Insomnia is when people take more than 30 minutes to fall asleep after going to bed for a long period of time. The next day they lack sleep. Frequent consequences are tiredness, irritability, listlessness and poor performance.
Many problems falling asleep are due to stress, worry, tension or other psychological problems. But illnesses, medication and other circumstances such as noise can also disturb falling asleep. Difficulties falling asleep and staying asleep, in which those affected wake up at night and then lie awake for a long time, are the most common sleep disorders.
Treatment depends on whether a cause can be found or not. Those affected often have to improve their sleep hygiene, i.e. discard unfavorable habits. Sometimes behavioral therapy is needed to calm them down. Medications can also be helpful.
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Difficulty Falling Asleep (Insomnia) Causes And Risk Factors
Doctors don't always find a cause for problems falling asleep. On the other hand, there are a number of different causes to consider.
Unfavorable behaviors, habits and living conditions:
- Caffeinated drinks (e.g. coffee, cola) in the late afternoon, evening or before bed can make it difficult to fall asleep. If you consume large amounts of it during the day, withdrawal symptoms can disturb your sleep at night.
- Rich food can be heavy on the stomach, an empty stomach can also be disturbing.
- Irregular bedtimes can make it difficult to fall asleep.
- Too much rest and sleep, such as long naps during the day or lying down for a long time after waking up in the morning, can lead to a lack of tiredness in the evening to fall asleep.
- Lack of exercise leads to an underutilized body, exercise before going to bed is also a hindrance. Regular endurance sports during the day are best.
Unfavorable sleeping environment:
- Mattresses that are too hard or too soft
- Pillows that are too high or that slip easily
- External sources of interference such as lots of light or noise, e.g. from snoring partners or traffic
- Stale, stuffy air
- Room temperature too high or too low
- Duvets that are too warm or too thin
Psyche:
- Excitement, stress, tension before stressful events (e.g. exams, travel, public appearances, operations) and in emotionally stressful situations (e.g. conflicts at work or privately, bereavement, financial difficulties, unemployment)
- Pondering about problems or upcoming decisions, not being able to switch off because the workplace is in the bedroom, for example, or because the sleep disorders themselves are very preoccupying
- Mental illnesses such as depression, anxiety disorders, schizophrenia
Many medical conditions can disrupt sleep. If you have chronic problems falling asleep, the doctor should know about all diseases, especially those that
- lead to severe, noticeable symptoms (stomach disorders, e.g. burning in the stomach, headaches such as migraine, diseases of the joints and/or muscles such as e.g. rheumatism and cramps, skin diseases with severe itching such as e.g. neurodermatitis).
- trigger nervous disorders such as some neurological diseases (e.g. Parkinson's disease, dementia, multiple sclerosis, restless legs syndrome, narcolepsy).
- associated with hormonal disorders (e.g. hyperthyroidism).
Special life phases and circumstances:
- Pregnancy and menopause are associated with hormonal fluctuations that can disrupt sleep.
- Shift work forces unfavorable rhythm changes in the daily routine.
- Long-distance travel often leads to jet lag with difficulty sleeping.
- Unfamiliar sleeping places when traveling can trigger sleep problems.
If you have trouble falling asleep, it always makes sense to go through the medication you are currently taking with your doctor or pharmacist. Because numerous drugs are able to prevent falling asleep or staying asleep, such as the following:
- Some medicines for high blood pressure (e.g. beta-blockers, calcium antagonists)
- Statins (against high blood fats)
- Some hormonal drugs
- Appetite suppressant
- Medicines for asthma
- Antibiotics
- Some painkillers
- Migraine tablets
- Drugs used to treat Parkinson's disease
- Some psychotropic drugs
- Sleeping pills can lead to difficulty falling asleep if you take them continuously or after stopping them
Risk factors
There are many risk factors that can promote insomnia. Of course, this includes the above-mentioned causes – i.e. unfavorable habits, many illnesses, the use of certain medications, street noise at the place of residence and so on. Shift work has a particularly heavy impact: every second shift worker complains of sleep disorders. Disorders also increase with age. Around four out of ten people over the age of 65 say they suffer from sleep disorders.
Difficulty Falling Asleep (Insomnia) Symptoms
Do you go to bed tired but still don't fall asleep for a long time?
Do you lack strength and drive the next day, so that you cannot perform as usual?
Perhaps your poor sleep worries you, making you ponder it before you fall asleep and sometimes throughout the day?
These are typical signs of a sleep disorder. It often brings with it several ailments, such as these:
- Lying awake for long periods of time before falling asleep (more than 30 minutes)
- Feeling like you're not getting enough rest from sleeping
- Rumination, anger, worry, or anxiety about difficulty falling asleep at night when lying awake and sometimes during the day
- Long wake-up phase until you feel really awake after getting up
- During the day, weakness, listlessness, lack of drive, tension, bad mood, irritability and difficulties in performing as usual, concentrating and remembering things
Combined sleep disturbances
Difficulty falling asleep can occur together with other sleep disorders such as difficulty staying asleep, sleepwalking, pauses in breathing (sleep apnea syndrome) or movements of the legs (restless legs syndrome). The combinations lead to other symptoms. These often include the following:
- Waking up one or more times during the night with difficulty going back to sleep afterwards
- Waking up too early, long before the scheduled time
- Severe daytime tiredness, sometimes despite feeling good sleep, and possibly unintentionally falling asleep during the day, for example while reading or watching TV, sometimes even microsleep
- Headache after getting up with no apparent cause
Symptoms such as nocturnal breathing pauses (sleep apnea), loud snoring, leg movements, teeth grinding, speaking and twitching are also reported.
A selection of different forms and further details can be found in the clinical picture “sleep disorders”.
When is sleep seriously disturbed?
If you have a hard time falling asleep a few times in a row, you shouldn't worry. Many people occasionally have trouble falling asleep. Those affected then usually know the cause: an upcoming exam, an upcoming trip, unfamiliar places to sleep, a job interview, a public appearance, problems at work or similar. If relaxation is not enough or not successful, a sleeping pill can be helpful in such cases. Because these stressful situations pass, and the difficulty falling asleep usually subsides.
Sometimes unfavorable behavior in the evening is also responsible, such as a sumptuous dinner, coffee consumption or exciting experiences. If such circumstances are avoided, almost all those affected fall asleep more quickly again.
At first you should try to stay relaxed and find out the origin of the disorder. Fears and worries about not getting enough sleep can make it harder to fall asleep. In addition, the quality of sleep does not depend solely on the duration of sleep. First and foremost, it is important how people judge their own sleep. If you feel good, you don't have to sleep a certain number of hours. It is then also unnecessary to adhere to certain sleeping times. Sleep needs, sleep duration and sleeping habits vary greatly from person to person.
When to the doctor?
A professional clarification is recommended at the latest when those affected have difficulty falling asleep three or more times a week over a period of more than four weeks - and their well-being and performance suffer greatly. Then sleep disorders are considered pathological. Treatment is particularly necessary when the sleep disturbance severely impairs the quality of sleep.
Especially in the case of very poor sleep quality and/or a completely unclear cause, it is often better to seek advice earlier. Difficulty falling asleep can lead to those affected changing their behavior in order to fall asleep better again. As a result, they can develop bad habits that increase their sleep problem and make it more difficult to treat.