Why can't I sleep? When broken sleep needs specialist help

Can't fall asleep? If you're suffering from chronic insomnia it can be difficult to know what the cause is. Discover the tell-tale signs.


Article: How do I know if I have a sleep disorder?

Sleep disturbances like chronic insomnia are incredibly frustrating, whether you find it hard to fall asleep, you're spending time lying awake or finding it impossible to stay asleep, sleep disorders can really affect your quality of life and mental health.


“If you’re routinely struggling with sleep, and basic rules just aren’t doing the trick, it’s definitely worth considering whether a sleep disorder is to blame. I’ll focus on three of the most common, but as a rule of thumb: if you think something is off, talk with your doctor. You are the expert on you.” 


If you're not sure why you can't sleep, below we walk you through some of the more common sleep disorders that may help you understand why you have trouble sleeping. 



Common signs: This is more than the occasional bad night’s sleep. It means regularly having difficulty falling asleep or staying asleep and waking up too early. 


How might you feel: Tired during the day, being late for things, more irritable, feeling anxious as the night draws in, heightened awareness of physical pain, mentally fatigued and depressed are all signs of chronic insomnia. 


How it’s diagnosed: Not sure whether you're dealing with short term insomnia or something more chronic? Use the 30/ 3/ 3 rule. Are you awake for 30 minutes or more at the beginning and/or during the night? Does it occur 3 or more nights per week? Has it gone on for at least 3 months? If you answered yes to all 3 questions, you might have chronic insomnia. 


What can be done? It is possible to treat insomnia with sleep medicine as well as non-medication treatments such as Cognitive Behaviour Therapy. 



Common signs: Snoring, choking or gasping and/ or pauses in breathing during sleep. 


How might you feel: Excessively sleepy during the day, irritable and needing to urinate frequently at night. You may also experience nighttime heartburn and waking with headaches. 


How’s it diagnosed: You don’t need to have all the symptoms, but if you have at least some snoring, pauses in breathing or excessive daytime sleepiness it needs to be investigated. 


What can be done? Sleep studies are commonly used to diagnose sleep apnea and there are lots of effective treatments such as a PAP (positive airway pressure) machine. 



Common signs: An irresistible urge to move the arms or legs - it doesn’t need to only be in the legs! 


How you might feel: Like you have pins and needles, creepy crawly sensations or itchiness. RLS gets worse at night and when sitting or laying in bed. The sensations are not typically present during the day. Trying to fall asleep can be challenging. 

How’s it diagnosed: It is more frequently seen in women and especially present during pregnancy and peri menopause. It is also thought to be genetic and certain medications can also cause RLS. 


What can be done? People with Restless Legs Syndrome typically have to get up, move and stretch to find relief, but there is a link between RLS and a lack of iron. As many women tend to be deficient because of the menstrual period, it is a useful thing to have checked when having RLS diagnosed. 


Task: Assess your sleep diary

By now, your sleep diary should be filled with lots of useful insights that can help you figure out whether you are getting enough sleep, how much sleep feels good to you or whether you have poor sleep habits. So what does it all mean and can it help you answer the question - why can't I sleep? 


1. Sleep quantity 

“There are two main pieces of information you need to consider when looking at your sleep diary,” says Dr Harris. “Firstly, how consolidated was your sleep. That means how long were you physically in your bed and how much of that time were you asleep. The aim is to be spending 85% or more of your time in bed asleep, at least 5 nights a week - this then allows for any nights where you don’t get as good a night’s sleep." 


2. Sleep quality 

"The next thing I want you to think about is the quality of your sleep. Were you content with the majority of your sleep in your diary? If you are, stick with what you’re doing because it’s working.” 


If you're suffering from chronic insomnia then it is likely that you’re not getting enough good quality sleep and this is where your data in the diary can help improve things. 


3. Sleep patterns 

 “Look for patterns in your diary that you may not have noticed otherwise. For example, on the day you had coffee at 4pm, did it take you longer to fall asleep? If so, make sure you finish your caffeine consumption earlier in the day. On the day you had a nap did you have to go to bed later? Another factor may be your wake times - if they have been inconsistent has that impacted on your night’s sleep?” Consistent sleep patterns and a consistent sleep schedule are important. 


4. Sleep aids 

And it’s not all about focusing on the negative, look at the sleep aids that helped you feel sleepy and enjoy quality sleep. If exercising slightly later in the day, instead of first thing, resulted in a better night’s sleep, make that part of your routine. If taking a warm bath a few hours before bed helped you go to sleep quicker, then definitely do that again. 


And the good news is that if the changes worked to promote sound sleep at night, you can stop writing your sleep data down, because a good night’s sleep will become instinctive and the norm. 


5. When to see a sleep doctor 

If the changes you make don’t impact on your sleep quality and quantity and you're still suffering from sleep deprivation, you may want to investigate further. It[s frustrating to constantly be asking yourself why can't I sleep? But, by keeping a sleep diary, it means that you are then you are armed with a lot of information that a sleep doctor would want to know and can hopefully help you identify the cause quicker so you can finally get a more consistent good night's sleep. 


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Shelby Harris

Shelby Harris

Dr. Shelby Harris is a Rituals Ambassador for Sleep, and a licensed clinical psychologist. With years of experience treating a wide variety of sleep disorders she uses evidence-based methods and non-pharmacological treatments to improve sleep for everyone from babies to adults. Dr. Harris currently holds a dual academic senior-level appointment as Clinical Associate Professor at the Albert Einstein College of Medicine in both the Neurology and Psychiatry Departments. and is board certified in Behavioral Sleep Medicine (BSM) by the American Academy of Sleep Medicine. She’s also the author of The Women’s Guide to Insomnia.