Sleeping problems: 8 common causes & what doctors specifically recommend
You’re lying in bed, tired – yet you still can’t fall asleep. This feeling is familiar to almost everyone. According to gesundheitsinformation.de, about a third of all people regularly struggle with falling asleep or staying asleep. The good news: In most cases, the causes are known and well treatable.
What happens in the body when we can’t fall asleep?
Falling asleep is an active biological process. The brain must be able to use adenosine (a sleep signal that accumulates with prolonged wakefulness), the cortisol level must decrease, and the body temperature must slightly drop. If one of these processes is disrupted, you remain awake.
The 8 most common causes of sleep onset problems
1. Stress and thought loops
The most common trigger. Cortisol and adrenaline keep the nervous system in fight-or-flight mode. The brain remains active, even when the body is exhausted. Harvard Health names cognitive behavioral therapy (CBT-I) as “First-Line-Treatment” – before any medication.
2. Screen light (blue light)
Smartphones, tablets, and laptop displays emit blue light in the wavelength range of 460–490 nm. This light inhibits melatonin production by the pineal gland – the body is signaled that it is still daytime. Recommendation from the Cleveland Clinic: Turn off screens at least 60 minutes before bedtime or switch to night mode.
3. Caffeine – underestimated
Caffeine blocks adenosine receptors in the brain. The half-life of caffeine is 5–7 hours. A coffee at 3 p.m. still has 50% of its effect at 9 p.m. The National Sleep Foundation recommends: no caffeine after 2 p.m.
4. Alcohol – the underestimated trap
Alcohol makes many people fall asleep faster – but it destroys sleep quality. It suppresses deep sleep (NREM stage 3) and REM sleep in the first half of the night. The result: You often wake up in the second half of the night and feel unrefreshed in the morning.
5. Irregular sleep times
The circadian rhythm is a biological clock that requires regularity. Those who sleep at 11 p.m. on weekdays and at 2 a.m. on weekends significantly disrupt this clock. Doctors refer to this as “social jet lag” – with similar consequences as real jet lag.
6. Too warm bedroom
For the transition into deep sleep, the core body temperature must slightly decrease. A warm room prevents this. Optimal: 16–18°C according to the Cleveland Clinic. Many people sleep in rooms at 22–24°C – too warm.
7. Physical complaints and pain
Chronic pain, nighttime urination, heartburn, or restless legs syndrome can significantly hinder falling asleep. Here, a medical diagnosis is important – sleep hygiene alone is not sufficient.
8. Mental illnesses
Anxiety disorders, depression, and PTSD often go hand in hand with sleep problems. According to Harvard Health, chronic insomnia is often both a symptom and a trigger of mental illnesses – a vicious cycle that must be specifically treated.
What doctors recommend first (non-medical)
Cognitive Behavioral Therapy for Insomnia (CBT-I) is, according to Harvard Health, the Cleveland Clinic, and national sleep specialists, the method with the strongest evidence. It combines:
- Sleep restriction: Consciously limit bedtime to build up sleep pressure
- Stimulus control: Associate the bed only with sleep and not with lying awake
- Relaxation techniques: Progressive muscle relaxation, breathing techniques
- Cognitive restructuring: Dispel catastrophic thoughts about sleep
Immediate measures for tonight
- Lower the room temperature to 17–18°C
- Put away screens 60 minutes before bedtime
- 20-minute evening walk (reduces cortisol)
- 4-7-8 breathing technique: Inhale for 4 seconds, hold for 7 seconds, exhale for 8 seconds
- For thought loops: Write down worries and “set them aside”
When should you see a doctor?
Medical evaluation is necessary if the following signals occur:
- Sleep onset problems more than three times per week for more than four weeks
- Loud snoring or observed breathing pauses (suspected sleep apnea)
- Itching or compelling urge to move in the legs (restless legs)
- Strong daytime sleepiness despite sufficient sleep duration
Frequently asked questions about sleep onset problems
Why can’t I fall asleep even though I’m exhausted?
Fatigue and sleepiness are not the same. Stress and cortisol can keep the nervous system so activated that falling asleep doesn’t work even with physical exhaustion – a state sleep specialists call “hyperarousal.”
Do sleeping pills help in the short term?
Prescription sleeping pills can help in the short term (a few days), but they are not a long-term solution. They often suppress deep sleep and can cause dependency. Over-the-counter antihistamines like diphenhydramine quickly lose their effectiveness and are not recommended for people over 65.
Does warm milk really work?
Milk contains L-tryptophan, a precursor to serotonin and melatonin. However, the amount is too small to have a measurable effect. Rather, the ritual itself helps – warm drinks and habits can condition the nervous system for sleep.
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