Tired but can’t sleep? Common causes for sleeplessness
Struggling to understand why you’re tired but can’t sleep? Various factors can contribute to difficulty sleeping, and while everyone’s experience is unique, there are some common causes. Below are some of the main reasons for bad sleep. Reading this may help you to better understand your sleep issues and find a way forward.
Please note that this article is about a general difficulty sleeping and is not about some specific sleep problems that require medical attention. These include sleep apnoea, parasomnias (e.g. sleep terrors & sleep walking), restless legs syndrome, narcolepsy, REM sleep behaviour disorder, specific mental health conditions and neurodegenerative disorders.
Bad sleep doesn’t always mean ‘insomnia’
Firstly, if you’re only having trouble sleeping occasionally, it’s not a cause for concern. Most people sleep badly now and again, sometimes for no obvious reason, but especially when life gets stressful and challenging. This is normal and doesn’t necessarily mean insomnia is the issue. Even the best sleepers have bad nights when under stress.
Since you’re reading this article, I suspect you’re currently somewhat bothered by your sleep, or lack of it. Bear in mind that ‘Insomnia’ is a descriptive term and not a definitive diagnosis. It is not a disorder anyone is stuck with, however bad it might feel or despite how long someone has been experiencing it. So try not to get too bogged down deciphering whether or not you are an ‘insomniac’ by definition or not. If you’re unhappy with your sleep, then that’s what’s important, you not being happy about it. As is usually the case, labels are often unhelpful and don’t tell the full story.
How do you know if you’re suffering from insomnia?
Some people wrongly assume that insomnia means that someone never sleeps, but this is incorrect. No one suffering with insomnia never sleeps, someone will always sleep eventually. Our biological sleep drive just gets too big to stop anyone from sleeping after being awake for long enough. Secondly most people chronically suffering from insomnia do actually sleep each night. They might not get much sleep, but it’s rare to go through a whole night without any sleep whatsoever.
The exact symptoms of insomnia can vary, but they typically include regularly experiencing one or more of the following over an extended period of time (i.e., not just occasionally and over a few months):
Getting less than six hours of sleep most nights.
Feeling sleepy and or especially tired during the day.
Struggling to fall asleep when going to bed.
Waking up too early and not being able to get back to sleep.
Waking up often during the night and struggling to fall asleep again.
Feeling anxious, worried and stressed about sleep.
Insomnia isn’t always the same for everyone and one way it’s categorised is by how long someone’s been suffering from it, either being acutely or chronically:
Acute Insomnia:
This is short-term insomnia that lasts from a few days to a few weeks. It’s usually caused by something stressful happening in life, such as exams, break ups, work stress, health scares, pregnancy or grieving. It can also be caused by jet lag, shift work, some medications and being ill. This type of insomnia often goes away on its own when the difficult period passes over. Experiencing some degree of acute insomnia is common for most adults at certain points in their lives.
Chronic Insomnia:
This is a more long-term problem and is when routinely sleeping badly has consistently lasted for more than three months. It might be because of underlying health problems (mental or physical), lifestyle factors and chronically high stress levels. Often though, chronic insomnia is a sleep-anxiety related issue, whereby anxiety, worry and stress about getting enough sleep consistently disrupt it. This often leads to other problematic behaviours and habitual patterns of thinking that further disrupt sleep.
At the surface level the main distinction between acute and chronic insomnia is time, i.e. how long has someone been sleeping badly for. However, another key difference between the two is someone’s perception of the problem and how much they see sleep as being a problem negatively affecting their life.
Someone suffering with ‘chronic insomnia’ is usually fully aware they’ve got an issue with sleep, and for them sleep becomes a problem in and of itself. Their thoughts and feelings around sleep lead to constant hyperarousal (feeling alert), anxiety and worry at night, routinely making sleep difficult. Not getting enough sleep often becomes a source of fear for these individuals. They regularly fear they won’t sleep and how this will affect them.
Whereas someone with ‘acute insomnia’ likely sees their difficulty sleeping as a temporary symptom and not their main issue. They put their difficulty sleeping down to a particularly stressful or challenging thing that has emerged in their lives. Consequently they’ll likely think that when this stressor in their life resolves itself, so will the sleep problem, as is often the case.
The good news is: sleep problems can always get better. You don’t have to suffer and can get help with the problem. Sleep is important, and you deserve to rest well. Acceptance & Commitment Therapy for insomnia might be what helps you.
Insomnia as a Primary or Secondary symptom
Why insomnia happens can sometimes be obvious, such as due to a specific life event, but it can often be hard to clarify its precise causes. Broadly speaking there are two main causes of insomnia, being either primary or secondary insomnia, which are explained below:
Primary Insomnia
This is when you can’t sleep, and there’s no obvious reason for it. There’s no underlying medical condition affecting your sleep or other obvious other life factors or events.
It’s usually got a psychological part, whereby racing thoughts keep you awake. These negative thought patterns also tend to lead to other problematic behaviours. It’s also got a physiological part, in which you experience uncomfortable feelings such as anxiety, stress, worry and hyperarousal at night, which keeps you awake too.
People often worry about not sleeping and what this lack of sleep might do to them. This then makes them more stressed and anxious, pushing sleep further away. Hence insomnia can quickly become a vicious cycle. Often it’s this worry and anxiety around sleep that affects insomniacs’ well-being the most, even more than the missed sleep itself.
It can be likened to feeling as though there’s a radio in your head that’s constantly spouting anxious, worrisome gloomy thoughts about sleep. These thoughts typically bring difficult feelings with them and can seem to go on and on, happening during the day as well as at night.
When people experience this sort of insomnia it can have a devastating effect on their quality of life. Unfortunately it’s something people often put up with for a long time and may not actively seek help for either. The reason typically being that they’ve given up hope anything can truly solve their issue with sleep.
Secondary Insomnia
This happens as a result of another health problem disrupting your sleep, causing you to not get enough of it. It might be a sleep disorder like restless legs syndrome, shift work disorder or sleep apnoea, or undergoing intensive medical treatment, such as for cancer, or suffering from chronic pain conditions. Even some medications can negatively affect sleep and cause this form of insomnia. Substance abuse of alcohol and drugs can be another cause.
If you have insomnia because of these issues, medical treatment for the underlying problem typically resolves the insomnia. However, insomnia can also need individual treatment, as it can sometimes be improved despite the other health problem not yet being fully resolved, and occasionally the insomnia symptoms persist even after the original health issue has dissipated.
Insomnia and Mental Health
Insomnia can play a massive part in mental health conditions, such as in depression and anxiety based ones. However insomnia and mental health is a complex relationship. Suffering from long term insomnia can be a cause of mental health problems and equally initial mental health problems can also cause both short and long term insomnia. Think of it like the ‘chicken and egg’ puzzle – It’s not often clear whether the sleep problem or mental health problem happened first for some individuals.
The relationship between stress and insomnia
Stress is something we all feel, and it seems like 21st century life today has only made our stress levels much worse. High stress levels certainly don’t help sleep and can be a contributing factor towards both triggering and maintaining difficulty sleeping. When we’re more stressed we’re more alert, tense and constantly problem solving in our heads, making sleep more difficult. We may even be more anxious and worried as a result of being highly stressed, which further disrupts sleep.
But it’s not that black and white. You don’t have to completely get rid of stress to sleep well at night. You can still sleep okay despite being stressed in life.
I am sure you know or can think of someone who is living an intensely stressful life, but still manages to sleep fine. That’s not to make you jealous, but to show you that it’s possible to have stress in your life and still get an okay night’s sleep.
If you’re doubting this, try to remember a time when you yourself were previously experiencing a lot of stress but still slept fine. Most people suffering with insomnia can name plenty of occasions when they’ve previously slept okay, despite being under stress. Even if you can’t recall such a moment, don’t worry, the key takeaway is you can always learn to sleep better, even with stress in your life.
Sleeping well despite experiencing stress in life is where ACT comes in. ACT doesn’t aim to eliminate your stress but instead helps you sleep well even when you’re stressed. Many things that are important to us in life can be stressful. That’s why it’s crucial to learn how to sleep well despite stress, empowering us to face challenges rather than shy away from them.
ACT doesn’t focus on changing your life to reduce stress, especially if that stress comes from something you value like being a new parent, working hard on a project you care about, or managing an important relationship. Instead it helps you to sleep in whatever situation you find yourself in.
It’s normal for your sleep to be a bit off during particularly tough times, and that’s okay. This doesn’t mean, though, that sleep has to be really bad or become a problem in your life. Challenging times will happen in life and knowing how to react in these moments towards ourselves and our sleep can make all the difference.
In the long run, you might decide to make some changes in your life to reduce your stress levels, and that’s great. Though sometimes we don’t have much control over what stresses us, and that’s where ACT can really help.
Lifestyle factors and insomnia
Insomnia can be influenced by several lifestyle factors, so it’s worth assessing if any of these apply to you. We hear lots about the importance of keeping good habits in order to sleep better, but bear in mind that lots of this advice is exaggerated. Let’s break down some common lifestyle factors that might be keeping you up at night, and some things you might not need to worry about.
Caffeine
If you’re drinking energy drinks or loads of coffee or tea late in the day, it might be keeping you awake somewhat. But here’s the twist: if you’re only having a few cups, it probably isn’t the caffeine that’s the problem. Think of all those people you know who drink way too much caffeine and still sleep. So, if you enjoy your coffee, keep drinking it, just keep an eye on how much you have and when. Ideally stick to just a few cups earlier in the day.
Exercise and sunlight
Sitting inside all day living a sedentary life isn’t great for sleep and getting some exercise and sunlight can help. But don’t stress about these. You don’t need to exercise everyday or be outside all day getting lots of sunlight to sleep well. In fact, worrying too much about exercising and getting the right amount of sunlight for your sleep will likely make things worse.
Alcohol
Drinking a lot, especially right before bed, can be very detrimental to sleep. Some people might think a little alcohol will help them fall asleep, but it’s a terrible sleep aid for lots of reasons. People chronically suffering from insomnia can sometimes turn to alcohol for relief to help them sleep, which can create its own problems.
But at the same time don’t worry about an occasional few social drinks. If this is something you enjoy and is important to you in life, then do what you value.
Late nights
Consistently going to bed too late can deprive you of sleep and disrupt your body clock. However, it’s okay to have fun, enjoy life and stay up late every now and again. A late night out with friends and family isn’t going to ruin your sleep. Equally if you’re working late on something you value, that’s important too.
It’s good to prioritise sleep some nights of the week, but we don’t always have to go to bed on time. Life is about much more than getting a great night’s sleep. Sleep shouldn’t be controlling your life, you should be making the most of it.
Shift work
If you work night shifts or irregular hours, it’s likely to disrupt your sleep patterns, making sleep temporarily challenging. But if you’re following this kind of schedule, it’s still possible to mitigate the disruption to your sleep. Secondly, the importance of shift work in some sectors might justify some temporary disruption to your sleep.
Snoring partners
Sleeping next to a snorer or loud breather can be really difficult. Most people try one of four things to deal with this: they try ear plugs; they put up with it; they try to mentally block it out; or they sleep in another room. Unfortunately none of these options are that great or sustainable.
So what do you do? The answer may lie in your reaction to the problem. Many people sleep soundly next to a snoring partner without getting bothered by it. ACT can be really useful at helping people get less bothered and wound up by their partners snoring.
The Three Ps of insomnia
If you’re routinely having trouble with sleep and find yourself worrying about what’s causing the issue, the Three Ps of insomnia model can be a helpful way to understand it better.
Often we get stuck wondering why we can’t sleep. Some fear serious medical reasons, like a hidden brain tumour, but this is usually just our mind fear mongering. Most of the time, there’s nothing physically wrong with someone suffering from insomnia. Usually it’s just a combination of bad habits, worry, stress and getting anxious about sleep that keep the problem happening.
Before examining the model, it’s important to note that the Three Ps is just that—a model. Like most models, it can be useful, but it doesn’t apply to everyone. The Three Ps stand for Predisposing Factors, Precipitating Factors, and Perpetuating Factors. In the model, the factors that apply to an individual typically occur in that order, leading to the development of chronic insomnia.
Predisposing Factors
These are factors that might make someone more prone to initially developing sleep problems in life. Examples of these include having a family history of insomnia, experiencing chronic stress, suffering adverse childhood experiences, being old, or living in poverty. However, just because some of these factors may apply to someone, it doesn’t mean that poor sleep is inevitable. Likewise, none of these factors need to apply to you for bad sleep to occur.
Precipitating Factors
These are specific events or changes that happen to you in life and cause initial disruption to your sleep for a few days or weeks. It may be undergoing a traumatic event, suffering from an illness, money worries, stress at work, undergoing pregnancy, or having a newborn etc.
Many people can identify a specific reason when their sleep troubles first began. However, these factors don’t always lead to long-term sleep problems and can often resolve on their own.
Perpetuating Factors
This is when short-term sleep troubles turn into longer-term issues. This often occurs due to specific behaviours, habits, and thought patterns that creep in, causing poor sleep to persist even after the precipitating factors have subsided. A person might start doubting their natural ability to sleep, become anxious about sleep, obsess over getting enough rest, rely too heavily on sleeping pills, or consume too much coffee or alcohol—all of which can exacerbate insomnia symptoms.
Understanding your expectations of sleep
It’s helpful to be aware that sometimes people think they’re suffering from insomnia, when in actual fact they aren’t. They may have high expectations for their sleep, which causes problems when their sleep doesn’t match up to them. Therefore knowing a little bit more about what you should realistically expect from your own sleep could take away some stress and worry. The following are some common things to be aware of:
Sleep changes as we age
As people get older, they may find their sleep patterns changing. This doesn’t mean their sleep is getting worse; it’s just different. Seniors might wake up more often during the night, need the bathroom more and find it harder to sleep in late. They may also need slightly less sleep than younger adults. So, if you’re seventy expecting to sleep like you did at thirty, you’ll likely end up feeling frustrated.
Teenagers often naturally go to bed later and wake up later than most adults. They find it harder to fall asleep earlier in the evening, when other adults go to sleep, and can’t get up as easily early in the morning. This is because their internal body clocks (circadian rhythms) are inherently shifted to be later than older adults and they also need more sleep per night. These sleep pattern differences are typical for their age.
Not everyone needs the same amount of sleep
You’ve probably heard that eight hours is the magic number, but that’s not true for everyone. Some people might feel great on just six and a half hours of sleep. Like shoe sizes, sleep needs vary from person to person and many people don’t need as much as eight hours. All that matters is that you feel reasonably well rested the next day.
Waking up at night is normal
If you wake up a few times during the night, don’t worry. Our sleep usually follows 90-minute cycles, and it’s not uncommon to briefly wake up at the end of them. Importantly this means you shouldn’t give up on sleep if you find yourself waking up earlier than expected. Instead stay in bed resting and let sleep naturally return to you.
Perfect sleep is a myth
Everyone has nights when they don’t sleep well, especially during stressful or challenging times. Trying too hard to consistently attain great sleep can also be problematic by putting too much pressure and emphasis on it. Accepting that sleep won’t always be perfect is essential, as perfectionism is only likely to heighten levels of anxiety around sleep, making it worse.
You may be sleeping more than you think
Some people think that they’re not sleeping that much when they actually are. People notoriously think it takes them longer to fall asleep than it actually does and typically underestimate how much they’ve slept in a night.
Feeling tired doesn’t always mean bad sleep
Feeling sleepy and feeling tired are two different things. If you feel tired, it might not be because of poor sleep. An endless list of many different factors and reasons can make you feel tired. However, if you still feel sleepy late in the morning, that might be one sign that you’re not getting enough good sleep.
In the end, sleep is a personal and sometimes complex part of our lives. It’s quite normal and expected for people to have different sleep patterns and needs. Recognising and accepting these facts can help you stress less and sleep better.
Struggling with sleep? I can help
Let me help you to identify the root cause of your difficulty sleeping and help you to resolve the issue using Acceptance & Commitment Therapy (ACT).
ACT is an approach that is:
✔︎ Drug and gimmick free
✔︎ Clinically proven and endorsed by NICE
✔︎ Mindfulness-based
✔︎ Tailored to your sleep issue
✔︎ Simple and gives quick results
Complete my free online course as a starting point to see how I can help you through ACT.
