Why Can't I Stay Asleep?

Medically Reviewed by Sabrina Felson, MD on July 18, 2023
Written by Alyson Powell Key
7 min read

Waking up in the middle of the night can leave you feeling tired the next day. When it happens over and over again, it’s a sign of insomnia, a sleep disorder that makes it hard to fall or stay asleep. But insomnia may not be the only reason why you wake up at night.

Many health conditions have symptoms that can seem worse at night, such as:

  • Breathing trouble from asthma, bronchitis, or another lung disease.
  • Digestive problems, especially pain and cough from acid reflux or symptoms of irritable bowel syndrome.
  • Hormones. Women often wake up at night when hormone levels change around their periods or during menopause. Hot flashes and night sweats also disrupt sleep.
  • Brain and nerve diseases, including Alzheimer’s and Parkinson’s.
  • Peeing a lot, possibly because you drank a lot of fluids during the day or because of a health condition like diabetes, urinary tract infection, or enlarged prostate.
  • Medications to treat health conditions can also affect your sleep, including beta-blockers, antidepressants, ADHD drugs, decongestants, and breathing treatments that have steroids.
  • Pain, especially from arthritis, heart failure, sickle cell anemia, or cancer.
  • Addiction behaviors, their associated cravings, and the substances themselves interfere with sleep. Alcohol impairs sleep and increases early awakenings, and so do stimulants like amphetamines and cocaine.

Tell your doctor if pain is making it hard for you to stay asleep. They might need to change your medication. A poor night’s sleep can also make you more sensitive to pain.

To manage pain:

  • Take a warm bath, try deep breathing, or listen to music.
  • Put pillows under your legs, hips, and knees to ease pain there.
  • Use a heating pad to relax stiff joints, but avoid heat if you have a serious injury.

Sleep disorders are conditions that keep you from getting enough good-quality sleep. They include:

Insomnia. This common sleep disorder can cause you to wake up during the night or too early in the morning. Nearly everyone has insomnia at times. But if it lasts for a month or more or interferes with your daily life, it may be time to seek treatment. Your doctor may suggest lifestyle changes and will treat other medical conditions that affect your sleep. If this doesn’t work, talk to your doctor about:

  • Cognitive behavioral therapy for insomnia
  • Prescription medication
  • Over-the-counter sleep aids

Sleep apnea. If you snore loudly and often, you may have obstructive sleep apnea. Tissues in your mouth and throat close off your airway, which stops your breathing many times a night. Your brain wakes you enough that you can breathe again, and you may wake up completely. One of the most effective treatments is to sleep with a breathing machine that keeps your airway open. For mild sleep apnea, your doctor may suggest that you:

  • Lose weight
  • Stop smoking
  • Treat any nasal allergies

Restless legs syndrome (RLS). This causes unpleasant or uncomfortable feelings in your legs as well as an uncontrollable desire to move them.  It can be worse at night. Here are some tips to ease your RLS:

  • Get regular exercise.
  • Massage your legs or use vibration pads designed to relieve RLS symptoms.
  • Do knee bends.
  • Take a hot bath.
  • Rotate a heating pad and an ice pack, or use foot wraps designed for people with RLS.
  • Avoid caffeine, alcohol, and nicotine.

Periodic limb movement disorder (PLMD). Many people with RLS also have this condition. Your arms and legs jerk and wake you up. As with RLS, massages, hot baths, and exercise may help your symptoms.

Narcolepsy. People with this sleep disorder feel very sleepy at times during the day and may wake up often at night. Some people also have cataplexy, or sudden attacks of muscle weakness.   

Your doctor can prescribe medications to treat the symptoms of narcolepsy. Sometimes, lifestyle changes can help, too. They include:

  • Naps during the day
  • A consistent sleep schedule
  • Regular exercise

Stress is one of the main reasons people wake up in the night. It can keep you from getting deep and REM sleep. When you worry about getting back to sleep, this makes the problem even worse. Try these tips for a less stressed night:

  • Get rid of clocks in your bedroom or turn them around so you can’t see the time.
  • Try mindfulness, which allows your brain to let go of thoughts and focus on the present so you can relax.
  • Write down what's making you feel stressed. Come back to it in the morning.

Other mental health problems can also cause sleep problems, including:

If a mental health condition is keeping you awake, get help from your doctor or a mental health professional.

Your body has a natural cycle of sleepiness and alertness. Your hormones and daylight control it. When that gets thrown off, you have trouble sleeping. Causes include:

  • Age. Your body’s sleep rhythms change as you get older. You get tired earlier in the evening and wake up earlier in the morning. You also spend more time in lighter stages and less time in deep and REM stages.
  • Jet lag
  • Working nights or rotating shifts

There’s not much you can do about some of these issues. Focus on the things you can control, like your daytime and nighttime habits and any health conditions that need treatment.

Trips to the bathroom at night to pee (called nocturia) disrupt your sleep and can make it hard to get back to sleep. A urinary tract infection (UTI), enlarged prostate, diabetes, or simply drinking too much liquid can all cause your body to make too much urineor lower the amount your bladder can hold. See a doctor for serious health issues. You can also:

  • Drink less liquid before bed.
  • Avoid alcohol and caffeine in the afternoon and evening.
  • Raise your legs before bed to ease the buildup of fluid, which can cause nighttime bathroom trips.

What you eat and drink, how much, and when can impact your rest. Before you go to bed, avoid:

  • Large meals 2-3 hours before bedtime
  • Foods with a lot of fat or sugar
  • Alcohol
  • Caffeine

Researchers are still studying the link between food and sleep. But they’ve found some evidence that certain foodswith melatonin or tryptophan (an amino acid) can make you sleepy or promote better sleep:

  • Tomatoes
  • Olives
  • Rice
  • Walnuts
  • Some types of grapes
  • Kiwi
  • Tart cherry juice
  • Fatty fish
  • Milk

 

Some of the things you do every day can keep you from sleeping well at night.

  • Your sleep schedule. Changing when you go to bed and wake up makes it hard to keep your internal clock set. Try to go to sleep and get up at the same time every day.
  • Electronics. The light from your phone and computer can wake up your brain. Avoid screens in the hour before bedtime if possible.
  • Alcohol. A drink before bed may make you fall asleep quickly, but you’ll wake up in the night as it wears off. And it doesn’t let you get to the deep or REM sleep stages.
  • Caffeine. It’s a stimulant that can take 8 hours to wear off.
  • Smoking. Nicotine is another stimulant that can make you sleep less soundly. Many smokers wake up too early as their bodies start to crave a cigarette. Nicotine raises your heart rate and makes you more alert. It also raises your risks of sleep apnea and snoring.

 

Things around you like light, pets, or the temperature can make it hard to stay asleep as you move between sleep stages. Experts suggest that you make sure your room is as cool, dark, and quiet as possible. To create a better sleep setting:

  • Put dark shades on windows or wear an eye mask to block light.
  • Use earplugs, a fan, or a white noise machine to cover sounds.
  • Keep the temperature on the cool side, between 60 and 70 degrees.
  • Only use your bedroom for sleep and sex.
  • Turn off your TV, smartphone, and computer. The blue light from these devices delays the release of the hormone that helps you fall asleep (melatonin).

Try some of these sleep hygiene practices to help you get more rest:

  • Go outdoors for at least 15 minutes each day to set your internal clock.
  • Get regular exercise. But don't do it too close to bedtime, since that can keep you up. Work out at least 5 hours before bed.
  • Follow a relaxing bedtime routine. Take a warm bath, listen to soft music, or read a book.
  • Don’t just lie there awake. If you wake up and can’t get back to sleep after 15 or 20 minutes, get out of bed and do something calminguntil you feel drowsy again. Resist the urge to grab your phone while you try to get back to sleep.