Why Can’t I Fall Asleep? 10 Common Reasons And What Actually Helps

Why Can’t I Fall Asleep?

Insomnia is the most common sleep complaint. The AASM says it occurs when you have trouble falling asleep or staying asleep even though you had the chance for a full night of sleep. Everyone has an occasional bad night, which does not mean you have insomnia. As many as 35 percent of adults complain of it (AASM Sleep Education).

It is more common in older adults, women, people under stress, and people with conditions such as depression. For the full picture, see our insomnia guide.

How Long Should It Take To Fall Asleep?

We found no Tier 1 source that gives a normal time. An AASM clinical guideline says no specific quantitative sleep measures define insomnia disorder (AASM insomnia guideline). What the AASM does offer is a self-check, shown below. One of its questions asks whether it takes you more than 30 minutes to fall asleep, or whether you wake and cannot get back to sleep.

The questions are a prompt, not a diagnosis. If you answered yes to all four, the AASM says you may have insomnia and suggests keeping a sleep diary for two weeks. Write down when you go to bed, when you wake and how long you were awake at night.

Common Reasons You Can’t Fall Asleep

The AASM says insomnia is most often tied to another problem that drives it. The table groups the causes it lists.

Reason	What the AASM Says
Stress	Work, loss, job change and relationship strain are common triggers
Other sleep disorders	People with restless legs syndrome may have a hard time falling asleep
Medical conditions	Pain, discomfort or limited mobility can make it hard to fall or stay asleep. Pregnancy, especially the third trimester, and menopause can cause sleep problems
Mental health	Depression is a frequent cause, and trouble falling asleep is common with anxiety disorders
Medicines and substances	Some prescription and over-the-counter medicines, caffeine and other stimulants, and alcohol close to bedtime can make it hard to fall asleep
Environment	Noise, light, temperature, or a bed partner who snores
Habits and schedule	Pushing bedtime too late, being a night owl, night shifts or a wide swing in bedtime

Tell your provider about all prescription and over-the-counter medicines you take, and about your caffeine and alcohol use. To see how long caffeine may stay active, try the caffeine impact on sleep calculator.

Stress And Racing Thoughts

Stress is a common cause of a poor night, the AASM says. An AASM guideline describes relaxation training, such as progressive muscle relaxation, guided imagery or abdominal breathing. It is designed to lower the body and mind arousal that interferes with sleep (AASM insomnia guideline).

The guideline also says the bed should be linked with sleep, not with worry. If your mind races, do not lie there trying to force sleep. The next section shows what the guideline recommends instead.

Is It Insomnia Or A Late Body Clock?

Some people cannot fall asleep at a normal bedtime because their body clock runs late. The AASM calls this delayed sleep-wake phase disorder. Sleep is delayed by two or more hours from societal norms, and once asleep, sleep is generally normal. About 7 to 16 percent of teens and young adults may have it, and it can look like insomnia (AASM delayed sleep-wake phase page).

Sign	Insomnia	Late Body Clock
Falling asleep at your desired bedtime	Hard	Hard
Sleep when you choose your own schedule	Still disturbed	Normal amount and quality, just later
Waking for work or school	May wake early or often	Very hard to get up
Daytime effects	Fatigue, mood and focus problems	Sleepiness and fatigue

If you fall asleep easily on weekends at a late hour and sleep well, a late body clock may be the cause. Talk to a doctor either way, and see our guide to waking at 3 AM if staying asleep is your main trouble.

Why Lying In Bed Awake Backfires

The guideline’s logic is simple. The more time you spend awake in bed, the more your brain may link the bed with being awake. That is why it advises using the bed only for sleep, leaving the bed when you are not sleeping, and returning only when sleepy. The aim is to rebuild the link between bed and sleep. The guideline also says to avoid clock-watching.

What To Do When You Can’t Fall Asleep

The AASM guideline’s stimulus control advice gives a clear plan. It was written for people with chronic insomnia, but the steps are simple and low risk:

1. Go to bed only when you feel sleepy, and keep a regular schedule.
2. Use the bed only for sleep.
3. If you cannot fall asleep within about 20 minutes, get out of bed. The guideline says to go by how long you feel you have been awake, not by watching the clock.
4. Do something relaxing, in low light and away from screens, until you feel drowsy.
5. Return to bed when sleepy, and repeat if needed.
6. Avoid naps, which can reduce sleep drive at night.

The AASM habits page agrees: if you do not fall asleep after 20 minutes, get out of bed and do a quiet activity without a lot of light, and avoid electronics (AASM healthy sleep habits).

Habits That Make Falling Asleep Easier

The AASM lists these quick tips. They help most as a set:

• Keep a consistent sleep schedule, with the same wake time every day, even on weekends.
• Set a bedtime early enough for at least 7 to 8 hours of sleep.
• Build a relaxing bedtime routine, and keep the bedroom quiet, relaxing and cool.
• Limit bright light in the evening, and turn off electronic devices at least 30 minutes before bed.
• Avoid large meals before bed. If you are hungry, have a light, healthy snack.
• Avoid caffeine in the afternoon or evening, and avoid alcohol before bedtime.
• Exercise regularly, eat a healthy diet and reduce fluids before bed.

For a tested example of how caffeine timing matters, read the 10-3-2-1-0 sleep rule.

Does Sleep Hygiene Alone Work?

For chronic insomnia, not by itself. The AASM guideline says there is insufficient evidence that sleep hygiene alone is effective for chronic insomnia, and it should be used together with other therapies. It lists cognitive behavioral therapy for insomnia (CBT-I) as a standard treatment. CBT-I combines cognitive therapy with behavioral treatments such as stimulus control and sleep restriction.

NHLBI says your provider may suggest CBT-I and a regular sleep schedule (NHLBI).

Learn the method in our CBT-I guide.

For a step-by-step plan, see how to cure insomnia.

When To See A Doctor

FAQs About Not Being Able To Fall Asleep

How Long Is Too Long To Fall Asleep?

No Tier 1 source sets a cut-off. The AASM self-check asks whether it takes more than 30 minutes, and whether this comes with daytime symptoms.

Can Caffeine Keep Me From Falling Asleep?

Yes. The AASM says caffeine and other stimulants can prevent you from falling or staying asleep, and advises avoiding caffeine in the afternoon or evening.

Should I Stay In Bed If I Can’t Sleep?

Not for long. Both the AASM guideline and its habits page say to get out of bed if you are not asleep after about 20 minutes, and return when sleepy.

Can Anxiety Make It Hard To Fall Asleep?

Yes. The AASM says trouble falling asleep is common in people with anxiety disorders, and that stress is a common cause of a poor night.

Can Napping Make It Harder To Fall Asleep?

It can. The AASM guideline advises avoiding naps as part of stimulus control, to help build sleep drive for the night.

Do I Need A Sleep Aid?

Talk to a provider first. The AASM notes some medicines can cause insomnia, so tell your provider about everything you take. CBT-I is a standard, non-drug treatment.

Sources

• AASM Sleep Education (insomnia)
• AASM Sleep Education (healthy sleep habits)
• NHLBI (insomnia)
• AASM clinical guideline for chronic insomnia (Schutte-Rodin 2008)
• AASM Sleep Education (delayed sleep-wake phase disorder)