10 medical reasons why you can’t sleep

If you’re tossing and turning no matter how tired you are, there’s probably an underlying reason why you can’t sleep. Many health conditions are tied to trouble sleeping, so the reasons why you’re not able to get some shut-eye fall into a wide range. Not getting enough sleep does more than make you grumpy, so read on for some common causes that could be to blame.

Bathroom visits can easily compromise sleep. “While urinary incontinence does affect women more often than men, millions of both men and women deal with some type of bladder control issue at some point in their lives and many suffer from symptoms that significantly impact their quality of sleep,” says urologic surgeon, Dr Adam Ramin. “And the truth is, if you suffer from urinary incontinence, it doesn’t have to be a condition that puts you in adult diapers for the rest of your life or prevent you from ever having a good night’s sleep again.”

Dr Ramin says diet and lifestyle changes can help with bladder control, including reducing your intake of caffeine.  “Caffeine stimulates bladder function and is also considered a diuretic,” Dr Ramin continues. “Though it can be much easier said than done, limiting or eliminating caffeine altogether has been known to be successful in diminishing and resolving issues of urinary incontinence.” Needing to go to the bathroom frequently may also be keeping you up at night. Try decreasing your fluid intake a few hours before bedtime. If that’s not enough, see your doctor about getting evaluated for underlying problems like infections. It’s just one of the sleep habits that are trying to tell you something.

Headache pain can keep you from falling asleep and even wake you up. “As many sufferers know, it’s tough to stop that runaway migraine train once it gets moving, let alone try to get a good night’s sleep,” says neurologist, Dr Vernon Williams. But if you can’t sleep, staying up might just make it worse. “Not getting enough sleep, and sometimes getting too much, can trigger a migraine,” he adds. Dr Williams suggests that staying hydrated, eating a balanced and nutritious diet, and staying active, which helps reduce the onset of migraines, are among the daily habits that can help you sleep better.

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Numerous studies have shown magnesium’s effectiveness in boosting mood, lowering anxiety, and reducing stress levels as well as helping with deeper more restful sleep, according to general practitioner, Dr Carolyn Dean. Most of us aren’t getting enough magnesium, so it could be one of the reasons why you can’t sleep. “Magnesium deficiency causes muscle tension, nerve irritability, adrenal surges, decreased production of serotonin, and muscle cramps. All of these symptoms and conditions interfere with sleep,” she says, calling magnesium a safe and important treatment for insomnia

However, not all forms of magnesium are easily absorbed by the body. “Magnesium citrate powder is a highly absorbable form that can be mixed with hot or cold water and sipped at work or at home throughout the day,” she says.

Everything from alertness to body temperature fluctuates based on where our bodies are in our 24-hour biological clock called the circadian rhythm, explains Dr Michael Howell. “Our circadian rhythms are primarily determined by when we are exposed to light, and our modern culture’s affinity to light in the evening (computer, tablet, television, and phone screens) activates a cell layer in our retina sending a signal that delays our circadian rhythm. That means that it could be 10pm, but the brain will think the sun is still out, so it won’t be ready to fall asleep – no matter how tired you actually are.”

Another problem could be a circadian rhythm delay, which is probably what’s happening when the alarm clock goes off, but you’re not ready to wake up yet. “If you have trouble falling asleep at night but can sleep in easily in the morning, you probably have a delay in your circadian rhythm. This problem is solved with bright light (sunlight or a 10,000 lux lightbox used first thing in the morning) along with a low dose (0.5mg) of melatonin about three to four hours before bedtime.” Avoiding caffeine and alcohol and not using different devices before bedtime can also help.

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Numerous medications can cause difficulty falling asleep, Dr Howell says. The most common ones include steroids such as prednisone; antidepressants such as bupropion and venlafaxine; stimulants such as methylphenidate and modafinil, adrenal, thyroid replacement medications, beta-agonists, and theophylline used for asthma. Some over-the-counter medications, such as some pain medications, allergy, and cold medications, and weight-loss products, contain caffeine and other stimulants that can disrupt sleep, according to the Mayo Clinic. Dr Howell suggests you talk to your doctor about the medication if you can’t sleep, and consider if the benefits you are receiving from the medication outweigh the consequences of poor sleep.

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Chronic obstructive pulmonary disease, or COPD, (an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, refractory asthma, and some forms of bronchiectasis) can make it harder to get a good night’s sleep. In fact, many COPD patients also suffer from insomnia, obstructive sleep apnoea, and depression,” says associate professor of thoracic medicine, Dr Fredric Jaffe. Medications used to treat COPD, including bronchodilators and steroids, can cause sleep difficulties, too. If you can’t sleep and have COPD, Dr Jaffe suggests having a solid bedtime routine and minimizing distractions in the bedroom. “Discuss with your pulmonologist if your COPD treatment is optimised and if any of the medications prescribed are impacting your sleep problems,” he advises.

Facia plastic surgeon, Dr Houtan Chaboki, sees many patients with a deviated septum who can’t sleep or have chronic sinus conditions that contribute to poor sleeping. “Ideally, one should be breathing through their nose during sleep. For anyone who has nasal congestion,  they cannot breathe through the nose and may snore, too. Patients with a deviated septum have worse symptoms during sleep due to gravity,” Dr Chaboki says. “Deviated nasal symptoms can occur naturally from genetics, or occur after injury. Patients may try allergy medication, but often need nasal surgery such as septoplasty or rhinoplasty for adequate nasal relief and better sleep.”

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An often-missed indicator of depression is a change in sleep patterns. “Many people who are depressed experience trouble falling asleep or staying asleep during the night. If sleeplessness is accompanied by other symptoms such as mood changes, disinterest in previously enjoyable activities, unexpected weight gain or loss, or thoughts of suicide, one should seek mental health evaluation by a doctor or therapist,” says clinical social worker, Ameshia Arthur. Generalised anxiety disorder (GAD) can also cause sleep troubles, she says. “Common indicators of GAD are restlessness and difficulty sleeping. If sleeplessness is accompanied by excessive worry, muscle soreness, and irritability, one should seek mental health evaluation by a doctor or therapist,” Arthur says.

Menopause introduces hormonal, physical, and psychological changes for women – including sleep problems. From peri-menopause to post-menopause, women report the most sleeping problems. The Australian Sleep Health Foundation notes that these may include hot flushes, mood disorders, insomnia, and sleep-disordered breathing and that sleep problems are often accompanied by depression and anxiety. Treatment with oestrogen (oestrogen replacement therapy) or with oestrogen and progesterone (hormone replacement therapy, HRT) has been found to help relieve menopausal symptoms for some but they do carry side effects, so think about lifestyle interventions, acupuncture, and mind-body techniques.

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