Sleep Concern

I can't fall asleep

Racing thoughts, restlessness, and difficulty transitioning into sleep.

Educational information — not medical advice. Talk to your care team about what's right for you.

Overview

Sleep-onset insomnia is the persistent difficulty falling asleep at the beginning of the night — often despite feeling exhausted. It is not a single bad night; it is a pattern that repeats three or more nights a week and leaves you dreading the moment your head hits the pillow. When the transition from wakefulness into sleep becomes a struggle, the bed itself can start to feel like a place of frustration rather than rest.

Common Causes

An overactive mind — racing thoughts, worry, or mental rehearsal of the day that refuses to quiet down.
Irregular sleep timing that confuses the circadian rhythm, so the body isn't sure when sleep is supposed to begin.
Evening exposure to bright light and screens, which suppresses melatonin and delays the sleep signal.
Caffeine or stimulants consumed late in the day, with effects that can linger for hours.
Conditioned arousal — the bedroom has become associated with frustration and wakefulness rather than sleep.

What You May Be Experiencing

Taking more than 20–30 minutes to fall asleep on most nights.
Feeling physically tired but mentally alert the moment you get into bed.
Racing or intrusive thoughts that intensify when the lights go out.
Tension, restlessness, or the urge to get up and 'do something' instead of waiting.
Anxiety about whether you will be able to fall asleep at all.

Dr. Morse's Approach

Dr. Morse approaches sleep-onset insomnia as a circadian and arousal problem, not a willpower problem. Her protocol begins with re-anchoring the body's sleep-wake rhythm to a consistent schedule, then systematically removing the cues that keep the brain in 'alert mode' after dark. She uses Cognitive Behavioral Therapy for Insomnia (CBT-I) as the first-line, evidence-based intervention — targeting the thoughts and behaviors that maintain the cycle rather than masking them. The goal is not to force sleep, but to rebuild the conditions under which sleep arrives on its own.

Treatment Options

Behavioral

CBT-I, stimulus control therapy, and sleep restriction to rebuild the brain's association between bed and sleep.

Lifestyle

Consistent wake time, a protected wind-down hour, dim evening light, and moving screens out of the bedroom.

Medical

Short-term pharmacologic support may be considered when behavioral therapy alone is insufficient — always under clinical supervision and never as a substitute for addressing the root cause.

Your Night-time Routine

A practical, step-by-step wind-down built around this concern's specific drivers. Follow it consistently for two to three weeks — rhythm, not perfection, is what resets sleep.

1
8:00 PM
Begin wind-down — dim the lights, stop work, and shift out of 'doing' mode.
2
8:30 PM
Take a warm shower; the post-shower drop in body temperature helps trigger sleep.
3
8:45 PM
Brain-dump journal — write down worries and tomorrow's to-dos to offload racing thoughts.
4
9:00 PM
Low-stimulation reading under warm, dim light (no screens).
5
9:30 PM
Lights out. If you're not asleep in 20 minutes, leave the bed and return only when sleepy (stimulus control).

Take this guide home

A printable PDF of this concern's full overview, routine, and treatment options.

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When to Seek Help

If difficulty falling asleep persists for more than a few weeks, occurs at least three nights per week, or begins to affect your daytime function, mood, or safety, it is time to seek professional evaluation. Sudden onset alongside significant life stress, pain, or mood changes warrants a sooner conversation.

Educational — Not Medical Advice

This content is provided for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not a substitute for consultation with a qualified healthcare professional. Submitting a question or receiving a reply does not establish a doctor-patient relationship. Always seek the advice of your physician or other qualified health provider with any questions about a medical condition, and discuss any changes to your care with your own care team.

Ready for personalized guidance?

Dr. Morse offers one-on-one and group coaching to help you move from understanding your sleep concern to changing it. Share what you're experiencing and she'll be in touch.

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