You Can’t Fall Asleep…What to Do?

By: Zlatan Krizan, Ph.D.

The clock says midnight, and you are tired. Indeed not the first time you have spent so much time looking at the ceiling from your bed, a sight both familiar and increasingly unwanted. Many share this experience; insomnia complaints are common, even rising over the last decade (1). A smooth sleeping experience is important for how we feel about sleep and for getting the most out of our sleep, and for allowing the brain to go through all the stages of sleep appropriately. It sure would be nice to fall asleep easier, but what to do?

Despair is a common response, but science suggests ways to address these problems, and I share some pointers here. Besides being a sleep scientist, I am also a lifelong insomniac and certainly not a stranger to ceiling gazing. Some of these suggestions did not work for me and may not work for you—but this is a toolbox. Even if only one tool offered here helps, your slumber should set in quicker, and the day afterwards you may thank yourself.

The general reason why people can’t fall asleep is hyper-arousal; high activation of emotional, cognitive and physiologic brain systems, which then interfere with the smooth transition from wakefulness to sleep (2). Because falling asleep requires several “switches” to work together, even if you are very sleepy, some parts of the brain may not be ready to switch – being more concerned with every silly thing you have done this week or all the problems awaiting you the next.

As a result, tools that help you fall asleep are usually aimed at lowering the arousal or its negative impact when going to sleep (immediate) or decreasing overall stress and improving psychological health (long-term). You cannot make yourself sleep, but you can help let yourself fall asleep. While a good plan for stress reduction and fitness improvement can help sleep performance, here I will focus on the more immediate solutions:

Have a Bedtime Routine

If you ever had to take care of a newborn, you will be painfully aware of how important routine is for the infant to fall asleep. From warm baths to songs and bedtime stories, a clear and consistent signal that it is bedtime is critical for developing healthy sleep habits in children. Most adults are no less sensitive to a lack of bedtime routine; if the only consistent cue for going to bed is a thought that “I should go to bed”, you may be in for a rough time. However, if you develop and stick with a consistent bedtime, develop a pre-sleep ritual (e.g., reading), and avoid exposure to electronic content and communications (which tend to drag stuff up you may not want to think about), you should have more success. The goal is simple; establish multiple cues for your brain that it’s time to shut off.

Make a List of Stuff That is Bugging You

A common type of pre-sleep arousal that gets in the way involves rumination and worry—churning things over in your mind that you just did, can’t do, or have to do tomorrow (personally a very familiar experience!). While difficult to stop, recent evidence shows there is a simple intervention—write things that are bugging you down, including steps you can take to resolve the concerns (3). If the mental chatter does not stop, get a pen and a piece of paper (ideally not a smartphone), and briefly jot down what is bugging you and what you can do to fix it. By “dumping” the worries on a piece of paper, you can create a sense of resolution that can help you fall asleep quicker.

Keep Your Mobile Device Outside of the Bedroom

You didn’t think it would all be easy, did you? Unfortunately, this may be one of the most important and powerful things you can do to avoid those ceiling-staring sessions. This move, which may be unsettling at first, works on multiple fronts. First, it removes a source of (blue) light emanating from the screen, which will help maintain healthy sleep-wake rhythms over time. Second, it removes a gateway to all the worries and successes, as well as unexpected communications, all of which can only interfere with sleep due to their arousing nature. While some individuals may need to keep their devices near because they are on-call, keeping them away is a powerful thing—I leave mine in the kitchen. But how do I wake up in the morning, you may ask? Luckily, an old-fashioned alarm clock costs only a few dollars.

Sticking with it

There are other ways to help oneself fall asleep, which can be found summarized on the National Sleep Foundation website (https://www.thensf.org/). But the three above are known to work, can be powerful, and can work long-term. However, they may not be easy—getting used to enforcing a bedtime routine may be new to you, or not having the mobile device next to you may be stressful at first. But change does not happen overnight—smooth sleep is a matter of consistency, so don’t give up. Try it for a while, and see what works for you—even a 1% improvement can set you on the right path toward smoother and better sleep.

(1) Hisler GC, Muranovic D, Krizan Z. Changes in sleep difficulties among the U.S. population from 2013 to 2017: results from the National Health Interview Survey. Sleep Health. 2019;5(6):615-620. doi:10.1016/j.sleh.2019.08.008

(2) Kalmbach DA, Cuamatzi-Castelan AS, Tonnu CV, et al. Hyperarousal and sleep reactivity in insomnia: current insights. Nat Sci Sleep. 2018;10:193-201. Published 2018 Jul 17. doi:10.2147/NSS.S138823

(3) Scullin, M. K., Krueger, M. L., Ballard, H. K., Pruett, N., & Bliwise, D. L. (2018). The effects of bedtime writing on difficulty falling asleep: A polysomnographic study comparing to-do lists and completed activity lists. Journal of Experimental Psychology: General, 147(1), 139–146. https://doi.org/10.1037/xge0000374