For the 70 million Americans who suffer from insomnia, nighttime can be endless and exhausting. If you're a chronic non-sleeper, you've no doubt followed expert advice to turn off the electronics, keep the bedroom dark and cool, and avoid alcohol and caffeine before bed. But we've found five surprising reasons why you might not be sleeping through the night. And they're all fixable.
1. You eat a lot of fast food
As if you really need another reason to give up sweetened beverages, consider this: Adults who drank a lot of soda were more likely to sleep just five hours a night or less, according to a 2016 study in the journal Sleep Health. Consuming large amounts of sugar may increase insulin resistance and produce inflammation. Add to the soda a fast-food meal like a burger and fries, and you've got the perfect recipe for poor snoozing. "When your body is constantly putting out fires from processing unhealthy foods, the result may be shallower sleep," says Michael Grandner, director of the Sleep & Health Research Program at the University of Arizona College of Medicine in Tucson.
Go for greens and green tea. Older adults who followed a Mediterranean diet — with its emphasis on fruits and vegetables, fish, nuts, seeds and olive oil — were more likely to snag better-quality slumber, a 2017 study in the journal Sleep found. Also, a new Japanese study discovered that lowering the amount of salt in the diet can dramatically cut middle-of-the-night bathroom calls.
2. Your back hurts
Of those who suffer from chronic pain, one-quarter said they have difficulty staying asleep at night, and 10 percent can't nod off easily, reports a 2017 study in BMC Family Practice. Unfortunately, pain can cause "micro-arousals" throughout the night, and insomnia can lower your pain tolerance. The result: a vicious cycle that feeds sleep problems.
Talk to your doctor about ways to relieve pain without drugs. Heat, massage and acupuncture, for example, are effective for lower-back pain. Or try tart cherry juice. Drinking eight ounces twice a day has been shown in preliminary research in older adults to reduce pain and increase sleep by 84 minutes per night, says Robert Oexman, director of the Sleep to Live Institute in Mebane, N.C.
3. You take sleep meds
Here's an eye-opening statistic: Sleep medicines give you just an extra 15 minutes of sleep per night on average, Oexman says. And you may not feel that refreshed the next day, either. "They have an amnesia effect, where you're still waking up, you just don't remember it," he says. That's a big price to pay for dangerous side effects, including addiction, sleepwalking and falling. While the sleep hormone melatonin can be safer, most people take it incorrectly, Grandner says. Melatonin works to shift your body clock—not induce sleep.
Sleep meds should be taken only as a short-term treatment for insomnia in response to a major life stressor, like divorce, death in the family or job loss, says Helena Schotland, M.D., sleep expert at the University of Michigan Sleep Disorders Center in Ann Arbor. If you want to try melatonin — for instance, if you're normally a night owl and want to get to sleep sooner — take a small dose two to three hours before bed.
4. You're on a beta-blocker or SSRI
When it comes to keeping awake at night, sleep medications aren't the only drug offenders, Oexman says. Certain beta-blockers for hypertension (labetalol and propranolol), asthma medications (theophylline and corticosteroids) and SSRI antidepressants (fluoxetine or sertraline) can cause sleepless nights. Some over-the-counter pain relievers contain stimulating caffeine. Also, nonprescription allergy drugs and natural supplements like ginseng have been associated with insomnia.
Sit down with your doctor (or pharmacist) and do a medication review. He or she can pinpoint which meds may be contributing to your insomnia and suggest alternatives. For instance, atenolol or bisoprolol are better options for beta-blockers if you're having trouble sleeping.
5. You have undiagnosed sleep apnea
Think you don't have sleep apnea if you don't snore? Not true, Schotland says. Many of the 23 million Americans with obstructive sleep apnea have uncommon symptoms, including night sweating, morning headaches, dry mouth and, yes, insomnia. And not all sufferers are overweight, which is why it is frequently missed. One telltale sign: You're especially tired during the day. "Many people ignore this red flag," Schotland says.
If you get a full night's sleep but are still dragging during the day, talk to your doctor. If you do have sleep apnea, treatments are effective and may include an oral device or CPAP machine. Even a little weight loss can help; one study found that losing just 20 pounds cut the number of apnea episodes per hour nearly in half.