The Ultimate Guide to What’s Keeping You Up at Night

Young woman in bed unable to sleep

Healthy adults should be getting seven to nine hours of sleep every night. However, if you’re frequently tossing and turning, dozing in and out of sleep, or constantly checking the clock, the thought of trying to go to sleep can spike your anxiety. You are not alone. 50 to 70 million Americans suffer from a sleep disorder, and not getting enough sleep can affect you mentally and physically. To avoid any damaging symptoms of sleep deprivation on your overall health, you must identify any underlying causes when sleep disturbances persist for over a month. This ultimate guide will detail what may be keeping you up at night.

Pain May Be Keeping You Up at Night

Chronic pain affects one-fifth of US adults. The experience of pain is real, often debilitating, and causes emotional and physical distress. In one study, two-thirds of Americans have reported having sleep problems, and of these, 15% suffered from chronic pain.

Chronic pain lingers for more than three to six months or sometimes years. Opioid medication can help relieve chronic pain, but long-term use can lead to overdose and addiction.

Chronic pain can result from many conditions, such as a bulging spine or an injury. It can also be associated with fibromyalgia, migraines, or linked to certain health conditions like arthritis and cancer. Chronic pain conditions are often related to poor health, disability, high healthcare costs, and missed workdays.

Causes of Pain

The leading causes of pain are back pain, problems with the jaw muscles, headaches, nerve pain, and joint pain. Additionally, musculoskeletal conditions such as fibromyalgia cause pain around the body.

Other causes of pain are related to cancer. Tumors may press on nerves or surrounding organs or cause fluid accumulation. Moreover, radiation and chemotherapy drugs can lead to neuropathic pain. Neuropathic or nerve pain can stem from damage to the central nervous system or peripheral nerves. Shingles, diabetes, certain infections, autoimmune diseases, and other conditions can cause damage to the peripheral nerves.


Chronic pain can be challenging to treat, and what your doctor recommends for you will depend on the severity of your symptoms and condition. Your doctor may prescribe opioids for your lingering pain. Opioids interrupt the pain processing signals and are effective treatments.

Your doctor may also prescribe non-opioid drugs such as NSAIDs, acetaminophen, aspirin, or antidepressants. Local electrical stimulation may also be effective at treating your chronic pain. These electrical pulses target the nerve endings of the skin.

Psychotherapy may also allow you to cope, deal with, and feel as if you control your pain. Spinal manipulation, massage, yoga, tai chi, and acupuncture may help relieve and manage your pain. Relaxation techniques such as music, hypnosis, and meditation may also help treat your pain.

A biofeedback device may also help treat your chronic pain. This device teaches you how to control certain physiological responses of your body. These include breathing patterns, muscle tension, and heart rate. A placebo treatment may also help relieve your chronic pain. If you don’t respond well to conventional treatments, surgery may be the best option.

Young woman lying in bed wincing in pain

Mental Illness and Stress May Be Keeping You Up at Night

Insomnia can be a symptom of anxiety and depression. Events or stressful situations, such as marital problems or money, often worsen insomnia and lead to long-term sleeping problems. In addition, sleep problems and anxiety are interlinked: sleep problems can cause anxiety, and anxiety can disrupt your sleep.

Causes of Mental Illness and Stress

Work-related stress may be interfering with your sleep if you are going over past events or are planning and worrying about upcoming tasks. Rumination is the root cause of stress. Rumination refers to the thoughts in your head, and negative emotions are often attached to it.

Feeling out of balance between your personal life and work may also be keeping you up at night. Not balancing work and your personal life can interfere with you psychologically, emotionally, and physically.

Bipolar disorder, anxiety, depression, and stress increase your likelihood of developing insomnia. According to the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders, 40% to 50% of people with insomnia also have a mental disorder. Whether or not insomnia and mental illness are linked, either problem can make the other worse.


If you have insomnia plus a mental disorder, or even stress, addressing the problem that you are experiencing first can help the other go away. For example, if you have insomnia, you should get treatment to get back to a healthy sleep schedule so that your anxiety symptoms don’t worsen. If you are suffering from anxiety, there are various ways to manage your sleep anxiety.


To reduce your risk of developing sleep anxiety, you should exercise regularly, eat a healthy diet, and practice good sleep hygiene. An example of good sleep hygiene is avoiding foods and drinks that can disrupt your sleep. If you have a mental illness or sleep disorder, taking medications will help prevent your sleepless nights.

Man with beard in bed, holding head as if upset or stressed

Snoring May Be Keeping You Up at Night

Snoring is a harsh or hoarse sound that occurs when air flows past the relaxed tissues in your throat, causing the tissues to vibrate as you breathe. Snoring can become a chronic problem and may indicate a severe health condition. It has been estimated that 30% to 50% of Americans snore, and about 37 million Americans are chronic snorers.

Causes of Snoring

Snoring may be caused by various factors such as the anatomy of your mouth and sinuses, your weight, alcohol consumption, a cold, and allergies. When the tissue of your throat relaxes, it partially blocks your airway and vibrates, so the more narrow your airway becomes, the more forceful the airflow becomes. The increasing vibration allows your snoring to grow even louder. So the anatomy of your mouth may be the cause of your snoring. Having a thick, low soft palate can narrow your airway.

Alcohol is another potential cause of snoring. If you consume too much alcohol before bed, your sleep will be disrupted as alcohol relaxes your throat muscles and hinders the flow of free air.

If you have a cold or allergies, your sleep may also be disrupted because of nasal congestion.

A crooked partition or chronic nasal congestion between your nostrils may be the cause of your snoring. Also, sleeping on your back narrows the airway, causing your snoring to be more frequent and loud.


If you are suffering from chronic snoring, your doctor will ask about your symptoms and medical history and do a physical exam to look for a deviated septum, chronic nasal congestion, or swollen tonsils. Your doctor may also perform an MRI scan, an X-ray, or a CT scan that can further look for problems in your airway. Your doctor may ask you to join a sleep study where you spend the night in a lab. You may also need to use a machine to monitor your sleep.


You should make lifestyle changes if you chronically snore, such as avoiding drinking alcohol close to bedtime. Sleeping on your side may also prevent you from snoring. Medical devices and surgery are also available if your snoring is chronic.

African american woman in bed and upset because her male partner is snoring

Jet Lag May Be Keeping You Up at Night

Traveling across the world will throw off your circadian rhythm. It can take up to three days for your body to adjust to another time zone’s new light and dark schedule. This adjustment period, known as jet lag, can cause chronic sleep problems if you fly across time zones.

Causes of Jet Lag

Jet lag occurs when you go from one time zone to another. Jet lag occurs because crossing multiple time zones puts your circadian rhythm out of sync with the new time zone. The influence of sunlight can also keep you up at night. During the day, the pineal gland releases very little melatonin (a hormone that regulates sleep), while the hypothalamus tells the brain to release melatonin at night.

Changes to high altitudes and cabin pressure may be associated with jet lag. The humidity levels are also low in planes, so you will get dehydrated if you don’t drink enough water while onboard. Dehydration may be associated with jet lag.


If you suffer from jet lag, you can reduce your symptoms by using sleeping pills or a hormone supplement such as melatonin. Taking melatonin may help reset your circadian rhythm. It would be best if you took melatonin after dark on the day of your travel and after dark for a few days after arriving at your destination. If you are flying east, you should take melatonin in the evening for a few days before you fly. Zolpidem (Ambien) and eszopiclone (Lunesta) are prescription sleeping pills that may help you treat jet lag.

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If you have an event or an important meeting to attend, you should arrive early to give your body a few days to adjust to the new time zone. You should get plenty of rest before traveling to prevent jet lag. You should gradually accommodate your schedule before leaving if you plan to travel. Regulating your light exposure will also help you adjust to the new time zone. Before you go, set your watch to the new time zone and try to stay awake until it is nighttime at your destination. Drink plenty of water while traveling so that you don’t get dehydrated. If it’s nighttime at your destination, try to sleep on the airplane.

Weary middle-aged man sitting with eyes closed in airport

Shift Work May Be Keeping You Up at Night

A schedule like those kept by doctors, nurses, firefighters, and other night-shift workers can upset the body’s circadian rhythm. According to a 2007 study at the Universidad de Buenos Aires in Argentina, people who work rotating shifts have lower serotonin levels, a hormone that helps regulate sleep. About 20% of full-time US workers are involved in shift work.

Timing of Shift Work

Shift work may be keeping you up at night if you work evening or overnight shifts, work very early morning shifts, or work rotating shifts.


If you suffer from shift work sleep disorder (SWSD), keep a diary to identify the problem and monitor its progression. Your doctor may ask you about your sleep patterns and disturbances. Your doctor may also recommend that you take medications. Furthermore, your doctor may also order a sleep study to rule out other conditions. Your doctor may prescribe hypnotics and sedatives like eszopiclone and zolpidem to help you sleep better.


Most shift workers sleep one to four hours less per day than non-shift workers. You must get at least seven to nine hours a day for optimal health. If you are a shift worker, you must make sleep a priority. Decrease the number of night shifts you do in a row. A routine might help you stick to your schedule and help prepare you for sleep. Try to stick to your sleep schedule, even on the weekends and holidays.

A quiet and peaceful environment at home can also help you to sleep. Consider getting black-out curtains to block out any light so that you can get a good rest.

Mining supervisor with clipboard on a night shift

Hormonal Changes May Be Keeping You Up at Night

Pregnancy, menstruation, and menopause are primary causes of sleep problems among women. Tender breasts, frequent urination, hot flashes, and a rise in body temperature may interrupt regular sleep patterns.

Causes of Hormonal Changes

As menopause approaches, hormonal changes will disrupt your sleep because of a decline in estrogen. Sleep problems are common in around 35 to 60 percent of menopausal women. The most common sleep issues reported by women are hot flashes, mood and sleep disorders, sleep-disordered breathing, and insomnia.

Many women have sleep problems during perimenopause, a period just prior to menopause during which hormone levels and menstrual periods become irregular. The estrogen level rises and falls during perimenopause, which can disrupt your quality of sleep. Researchers have found that women in perimenopause are more likely to have sleep disturbances. In fact, according to the National Sleep Foundation, approximately 40% of perimenopausal women have sleep problems. Furthermore, about two-thirds of perimenopausal women have hot flashes and experience sleep problems.

Being pregnant may also be keeping you up at night. Tender breasts, a growing belly, and a constant need to urinate will keep you awake. After giving birth, factors such as postpartum sleep problems, breastfeeding, and caring for a newborn can take a toll on your sleep.

If you suffer from premenstrual syndrome, your sleep may be disrupted. Hormonal changes before and after menstruation may disturb your sleep through the effects of melatonin production and body temperature. Research has found altered levels of melatonin during a menstrual cycle. Higher levels of progesterone also increase body temperature. Moreover, studies have found that women experiencing PMS have altered sleep architecture, which means that women with PMS have less rapid eye movement (REM) sleep during the late luteal phase. Research has also found that women experience more rapid hormone fluctuations before their period, which is correlated with fragmented sleep.


If you are experiencing perimenopause symptoms, a dose of estrogen might help you get a good night’s sleep. A large study from the American College of Obstetricians and Gynecologists found relief from estrogen therapy in perimenopausal women. Keeping your bedroom cooler at night may also help you sleep better. After giving birth, if you are at risk for postpartum depression, antidepressant medication may help you get a good rest.

Your doctor may prescribe birth control if you are suffering from premenstrual syndrome. If you suffer from severe cramps or other menstrual symptoms, a pain reliever combined with a sleep medication will help you get a good sleep.

Young pregant woman unable to sleep

Medical Illnesses May Be Keeping You Up at Night

Sleep problems are often associated with other medical conditions. For example, lung disease or asthma, shortness of breath, and wheezing can all disrupt your sleep. If you suffer from a heart problem, you may develop abnormal breathing patterns. Parkinson’s and other neurological diseases can also disrupt your sleep. Diabetes, heartburn, kidney disease, thyroid disease, musculoskeletal disorders, and diabetes can also have an impact on your rest.

Causes of Medical Illnesses

Your genetic makeup, lifestyle behaviors, exposure to toxic substances, and other factors can all be making you unwell and keeping you up at night, though sometimes the exact cause of an illness may be unknown.


If you are diagnosed with a medical illness, your doctor may prescribe thyroid hormone, beta-blockers, diuretics, clonidine, theophylline, corticosteroids, etc. If your medical condition is due to a sleep disorder, like sleep apnea, your doctor will treat your sleep disorder so that you can get a good night’s rest.

Type 2 diabetes is commonly associated with sleep apnea. If you have sleep apnea, it can be treated with breathing devices such as lifestyle changes, including losing weight. A breathing device such as a positive airway pressure (PAP) machine may help treat your sleep apnea to help you sleep better. If you have type 2 diabetes, make sure to manage your blood sugar levels to get better rest.


If you have a medical illness, you should stay on top of your medication and practice good sleep hygiene by avoiding foods and drinks that disrupt sleep and sticking to your sleep routine. You should also avoid drinking caffeine and alcohol an hour before bedtime.

Note that prescription and over-the-counter drugs can disrupt your sleep, mainly if you take them close to bedtime or if your dosage has been increased. If you have had a recent change in your prescription, ask your doctor if there is a possible connection.

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