6 REASONS YOU’RE NOT SLEEPING WELL

Sleep helps your body heal, strengthens your memory, and keeps your mood steady. Not sleeping well can leave you feeling tired, irritable, or sluggish. Poor sleep can also increase your risk of falls, memory problems, and other health issues.

There are many reasons you might not be sleeping well. Below, we cover 6 common causes of poor sleep, how to recognize them, what tests or treatments your doctor might recommend, and simple steps you can try at home tonight.

Read more: What makes you snore when you sleep

Signs and symptoms you’re not sleeping well

• It takes a long time to fall asleep, or you wake up several times.
• You wake up too early and cannot go back to sleep.
• You feel sleepy during the day, or fall asleep doing small tasks.
• You need naps to get through the day.
• You feel forgetful, moody, or have trouble with maintaining your balance.

6 common reasons, one by one

If you experience the below most days for a period of several weeks, it’s worth checking with a health provider since chronic poor sleep raises the chance of heart disease, diabetes, and depression.

1. Natural changes in sleep timing and depth

What happens: As people age, they tend to sleep lighter, and less. The body clock may shift so you feel sleepy earlier and wake earlier. You may also spend less time in deep sleep, so noise or small issues wake you more easily. These can make nights feel broken and leave you tired.

What to look for: You’re going to bed earlier, but still not sleeping for 7-9 hours. You wake at every small noise. You feel tired during the day.

Tests and checks: Your doctor will ask about sleep time and patterns. A sleep diary or actigraph (a watch-like device) can track sleep. If needed, a sleep clinic can study sleep stages.

How to handle it:

• Wake up at the same time every day, even on weekends.
• Get bright light in the morning from a window, or take a walk outside. This helps reset the body clock.
• Limit daytime naps to 20-30 minutes only.
• Follow calming bedtime routines: take a warm bath, listen to soft music, practice simple breathing exercises.

2. Medical conditions and pain that wake you up

What happens: Pain from arthritis, back problems, or conditions such as Restless Legs Syndrome, digestive issues, itching, lung disease, and bladder problems can break sleep.

Needing to get up to urinate at night (nocturia) is a very common cause of night wakings and daytime tiredness.

What to look for: Pain that gets worse at night, heartburn after meals, coughing or shortness of breath when lying down, or multiple bathroom trips at night.

Tests and checks: Your doctor may run blood tests, imaging, heart and lung exams, bladder tests, or refer you to a specialist. A bathroom diary where you note down the time you get up to pee, how long it takes, and how much urine is produced, can help figure out nocturia causes.

How to handle it:

• Avoid drinking liquids 2-3 hours before bed. Limit caffeine and alcohol in the evening.
• Use night lights and sturdy footwear to reduce the risk of falling when you get up.

3. Medicines and taking many drugs (polypharmacy)

What happens: Some prescription and over-the-counter medicines can cause insomnia or daytime sleepiness. Taking five or more medicines increases the chance of side effects that harm sleep. Medicines for blood pressure, mood, pain, lung disease, allergies, and even some cold pills can interfere with sleep.

What to look for: New or worse sleep problems after a medicine change. Daytime drowsiness, confusion, or falls.

Tests and checks: Bring a full list of all medicines, vitamins, and supplements you take to your visit. Your clinician can do a medication review and look for drugs that may be need to be changed, re-timed, or stopped.

How to handle it:

• Talk with your doctor about changing the dose or time of medicines that keep you awake.
• Avoid diphenhydramine (antihistamines) and similar over-the-counter sleep aids for long-term use; they can cause confusion and falls. Prescription “sleeping pills” may help short-term, but have risks.

4. Obstructive sleep apnea: breathing pauses at night

What happens: Airways getting partly or fully blocked while sleeping can make you snore loudly, choke, or gasp, which breaks sleep several times during the night.

Sleep apnea becomes more common with age and raises the risk of high blood pressure, heart disease, stroke, and daytime sleepiness. Yet despite how common it is, many people remain undiagnosed.

What to look for: Loud snoring, choking or gasping during sleep, waking up short of breath, morning headaches, or falling asleep during the day.

Tests and checks: A doctor may order a sleep study. This can be an at-home breathing test or a full overnight test in a sleep lab (polysomnography).

How to handle it:

• Continuous positive airway pressure (CPAP) is the most common and effective treatment. It uses a machine to deliver pressurized air through a mask, preventing the airway from collapsing during sleep.
• Losing weight, changing sleep position, dental devices, and in some cases surgery can help.

5. Restless Legs Syndrome and periodic limb movement

What happens: Restless Legs Syndrome is a neurological disorder that causes you to feel unpleasant sensations in your legs, and a strong urge to shake them, especially at night. Moving legs can bring short-term relief, but it may interrupt sleep or make it lighter. Low iron levels and certain medicines can trigger these issues.

What to look for: Creepy, crawling, or aching feelings in the legs at night and a strong urge to move them, or a bed partner noting repeated leg jerks.

Tests and checks: Your doctor may check blood iron stores and order a sleep study if movements are severe.

How to handle it:

• If your iron levels are low, iron supplements may help. Always ask your doctor before taking any supplements.

6. Stress, worry, and mood problems

What happens: Stress, anxiety, and depression may make it hard for you to fall asleep, or stay asleep. Worrying in bed makes the mind active instead of calm. Sleep loss can also make mood problems worse.

What to look for: Racing thoughts at bedtime, waking with worry, low mood, or trouble enjoying activities.

Tests and checks: Your clinician will ask about your thoughts and how you feel during daily life. They may screen for depression or anxiety and suggest therapy.

How to handle it:

• Cognitive behavioral therapy for insomnia, or CBT-I, is the proven first-line treatment for chronic insomnia. It teaches new habits and ways to handle sleep worry. Many clinics offer group, phone, or online CBT-I. Medicines can help short term, but CBT-I aims to fix the root causes.

At-home steps to help with many sleep problems

As well as medical treatments, try some simple sleep hygiene practices to sleep better.

• Wake up at the same time every day.
• Get plenty of morning light to reset your body clock.
• Avoid large meals, alcohol, and caffeine in the late afternoon and evening.
• Keep naps short, no more than 20-30 minutes.
• Make the bedroom quiet, dark, and cool.
• Use the bed only for sleep and sex, not for watching television or paying bills.
• Turn off phones, computers, and other gadgets. Ideally, put them in another room.

What tests do doctors use to check your sleep

• Sleep diary or actigraphy: You may be asked to keep a sleep log, or wear a sensor, often a watch-like device, that tracks your sleep patterns.
• Polysomnography (sleep study): This is a comprehensive, overnight test that measures brain waves, breathing, oxygen, and limb movement.
• Home sleep apnea test: A simpler breathing and oxygen test done at home, using a device that monitors air flow, oxygen levels, and heart rate.
• Blood tests: To check for anemia, thyroid problems, or other causes that may be the underlying reason for poor sleep.

When to see a doctor right away

Call your clinician immediately if you:

• Start gasping loudly or choke while asleep
• Fall asleep while driving
• Experience sudden confusion
• Extreme sleepiness in the daytime, that affects your ability to perform daily tasks
• New or sudden sleep loss after changing a medicine, changing dosages of current medications, or starting a new drug

Frequently Asked Questions about poor sleep

1. How much sleep do adults need?
   Most adults, including people aged 65 years and above, should aim for at least 7 hours a night.
2. Are sleeping pills safe for long-term use?
   Sleeping pills can help in the short term, but have risks like daytime drowsiness, falls, and confusion. Talk with your doctor before long-term use.
3. Could my medicine be causing my sleep trouble?
   It is possible. Many prescriptions and over-the-counter drugs can affect sleep. Bring a list of all medicines to your clinician for a review.
4. How is sleep apnea tested?
   Doctors may use a home breathing test or a full overnight sleep study (polysomnography) depending on your health and symptoms.
5. What if my sleep problem started with mood or worry?
   Treating anxiety or depression and doing CBT-I usually helps sleep. Ask your clinician about therapy options.