Tired but Wired: Why Am I Tired but Can't Sleep?

Are you very tired but unable to sleep at night? Maybe you toss and turn all night and get up in the morning feeling just as tired as when you went to bed.

You might be “tired but wired”, and it’s a key challenge for many people, including those who live with fatigue and ongoing pain.

Tiredness & fatigue

Being tired but unable to sleep is incredibly frustrating (and feeling annoyed or stressed about it can impact our ability to sleep!).

If you've had some restless nights, you're probably feeling sleepy, forgetful and irritable, among a range of other things. You might have physical symptoms, such as difficulty in temperature control or itchiness, mental symptoms such as difficulty concentrating, or emotional symptoms such as being quick to feel angry or upset.¹

Usually, in this state we just need to get a good night or two of sleep and then we wake up feeling rested and restored.

But when sleep eludes us, either in quantity or quality – or both – our troubles can really start to build. If we can't alleviate our tiredness, for whatever reason, we can become fatigued. Fatigue can interrupt other parts of our life which promotes stress, stress further impacts our sleep and so the cycle continues! And for those who live with pain, pain, sleep and stress are all linked, which means getting stuck in a self-reinforcing cycle of pain, fatigue, stress and sleeplessness.² Phew!

Why can’t I sleep?

There are many reasons why you might be struggling to sleep. Is your bed uncomfortable? Do you share with a person or pet who keeps you awake with their snoring or by moving around? Are you under a lot of stress?

For people with fibromyalgia, sleep problems could be tied to a dysfunction in the autonomic nervous system called sympathetic hyperactivity. Under this state, the body is unable to truly relax, as the fight and flight mode is constantly switched on. That could be why you sometimes feel as though you’re sleeping with one eye open.³

How can I get to sleep?

Depending on the cause of your sleeplessness, you may need to make a number of small changes. Ask yourself the following and then act accordingly.

Get physically comfortable

How comfortable is your bed? Do you like a firm mattress or a soft one? Is your pillow the right height so that your neck and spine are straight and aligned when you are lying down? Are your sheets and bed clothes itchy or scratchy, or do they feel nice against your skin? Does the weight of your bedding feel comforting or is it restrictive?

What temperature is your room and your bedding? To sleep, we need to be the right temperature – too hot or too cold and you’ll probably struggle or fall asleep or stay asleep. For most people, having their bedroom between 16 and 20 degrees Celsius (60 to 68 degrees Fahrenheit) is ideal.⁴

If you share your sleeping space with others (people or pets!) do you have enough space?

Do you need to use the bathroom or take pain medication to help you feel more comfortable? If you do want to try pain relief, see your doctor or pharmacist to talk this through. Whenever possible, avoid the regular use of the opiates such as codeine, because they can make your pain dial more sensitive in the long run and they also carry more risk than over-the-counter medicines such as paracetamol.

Remember too that medications for chronic pain can usually only offer short term benefits, so also consider holistic approaches such as movement, nutrition and psychology.

Switch off your senses

Most people prefer a dark and quiet space in order to sleep. Depending on your situation you might need to use an eye mask, ear plugs, a white noise machine (such as a fan or your phone) or something else to make your space restful.

Calm your brain & nervous system

When you’re in bed, unable to sleep, is your brain still whirring? This is very common for people who struggle to sleep, especially if you are experiencing stress. Do you have any stressful situations going on in your waking life? Perhaps a stressful job, a challenging relationship, or a big decision to make. If you can address these then sleep may come on its own accord.

For anything that you can’t immediately deal with, having methods to relax your body and your mind can make all the difference.

First of all, if you are going over something in your mind, it can be helpful to get it out of your head and onto paper. By writing it down your brain can let it go, knowing it can come back to it tomorrow. The goal is just to get it out of your brain and get it onto paper, don't worry about being perfect or finding solutions!

Instead of feeling anxious or annoyed that you’re not sleeping, try distracting your brain with something relaxing. This might be gentle music or a relaxing audiobook playing softly or something like counting the proverbial sheep!

Think about something that keeps you just engaged enough to not think about your stressors but not so stimulated that you stay awake is ideal. For example, can you imagine walking around your childhood home? Picture as many details as possible. What color was the door? When we walked in the front door did you turn left, right or walk straight ahead?

Another simple mind game could be to pick a category (such as fruits) and go through the alphabet and think of something for each letter.

Relaxing your body before bedtime with a warm bath and some gentle stretching can also be very helpful to ease out any aches and pains and switch the nervous system into “rest and digest”.

Get downtime during the day

So many of us are go, go, go! And when we have five minutes to ourselves we’re catching up on social media, email, TV shows and other activities that aren’t relaxing. This means that our brains are still buzzing at bedtime.

Think about the different types of rest that you might need during a regular day or week, but try to avoid daytime naps if you can. If you do need to nap during your normal waking hours, aim for napping earlier in your day and set an alarm so that you don’t sleep for more than 20 minutes because that can make it even harder to sleep when you want to be sleeping.⁵

Check your food & drink

We all know that caffeine can keep us awake, but did you know that the half life of caffeine for the average person is about 5 hours in the blood?⁶ This means that 5 hours after drinking a cup of coffee, about half of that cup is still going around your body!

For this reason, it’s a good idea to avoid all caffeine after lunchtime. And watch out for the sneaky places that caffeine hides, for example in black and green teas, chocolate, sodas, and energy drinks. Limit your sugar intake later in the day too! Get to know yourself and the way that caffeine and sugar impact you.

Eat a meal a few hours before bed but avoid eating in the two hours immediately before you lay down to sleep. This will give you the best chance to digest your meal properly and avoid heartburn, while also avoiding being woken up by hunger in the middle of the night.^7,8

Similarly, drink fluids so that you don’t get dehydrated, but don’t drink in the hour before bed to minimize the need to wake up for a bathroom break.

Manage your sleep hygiene

Sleep hygiene has become a bit of a buzzword, but it is so important.

1. Set a regular sleep time and a regular wake time, based on how much sleep you think you need and when you need to wake up. Stick to it as much as possible to reset your biological clock.
2. Design a relaxing pre-bedtime routine. Swap screens, work, and news for a warm bath and a relaxing book.
3. Turn off your electronic devices at least an hour before bed. Blue light and beeps are not restful!⁹

When should I see a doctor for sleeplessness?

If you think that your sleeplessness is causing any health problems or impacting your ability to safely work, drive or carry out your other tasks, chat with your doctor.

Certain causes of insomnia may need help from your doctor.

Mental health challenges, such as anxiety and depression, can impact your ability to get a good night’s sleep.¹⁰ In this case, antidepressant medication or talking with a psychologist can help you to address the underlying causes.

Hormonal imbalances are another common cause of insomnia, particularly for women who are experiencing menopause¹¹ and this can sometimes be addressed with hormonal replacement therapy. Other changes in your menstrual cycle can also play with your sleep so check with a physician for more support.¹²

If you’d like to learn more about these, we recently launched our mobile app providing evidence-based pain management. Download it and try it out for free via the App Store or the Play Store.