SymptomBrain & nerves
Sleep Disturbances: Why You Are Not Sleeping Well
Sleep disturbances are problems with the amount, timing or quality of sleep: trouble falling asleep, waking often or too early, unrefreshing sleep, or unusual events during sleep such as snoring, leg movements or acting out dreams. Most short-term problems come from stress, caffeine, alcohol, screens or irregular schedules. Persistent problems are often caused by insomnia, sleep apnea, restless legs, pain, reflux, depression or anxiety, all of which are treatable.
Also called: Sleep problems, disturbed sleep, poor sleep quality, sleep disruption
At a glance
- What it is
- Any persistent problem with getting enough good-quality sleep at the right time.
- Common types
- Insomnia, sleep apnea, restless legs, circadian rhythm problems, parasomnias.
- Common causes
- Stress, caffeine, alcohol, screens, shift work, pain, reflux, depression, medicines.
- How much sleep adults need
- At least 7 hours a night.
- Treatment
- Sleep habits, CBT for insomnia, CPAP for apnea, and treating the underlying cause.
When to get help
Call 911 or go to the ER
- Thoughts of suicide with sleep loss: call or text 988 (US) or call 911 or your local emergency number
- Falling asleep while driving, or a near-miss due to sleepiness: stop driving and seek urgent advice
See a doctor within a day or two
- Witnessed pauses in breathing, gasping or choking during sleep with heavy daytime sleepiness
- Acting out violent dreams, injuring yourself or a bed partner
- Severe sleeplessness for several nights with racing thoughts, high energy or unusual behavior
Book a routine appointment
- Trouble sleeping 3 or more nights a week for more than 3 months
- Loud snoring with morning headaches or high blood pressure
- An urge to move the legs in the evening that disturbs sleep
- Excessive daytime sleepiness despite enough time in bed
Usually safe to manage at home
- A few bad nights during stress, travel or illness that settle when the trigger passes
Types of sleep disturbances
| Type | What it looks like |
|---|---|
| Insomnia | Difficulty falling asleep, staying asleep or waking too early, with daytime effects |
| Sleep apnea | Loud snoring, pauses in breathing, gasping, unrefreshing sleep, daytime sleepiness |
| Restless legs syndrome | Uncomfortable urge to move the legs in the evening, relieved by movement |
| Circadian rhythm disorders | Sleep at the wrong times: delayed sleep in teens, shift work, jet lag |
| Narcolepsy | Overwhelming daytime sleepiness, sudden muscle weakness with emotion |
| Parasomnias | Sleepwalking, night terrors, nightmares, acting out dreams |
Common causes of disturbed sleep
Lifestyle and environment
- caffeine after early afternoon (its effect lasts 6 hours or more)
- alcohol, which helps you fall asleep but fragments sleep later in the night
- nicotine
- large or spicy meals late in the evening
- screens and bright light before bed, which delay melatonin release
- irregular sleep times, long naps, or lying in bed awake for hours
- a noisy, hot or light bedroom
Mental health
Stress, anxiety and depression are the most common causes of chronic insomnia. Early-morning waking is typical of depression. Racing thoughts at bedtime are typical of anxiety. PTSD causes nightmares and frequent waking.
Physical health
- Pain: arthritis, back pain, headaches.
- Reflux: heartburn and coughing when lying flat. See acid reflux.
- Needing to urinate at night: an enlarged prostate, overactive bladder, diabetes, heart failure.
- Breathing problems: asthma, COPD, nasal congestion.
- Hormonal changes: night sweats in menopause, overactive thyroid, pregnancy.
- Neurological conditions: Parkinson's disease and dementia.
Medicines and substances
Decongestants, steroids, some antidepressants, beta-blockers, diuretics taken late in the day, stimulants for ADHD, and withdrawal from sleeping pills or alcohol can all disturb sleep.
Sleep disturbances in children and older adults
- Children: bedtime resistance, night waking, nightmares, night terrors and snoring from large tonsils. Snoring with pauses in a child can cause daytime behavior problems.
- Teens: a natural shift to later sleep times, worsened by screens and early school starts.
- Older adults: lighter, more broken sleep and earlier waking are common, but persistent insomnia or daytime sleepiness is not a normal part of aging.
How sleep problems are diagnosed
A doctor asks about your sleep schedule, bedtime routine, caffeine and alcohol, snoring, leg symptoms, mood, medicines and daytime effects. A sleep diary kept for 1 to 2 weeks is very useful. A bed partner's observations help with snoring and breathing pauses.
Tests may include:
- Home sleep apnea test or an overnight sleep study (polysomnography).
- Blood tests for iron (low ferritin worsens restless legs) and thyroid function.
- Multiple sleep latency test for narcolepsy.
How to sleep better
Habits that help
- Keep the same wake-up time every day, including weekends.
- Get daylight in the morning and stay active during the day.
- Avoid caffeine after early afternoon and limit alcohol.
- Wind down for 30 to 60 minutes before bed without screens.
- Keep the bedroom cool, dark and quiet.
- If you are awake for more than about 20 minutes, get up and do something calm in dim light until sleepy.
- Limit naps to 20 to 30 minutes, before mid-afternoon.
Treatments
- Cognitive behavioral therapy for insomnia (CBT-I): the recommended first-line treatment for chronic insomnia. It works better long term than sleeping pills and is available in person, online and via apps.
- CPAP or oral appliances for obstructive sleep apnea, plus weight loss and sleeping on your side.
- Iron supplements when ferritin is low, and other medicines for restless legs.
- Light therapy and timed melatonin for circadian rhythm disorders.
- Treating the cause: reflux, pain, depression, anxiety or bladder problems.
- Sleeping pills: sometimes used short term. They carry risks of dependence, next-day drowsiness and falls, especially in older adults.
Frequently asked questions
What causes sleep disturbances?
Common causes are stress, anxiety, depression, caffeine, alcohol, screens, irregular schedules and shift work. Medical causes include sleep apnea, restless legs, chronic pain, reflux, frequent urination at night, menopause and some medicines.
Why do I keep waking up at night?
Frequent waking can come from alcohol, needing to urinate, pain, reflux, a hot or noisy room, stress, or sleep apnea. Waking very early and being unable to return to sleep is common in depression. A sleep diary can help pinpoint the cause.
How much sleep do adults need?
Most adults need at least 7 hours a night for good health. Regularly getting less is linked to poorer concentration, mood problems, weight gain, high blood pressure and a weakened immune system. Teens need 8 to 10 hours.
When should I see a doctor about sleep problems?
See a doctor if poor sleep happens at least 3 nights a week for more than 3 months, if you are very sleepy during the day, if someone notices you stop breathing or gasp in sleep, or if leg sensations keep you awake.
Is melatonin good for sleep disturbances?
Melatonin helps most with jet lag and circadian rhythm problems such as delayed sleep. It has a small effect on general insomnia. Supplement doses vary between brands. Talk to a doctor before giving it to children or using it long term.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Sleep Medicine: Healthy sleep habits
- National Heart, Lung, and Blood Institute: Sleep deprivation and deficiency
- CDC: About sleep
- NHS: Insomnia
- American College of Physicians: Management of chronic insomnia disorder in adults