Psychiatrist Questions Sleep Disorders

At night, thinking prevents me from sleeping. Can I do anything about it?

It normally takes me 1-2 hours to finally fall asleep at night. I can't stop thinking and it's hard for me to divert my thoughts. Why does this happen and how can I stop it from happening?

18 Answers

Don't lie in bed more than 20 minutes. Avoid screens for an hour before bed. Listen to music podcasts, or color. Learn meditation. Journal and make appointments so it's not at bed time.
Please read about sleep hygiene. If it still persists, please seek help. Cold shower, relaxation helps. All the best.
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Cognitive behavioral therapy can help in this regard by a trained therapist. Mindfulness techniques, meditation, consistently same time to go to bed and get up every day, not taking naps during the day, not watching TV, spending time on computer close to sleeping time or any other stimulating activity needs to be avoided in the evening. Regular exercise but at least 4-5 hours before bed time and treating any underlying illness like anxiety or depression or primary insomnia. In your case, it seems like you are under stress and may have anxiety bringing thoughts to your mind. In any case, you need to see your doctor and talk about all these different options. There are some medications that work only on the phase of falling asleep if you can maintain it after you fall asleep.
There are many reasons for it, therefore you need evaluation for proper treatment.
Common symptom of anxiety which can be treated with CBT, hypnotherapy and/or medication.
It sounds as if you have the "can't-shut-my-brain-off" symptoms which I see frequently in practice. You said that this delay in sleep onset is "normal" which points in the general direction of anxiety or depressive disorders though that is not by any means an exhaustive list. As with many of these other inquiries, I recommend a mental health consultation with a licensed professional. In the meantime, I can share the recommendations of sleep experts which include not laying in bed for more than about 45 minutes without falling asleep. Get out of the bedroom and move to a different location, and try to engage in a quiet but productive activity that is unlikely to provoke more anxiety (for example, clipping coupons or finishing that belated birthday card you've been promising yourself you would send). When you begin to feel ready for sleep again, return to the bedroom and try to sleep. Repeat as necessary.
Why such things happen are really unique to the person suffering. Distraction techniques like leaving on the TV while you start to fall asleep helps some people. Others can divert the ruminative thinking with a mental task such as counting until that becomes boring enough to fall asleep. You can also consider asking your provider to request a formal sleep study to make sure there is nothing else going on that might affect your sleep cycle. If there is a lot of stress, you may wish to consider seeing a therapist to personally help with some coping skills as well.
This is quite common. It probably stems from anxiety. Many people use short acting sedatives like zolpidem to go to sleep. Others are opposed to using "drugs" or are concerned about side effects or worry about drug dependence. One thing to try (if you haven't already done so) is to go through the alphabet thinking of animals whose names start with its letters. Some find they have fallen asleep before they finish the alphabet.
It sounds like you are feeling overwhelmed and stressed and your mind has difficulty quieting down. I recommend following a good sleep hygiene as well as some form of quieting activities prior to bedtime to start quieting down your thoughts. This could be warm shower, bath with Epsom magnesium salt, listening to relaxing music, meditation, or light reading. You can also try magnesium supplement or melatonin. If the sleep problems persists, please seek a consultation via your primary care provider or psychiatrist. I do not recommend long term use of sleep medications to manage this.
Hi, I can tell this must be frustrating for you. Sleep is very important to our daily functioning. There could be many reasons why your mind won't turn off. Could be worries, racing thoughts (related to bipolar illness for example), reflective thoughts, etc? May I ask what are you thinking about primarily? Are you stressed? I'd first try to determine what types of thoughts you have then figure out why you're having them. You may need to consult a therapist to assist you with this but my experience has been that most people know what's bothering them--it's just really hard to say it out loud. There may be something weighing heavily on your mind such as family, your job, relationships, etc that perhaps is difficult to deal with but really hits you hard at night when you're trying to rest. Before I'd recommend any meds (natural or prescription), again, I'd reflect on the origin of the thoughts. I'd be happy to discuss further in another follow-up question if you like. Please take care of yourself. Sincerely, Tanya
Guided meditation, stop procrastinating and leaving projects to the last minute, do not obsess over the future and the past, take one day at a time, make small goals limiting them to 2-3 a day and accomplish them to increase your self-esteem and stay on track.

Do not spend more than 30 minutes in bed if you cannot sleep. Get up and distract yourself by reading a book, or drink warm non-fat or 2 percent milk about half a cup which contains tryptophan and that converts into serotonin which has sedative properties and relaxes you. That is why people from older generations drank milk at night though they didn't know the science behind it, but it worked. Hope this helps you some.
If this has been a problem for a while, you would be best served by a consultation with your primary care physician. There are so many causes of insomnia, and so many treatments, that I can't give you a specific recommendation for a treatment without an exam, and understanding what is causing your insomnia. It could be an anxiety disorder, other medications, sleep hygiene, or any of several general medical illnesses. Go see your doctor.
I am sorry to hear you are struggling to fall asleep. Some things that can help are to
1. try to give yourself time to unwind before going to sleep - rather than using an iPad or watching tv before bed, consider reading a book outside of bed and returning to bed only to sleep.
2. Limit emails, facebook, twitter and other interactive activities before bed - this way you won't have new information to ponder before going to sleep.
3. meditation can be very useful to help you fall asleep - meditation apps like Headspace or Om can be very helpful to reduce unnecessary distractions and reduce anxiety before bed, and to lull you to sleep.
4. limit caffeine intake overall and stop drinking caffeinated beverages after 2 or 3 pm.
5. If there are many issues weighing on your mind, try writing them down to 'purge' your mind.
6. Therapy can be helpful to explore the reasons for your anxiety and work towards resolutions.
Discussion with your LMD is the first step, with a request for referral to a mental health specialist as part of the dialogue. Anxiety and depression sometimes present this way.
It could be OCD.
After a busy day, lying in bed is often the first time we have to be alone with our thoughts. Many people can start to overthink during this time, leading to heightened alertness and inability to fall asleep. There are many ways to address this issue. First, look at your bedtime ritual. Are you going to bed the same time every night? Are you waking the same time every morning? How many caffeinated beverages are you consuming? How late are you drinking caffeine? Do you have a television in your bedroom? Is the bedroom dark enough and cool enough for comfortable sleep? Are you looking at a bright tablet or phone screen before bed?

It is important to ensure your bedtime environment is optimal for proper sleep. Avoid caffeine after 1 pm. Avoid watching or listening to TV in the bedroom or right before bed. Make sure the bedroom is cool and dark. If there are noises keeping you awake, try wearing ear plugs. Bright screens before bed can be too stimulating and cause more difficulty falling asleep. Avoid alcohol because alcohol can inhibit deep, restorative sleep and lead to multiple awakenings. Keep a regular sleep schedule, going to sleep and waking about the same time every day.

Relaxation exercises such as deep breathing can be helpful for sleep initiation. While deep breathing, try to allow your worries to gently flow by without trying to fight them. You can visualize this happening as if a worry is drifting on water, in one ear and out the other. You can shift your focus to a soothing word such as "peace."

Another helpful strategy is to write down the thoughts that are bothering you. Do the worries seem as important when you read them? Are any solutions coming to mind that you would like to remember? Write that down too. Some people find it helpful to write down the things they feel grateful for, shifting their focus to the positive aspects of their daily lives.

If these strategies are not enough, and the worrying and trouble falling asleep are associated with muscle tension, restless energy, irritable mood, excessive worry throughout the day, and trouble with daily functioning due to these symptoms, you may be suffering from an anxiety disorder that may be identified and treated by your primary care physician or a psychiatrist.
There are several medical and mental conditions which prevents people to fall asleep at bedtime.

Simply: Too much caffeine intake from coffee, tea, energy drinks, and sodas are the most common sleep disturbances. By limiting the intake the problem would improve in no time.

Alcohol is a major chemical that interacts with sleep cycles. At times, prescription drugs may cause sleep disturbance: antidepressants, stimulants are most common medications. They need to be moved to earlier times.

Heavy meals closer to the sleep time also disturbs/interrupts sleep.

Sleep is sensitive to daily stressors. During the idle time at night, thoughts may keep coming back and cause disturbance. First, all factors mentioned above (coffee, medications, alcohol) should be avoided. Then, sleep hygiene should be followed which require no blinking lights, no TV or music, no noise, animals, or snoring partners allowed in the room. Light exercise and light snacks prior to sleep are recommended.

Some over-the-counter medications are available as "sleep starters"

Some sleep disturbances are related to mental conditions. Excessive thinking, racing thoughts, no need for any sleep, or excessive energy all night could be a sign of a major mental condition such as Bipolar Disorder, and requires an assessment by a MH provider.

Hope it helps, and you feel better soon!

Dr. T
There can be many reasons to why initiating sleep can be hard for someone. Some habits for e.g. eating sweets or caffeinated items in the evening can effect, or a late work out can effect the sleep cycle as well. Often the stress of daily life gets to us and starts to affect the mood, appetite as well as sleep. Sometimes getting off the technologies early in evening helps. Also giving self some quiet unwinding time or meditation can be helpful.