Difficulty falling asleep is known as insomnia and can be caused by many different factors. These range from physiological to psychological causes. One example of a physiological cause for insomnia is the Restless Legs Syndrome (see the sheet on the Restless Legs Syndrome for more details). It is important to recognize that most physicians were never trained how to evaluate or treat their patients’ sleep problems.

Too frequently, when patients complain of difficulty with their sleep physicians quickly resort to prescribing sleeping medications known as sedative hypnotics (“sleeping pills”). If you have difficulty falling asleep at night, then these facts are important to know and follow. But remember that not everyone is the same. People who do not have problems falling asleep may not need to follow the steps listed below:

    • You must wake up within an hour of the same time each morning, seven days a week. We are creatures of habit and our brains sleep best when we maintain a regular schedule.
    • Do not take long naps during the day. Frequently people who do not get to sleep until 3 or 4 in the morning either sleep late in the morning or nap during or after work or school. It is better to wake up at a regular time in the morning (as stated in step one), even if you are tired.
    • Your bedroom should not be a multi-media center. It should be mostly used for sleeping. For example, do not watch TV or read in bed. These activities reduce the effectiveness of the learned relationship you have between your bed and bedroom and the act of falling asleep.
    • Avoid clock watching. Many people with insomnia watch the minutes and hours ticking away. This creates more anxiety and increases your difficulty in falling asleep. Turn the face of the clock away so it is out of sight.
    • Watch what you drink. Avoid caffeinated beverages after lunch. Also, don’t drink alcoholic beverages before bed. This can awaken you several hours later when its effects wear off. Alcohol can cause the muscles in your throat to become more relaxed when you’re asleep, which can block your airway, and your breathing can briefly stop. This is known as obstructive sleep apnea. So, if you snore, be aware that drinking before sleep can make your breathing worse and cause sleep apnea.
    • Set aside a stress or worry time several hours before going to bed. You should go to bed knowing that you have already thought about stressful issues on some level. It is best to make a list of all of the things you need to do the following day.
    • Use relaxation techniques right before going to bed. Biofeedback, Yoga, Transcendental Meditation and relaxation tapes are a few methods proven to decrease anxiety and help with relaxation before going to bed.
    • If you are not tired, don’t go to bed. If you are in bed and can’t fall asleep within what you guess to be about 30 minutes without looking at the clock, get out of bed and do something relaxing such as the recommendations from number seven. When you feel drowsy again go back to bed. This helps you to stop relating to your bed as a place where you struggle to fall asleep. Many people with a type of insomnia called psychophysiological insomnia find that when they are away from home, on vacation for example, they have no problem falling asleep. This is because they have learned to feel anxiety about sleep in their usual sleeping environment.


If you have an insomnia problem, and it does not improve by trying these basic steps, then you should consider being evaluated by a sleep disorders specialist. With proper care, most people can obtain the treatment they need to improve their sleep.

More information on Insomnia:

US News & World Report: A Patient’s Guide to Insomnia