massage
• trying foot and leg wraps
• stretching
• exercising
• taking vitamin supplements

Delayed sleep phase disorder

Delayed sleep phase disorder disrupts the body’s natural sleep/wake cycle. People with this condition have a delayed reaction to darkness, which means that they may not fall asleep until very late at night.

Delayed sleep onset can completely shift a person’s sleep/wake cycle. As a result, people may have difficulty waking up in the morning, or they may experience daytime fatigue.

Lack of sleep can negatively impact a person’s mental and physical health. Some people may experience occasional sleeping problems that resolve on their own. Others may have an undiagnosed or untreated medical condition that is interfering with their sleep.

A person should see a healthcare professional if their sleeping difficulty persists, or if it affects how they feel or function throughout the day.

People who have difficulty sleeping may benefit from making certain lifestyle changes and using sleep aids. The sections below list some of these potential treatment options.

Lifestyle changes

Making the following lifestyle changes may help improve a person’s quality of sleep:

• going to bed and waking up at the same time every day, including weekends
• avoiding caffeine, alcohol, and nicotine before bedtime
• not eating right before going to sleep
• spending some time doing a relaxing bedtime activity, such as reading or taking a bath
• minimizing daytime napping as much as possible
• falling asleep in a dark, quiet, and cool room
• exercising during the day

Sleep aids

Some over-the-counter (OTC) sleep aids, such as melatonin, can help promote earlier sleep onset. Prescription sleep aids may be necessary for people who do not respond to OTC products or those with a sleep disorder.

However, some OTC and prescription sleep aids can cause side effects. These may include:

• daytime fatigue
• excessive thirst
• coordination issues

The following are some general tips for improving sleep quality:

• increasing exposure to sunlight or other sources of bright light during the daytime
• reducing exposure to electronic devices before bedtime, such as by removing televisions, tablets, and computers from the bedroom
• not exercising before bed
• replacing old mattresses and pillows
• minimizing stress
• creating a relaxing bedtime routine
• sleeping in a dark, cool room
• tracking sleep habits in a notebook or sleep tracking app

Sleeping difficulty occurs when a person has trouble falling asleep, staying asleep, or a combination of the two.

Sleeping difficulty can result from lifestyle factors such as age, lack of exercise, and stress. Improved sleep hygiene may help resolve lifestyle-related sleeping problems.

People who suspect that they have a sleep disorder should see a healthcare professional. They may be able to provide prescription medications or recommend other therapies.