6 Causes Of Sleep Onset Insomnia And What Doctors Say You Should Do About It

Insomnia is often used as a catch-all term to describe a whole slew of sleep problems. Trouble falling asleep, waking up in the middle of the night and not being able to fall back asleep, and waking up too early in the morning can all be described as insomnia. But what many people don’t realise is that these sleep problems are different types of insomnia – and they don’t always have the same causes.

Sleep onset insomnia, also called initial insomnia, describes struggling to initially fall asleep. This is different from waking up too early in the morning (late insomnia) or waking up in the middle of the night and not being able to fall back asleep (middle, or maintenance, insomnia). “Often, sleep onset insomnia is how maintenance insomnia begins,” said Dr. Rafael Pelayo, a sleep medicine doctor and clinical professor at Stanford University’s Sleep Medicine division.

Treating sleep onset insomnia can stop the domino effect. But it starts with knowing what causes it in the first place.

What causes sleep onset insomnia?

Typically, it should take between 10 and 20 minutes to fall asleep, according to Dr. Alex Dimitriu, a psychiatrist and sleep medicine doctor. But he added that it depends on what you were doing before you hit the lights. If you were reading in dim lighting, you’re probably going to fall asleep faster than if you were scrolling your phone before trying to fall asleep, he said. 

“Doing work or anything else stimulating is not good for sleep because your brain needs some space, silence and a chance to slow down. So, if you are doing anything overly exciting or stimulating, you will need longer to fall asleep and your sleep quality will be worse once you do,” he told HuffPost.

The sleep doctors we talked to also point out that everyone has trouble falling asleep once in a while. But if you have trouble falling asleep at least three times a week for three months or longer, that’s when you’re considered to have sleep onset insomnia, according to Dr. Richard Schwab, chief of the Division of Sleep Medicine at the University of Pennsylvania Perelman School of Medicine.

What causes sleep onset insomnia? Below are the six most common causes, according to the doctors we talked to.

1. Stress

If your mind starts to race as soon as your head hits the pillow, you (unfortunately) know firsthand how stress can keep you up at night. “Stress, anxiety and depression are probably the biggest causes of sleep onset insomnia,” Schwab said. 

It isn’t exactly easy to turn your thoughts off, and worrying about being able to fall asleep can make it worse. “As soon as you start pressuring yourself to sleep, it becomes an issue,” Pelayo said. Soon, all you’ll be able to focus on is the fact that you’re still awake. 

2. Not having an effective bedtime routine

Remember how Dimitriu said that doing something stimulating before bed makes it harder to fall asleep? Dental sleep expert Dr. Stephen Carstensen told HuffPost that this is a major driver of sleep onset insomnia. Consistently going from a stimulating environment or activity to immediately trying to fall asleep just doesn’t work for many people. 

3. Exercising right before bed

While the sleep doctors say that, in general, exercise is beneficial for sleep, Carstensen and Schwab both said exercising too late in the evening can lead to trouble falling asleep. “Exercising late can be a problem because the rise in body temperature can cause a delay in the sleep cycle,” Carstensensaid. 

A rise in body temperature makes it harder to fall asleep because the body naturally cools down in the process of falling asleep. It’s part of the reason having a room or bedding that’s too warm can work against you.

4. Diet habits

All four sleep experts said consuming caffeine too late in the day can make it harder to fall asleep. Consistently eating a large meal late at night or experiencing heartburn are other ways that diet can cause sleep onset insomnia. 

Regularly drinking alcohol in the evening can also mess with your sleep, all four sleep experts say, but it is more likely to cause maintenance insomnia (waking up in the middle of the night) than sleep onset insomnia. 

5. Melatonin

While Pelayo said melatonin can be helpful in certain situations, he explained that relying on it as a crutch to fall asleep can eventually backfire. If you try to sleep without it, you’ll likely have trouble falling asleep because you’ve come to depend on it, psychologically. He said the same thing can happen if you rely on alcohol to fall asleep (which will cause you to wake up in the middle of the night anyway) or other sedatives. 

He explains that in each case, the melatonin, alcohol or sedatives are being used to mask the underlying problem instead of treating it. “Instead of treating the issue, you’re just blocking it out,” he said. In the long term, he emphasised, this just doesn’t work.

6. Environmental factors

Outside noise, a fussy infant, an overactive pet and a snoring partner are all examples of how environmental factors can prevent you from falling asleep. If they’re consistent, the sleep experts say they can cause sleep onset insomnia. 

What’s the solution? 

All four sleep experts emphasised that the key to solving sleep onset insomnia is treating the underlying cause. That means you first have to figure out what exactly is keeping you up. If the reason you can’t fall asleep at night is that you’re stressed or anxious, Schwab said it’s important to have ways to manage it. “For some people, it helps to get a bath or shower before bed as a way to relieve stress. Exercise is also helpful as long as it’s not too late in the evening,” he said. Knowing how to effectively manage stress is key to getting good sleep.

If you’re relying on alcohol, a sedative or a sleep aid to fall asleep, talk to your health care provider about how you can safely transition away from depending on it. The transition may take time, but your sleep will benefit in the long run.

It’s worth it to consider ways your diet could be impacting your sleep. If you have no choice but to eat right before bedtime, try making your midday meal your biggest meal of the day and eating lighter at night. It can also be helpful to choose foods that are easy to digest, like soup. 

Dimitriu emphasised the importance of setting up your bedroom for sleep and having an evening routine that helps you wind down. “Dimmed lights of sunset colours help, no blue light. Ideally, get in bed early and have an hour to read or hang with your partner, not your phone. Try to go to bed and wake up at the same time,” he said.

If you can’t figure out the root cause of your sleep woes or don’t know what to do about it, seeing a sleep doctor can help. Schwab said this is beneficial because a sleep doctor can come up with a plan that works specifically for you. He added that they can also make sure an underlying health condition isn’t contributing to your sleep problems.

As far as what to do in the moment, Pelayo’s best piece of advice is to turn on a dim light and read a book until you start feeling sleepy and then try again to fall asleep. “What’s important to remember is that sleep will come. You will fall asleep eventually,” he said. Until then, try not to obsess about it too much — and definitely don’t reach for your phone.