10 Medical Reasons Why You Can’t Sleep

Updated: Mar. 14, 2022

Whether you can't get to sleep, stay asleep, or get truly restful sleep, there could be a medical reason. Here are the most common problems.

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Why can’t you 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.

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Urinary incontinence

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 Adam Ramin, MD, urologic surgeon and medical director of Urology Cancer Specialists in Los Angeles. “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.

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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 Vernon Williams, MD, neurologist, and director of the Kerlan-Jobe Center for Sports Neurology and Pain Medicine at Kerlan-Jobe Orthopedic Clinic in Los Angeles. 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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Magnesium deficiency

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 Carolyn Dean, MD, a general practitioner based in Kihei, Hawaii and a medical advisory board member with the Nutritional Magnesium Association. Most Americans 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. (Here are 13 more strange things you didn’t know were wrecking your sleep.)

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Circadian rhythm delay

Everything from alertness to body temperature fluctuates based on where our bodies are in our 24-hour biological clock called the circadian rhythm, explains Michael Howell, MD, CEO of Sleep Performance Institute in Edina, Minnesota. “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 10 p.m., 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. (Did you know that sleeping just one extra hour a night could save your life?)

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Stimulant medications

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. (You could also give these weird sleep tricks a shot.)

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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 apnea, and depression,” says Fredric Jaffe, DO, associate professor of Thoracic Medicine and Surgery at the Lewis Katz School of Medicine at Temple University. 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 optimized and if any of the medications prescribed are impacting your sleep problems,” he advises.

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Nasal issues

Houtan Chaboki, MD, a facial plastic surgeon in Washington, DC, 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.” (Check out these 13 secrets to better sleep that doctors want you to know.)

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Depression and anxiety

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 Ameshia Arthur, a licensed clinical social worker, and therapist in Sacramento, California. Generalized 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. (These are the mistakes people with insomnia make when they’re trying to fall asleep.)

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Menopause introduces hormonal, physical, and psychological changes for women—including sleep problems. “From peri-menopause (or transition phase) to post-menopause, women report the most sleeping problems,” reports the National Sleep Foundation (NSF). “These include hot flashes, mood disorders, insomnia, and sleep-disordered breathing. Sleep problems are often accompanied by depression and anxiety.” Treatment with estrogen (estrogen replacement therapy, ERT) or with estrogen and progesterone (hormone replacement therapy, HRT) has been found to help relieve menopausal symptoms, reports the NSF. These do carry side effects, however, so think about lifestyle interventions, acupuncture, and mind-body techniques.

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Restless leg syndrome

Sleep-related movement disorders, like restless leg syndrome, can impact sleep substantially. The condition is associated with symptoms ranging from “tingling, stinging, or creepy-crawly sensations before bedtime” to “periodic limb movement disorder, an involuntary rhythmic movement of the legs,” according to the NSF. If you think you have it, discuss treatment options with a doctor and make sure you look for these 17 subtle signs that you need to see a sleep doctor.