Can’t Sleep? Why You’re Tossing and Turning at Night

You know the feeling: It’s been a long day and you’re more than ready for bed. You swiftly move through your evening routine and eventually hit the sheets for a good night’s rest. No such luck. You find yourself tossing and turning, unable to get comfortable as you watch the bright numbers on your clock tick away over the course of the night. Between all the fidgeting and frustration, you don’t get any quality sleep, leaving you bleary-eyed the next morning as you struggle to start the day.

If this sounds familiar, you’re not alone. In fact, the Centers for Disease Control and Prevention (CDC) estimates a third of American adults don’t get the requisite seven-plus hours sleep we need to stay healthy. A whole host of reasons may be to blame, say our experts, from irregular sleep schedules to sleep anxiety itself. Learn what’s behind your tossing and turning, as well as tips for figuring out how to sleep better.

Why You May Be Tossing and Turning at Night

There are a host of reasons—lifestyle and medical—why you might be endlessly readjusting your position and your pillow at night, says Julia Scali, D.O., an internal medicine specialist at Jefferson Stratford Hospital in Stratford, NJ, and many of them involve circadian rhythm disturbances.

Your body has an internal “clock” that closely follows the 24-hour day-night cycle. It’s called the circadian rhythm, and it regulates hormone levels, some of your eating habits, body temperature, and more, all in the service of getting you to sleep and waking you up.

Disrupting this cycle can lead to a host of poor health outcomes. According to a systematic review in Applied Physiology, Nutrition, and Metabolism, these can include:

• Cognitive decline

• Depression

• Diabetes

• Osteoporosis

• Weight gain

So, what’s likely to throw off your circadian rhythm or otherwise keep you tossing and turning at night? Dr. Scali and Devin Toledo, D.O., a family medicine practitioner at Overlook Medical Center in Summit, NJ, say these are some of the more common reasons.

Inconsistent Bedtime

One of the easiest ways to throw your biological clock out of whack is messing with your sleep schedule, says Dr. Toledo. Shift work, jet lag, or just staying up and sleeping later on weekends (a phenomenon called social jetlag) can throw off your circadian rhythm and keep you from restful sleep.

“The idea is to go to bed and wake up at the same time every day to establish a regular sleep routine,” says Dr. Toledo. “This will help regulate your body's internal clock and promote better sleep.”

Light Exposure

Light is a key factor for keeping your circadian rhythm on track. Exposure to light in the morning encourages your adrenal glands to produce cortisol (the stress hormone) that promotes wakefulness. Cortisol peaks around 8:30 a.m., and its lowest point is around midnight. Meanwhile, your pineal gland releases melatonin in response to darkness to make you sleepy.

Too much light at the wrong time of day throws this balance off. A study in The Journal of Clinical Endocrinology & Metabolism of more than 100 people found that light before bedtime delayed melatonin production in 99% of study participants, and light during sleep hours caused a 50% reduction in melatonin production. Blue light from devices like smartphones and tablets is especially insidious, according to the Centers for Disease Control and Prevention (CDC) and others.

Sleep Anxiety

Talk about a vicious cycle: You can’t sleep. You start thinking about how tired you’ll be tomorrow. You get stressed. Now you definitely can’t sleep. That’s sleep anxiety.

Your anxiety doesn’t even need to be specifically about sleep to keep you tossing and turning. Anxiety affects nearly one in five American adults every year, according to data from the National Institute of Mental Health and counts sleep disturbance as a symptom. A study in Frontiers in Neurology found anxiety in more than 20% of participants with insomnia.

Underlying Medical Conditions

Besides anxiety, an array of health conditions can prevent you from sleeping or getting restful sleep. Some include:

• Chronic pain conditions: Chronic pain from conditions like osteoarthritis, rheumatoid arthritis, or fibromyalgia can make it difficult to find a comfortable sleeping position, leading to restlessness and frequent waking.

• Obstructive sleep apnea: This is a condition where the airway becomes partially or completely blocked during sleep, leading to pauses in breathing and interruptions in sleep. People with elevated weight or BMI are at high risk for sleep apnea, as are people with a greater than average neck circumference and smaller than average lower jaws.

• Nocturia: Nocturia is a condition that occurs when you have to get out of bed to urinate one or more times during the night, and affects around 40 percent of adults.

• Restless legs syndrome (RLS): RLS is a neurological disorder that causes an irresistible urge to move the legs, often accompanied by unpleasant sensations like tingling or crawling.

How Do You Know if You're a Restless Sleeper?

You probably know if you’re tossing and turning for hours trying to fall asleep, since you’re awake (which is the whole problem). Being aware of tossing and turning in your sleep is more difficult—you’re asleep, after all—but there’s a telltale sign, says Dr. Toledo.

“One of the biggest signs of being restless is frequently waking up feeling tired,” he says. “If you wake up feeling groggy, it could be a sign that you're not getting enough uninterrupted sleep.”

Dr. Scali says back pain may tip you off as well. “Frequently waking up with a sore neck or back could be a sign that you're not getting comfortable sleep and that you're moving around a lot during the night,” she says.

Additionally, if you share a bed with your partner and they tell you that you move around a lot or make noise while you sleep, that’s another sign of restless sleep, says Dr. Toledo, adding that there are other signs that your partner may notice that can indicate restless sleep. These include:

• Constant limb movement or sleepwalking

• Grinding your teeth when you’re sleeping (also known as sleep-related bruxism)

• Loudly snoring with choking or gasping noises

• Talking or yelling in your sleep

Tips to Stop Tossing and Turning

The number one most important habit to ensure a good night sleep is to establish a regular sleep routine. “It is also important to create a comfortable, cool, sleep environment,” Dr. Toledo says. “Avoiding caffeine and alcohol—especially at least eight hours before bed—can be beneficial, as well.”

“Perhaps most relevant in this day and age is reducing the amount of screen time you consume before bed,” states Dr. Scali. “I advise all my patients with sleep-related disturbances to put their phone or computer away [at least] two hours prior to bedtime.”

Other strategies for improving your sleep? Drs. Scali and Toledo also recommend:

• Eating a balanced diet: In addition to avoiding caffeine and alcohol before bed, having a balanced diet can help your body sleep better.

• Getting up if you aren’t sleepy: If you don’t fall to sleep within 30 minutes or so, get out of bed and do a relaxing activity in another room to avoid associating anxiousness with your bed and potentially end up with insomnia as a result.

• Practicing relaxation techniques: Employing techniques such as mindfulness meditation can reduce stress and help you relax, per research in Clinical Psychology Review and elsewhere.

• Regular exercise: Consistent exercise has been shown to help the body relax and improve the quality of sleep you get, especially if you feel anxious and jittery.

If lifestyle changes don’t work, there are a variety of OTC and prescription sleep aids that might help.

No matter what, if you are struggling with tossing and turning at night and are unable to improve the quality of your sleep despite your best efforts, reach out to your health care professional to discuss your treatment options. Rest assured, together you will find a solution.