Why the brain sometimes refuses to switch off at night, what the evidence supports, and when a sleep problem deserves a closer look.
If you can’t fall asleep most nights, or you drift off and then lie awake in the small hours watching the clock, you have a very common sleep problem. It can have several possible sources: stress, the habits that build up around the bed, caffeine or alcohol, and sometimes a medical problem sitting underneath. Several of those can be changed, and the rest are worth finding.
I am Dr. Alireza Chizari, DC, DACNB, a board-certified chiropractic neurologist, and I practice functional neurology at California Brain & Spine Center in Calabasas. Sleep comes up again and again in my conversations with patients, especially people recovering from a concussion or living with dizziness and autonomic symptoms. They rarely come in for sleep. They mention it near the end of the visit, almost as an apology.
Maybe this sounds familiar. You are still getting through the workday, still driving the 101, still answering email, and quietly running on far less than you need. Maybe your tests came back normal and the nights stayed exactly as they were. That gap, between how you look on paper and how you feel lying awake in the dark, deserves to be taken seriously.
Key Takeaway
If you can’t fall asleep or stay asleep, it is common. Short spells may follow stress or a change in schedule. When it happens 3 or more nights a week for more than 3 months it is called chronic insomnia, which is often a symptom of something else. Cognitive behavioral therapy for insomnia (CBT-I) is usually the first recommended treatment.
Why can’t I fall asleep at night?
Trouble falling asleep can have several possible sources. When you can’t fall asleep after a hard week, stress or a change in schedule may be the trigger, and caffeine, nicotine and alcohol can contribute. When it persists for months, it is often a symptom of something else, such as a medical condition, a medicine or another sleep disorder.
Insomnia is a common sleep disorder that may involve trouble falling asleep, staying asleep, or both, as the National Heart, Lung, and Blood Institute explains. Short-term insomnia may follow stress or a change in schedule. Insomnia is called chronic when it happens 3 or more nights a week for more than 3 months.
That line between short-term and chronic matters more than it sounds. A rough patch after a move or a deadline is one thing. Months of nights when you can’t fall asleep are another, and at that point it is worth asking what keeps the pattern going.
The bed can turn into a cue for being awake
If you can’t fall asleep in the same bed night after night, however hard you try, the bed itself can start to signal wakefulness. Sleep clinicians call this conditioned arousal. The part of cognitive behavioral therapy for insomnia called stimulus control is used to rebuild the bed as a cue for sleep rather than wakefulness, and one of its core instructions surprises people: when sleep does not come, get up.
The nervous system may stay switched on
A systematic review in PLOS One looked at heart-rate-related measures of autonomic activity in insomnia and found differences between people with insomnia and people without it in most of the observational studies it examined. The authors suggested those differences may be an expression of hyperarousal, a nervous system stuck in a more alert, ‘on’ state. That is one proposed explanation, and it is a hypothesis rather than a settled mechanism. The findings are not uniform.
This is the part of the picture Dr. Alireza Chizari, DC, DACNB, looks at most closely, because autonomic regulation sits inside functional neurology. For most people with a bad week it stays in the background. It moves forward when you can’t fall asleep and the poor nights arrive alongside dizziness, headaches or a slow recovery from a head injury.
Sometimes insomnia is a symptom of something else
MedlinePlus describes most cases of chronic insomnia as secondary: often a symptom of something else, such as a medical condition, a medicine or another sleep disorder. Caffeine, nicotine and alcohol can contribute to trouble sleeping as well. When you can’t fall asleep for months, the problem therefore calls for an evaluation that looks for the driver, alongside any change to the bedtime routine.
What does trouble staying asleep look like?
Trouble staying asleep is the other half of the same problem. You fall asleep without much difficulty, then wake in the night fully alert, your mind already working through tomorrow, and the minutes stretch. Or you sleep what looks like enough hours and still get up feeling as though you never really went under. That last version fits the third part of the NHLBI description: sleep that is not good quality.
If your nights end that way and you also live with POTS (postural orthostatic tachycardia syndrome), I cover that pattern separately in waking up unrefreshed with POTS.
A note on waking in the night
The stimulus control instruction applies at any hour. If you wake in the middle of the night and cannot get back to sleep, get out of bed and return only when you feel sleepy again. The aim is the same as at bedtime: keep the bed paired with sleep.
Can a concussion cause trouble falling asleep?
It can be part of the picture. Sleep problems, especially insomnia, are common after a concussion, can persist, and are often overlooked, according to a review of insomnia after mild traumatic brain injury in Brain Sciences.
The same review notes that CBT for insomnia is widely advocated after brain injury as well, and that nonpharmacologic approaches, meaning approaches without medication, are generally preferred.
If you or your teenager is recovering from a concussion and can’t fall asleep, give sleep a deliberate place in the plan from the start. I lay out a practical version in a sleep routine for concussion recovery.
Sleep is one piece of a wider pattern of symptoms, and the page on post-concussion syndrome covers what else an evaluation looks at.
Sleep that has not settled since a head injury?
When trouble falling or staying asleep sits alongside dizziness, headaches or a slow concussion recovery, a complimentary consultation is a sensible place to start the conversation.
What actually helps when you can’t fall asleep?
When you can’t fall asleep for a few nights running, the basics often do the job. According to MedlinePlus, good sleep habits often help with short-term insomnia. On their own they may not be enough for chronic insomnia.
The stimulus control instructions used in CBT-I are simple to say and harder to keep:
- Keep the same morning rise time from day to day.
- Go to bed only when you feel sleepy, whatever the clock says.
- If you cannot sleep at the start of the night or in the middle of it, get out of bed and come back only when sleepy again.
If you can’t fall asleep, keep caffeine, nicotine and alcohol in the frame too. Each can contribute to trouble sleeping, so their timing deserves an honest look before anything else is added.
What is CBT-I?
CBT-I, cognitive behavioral therapy for insomnia, is a structured program meant to help people fall asleep faster and stay asleep longer. The NHLBI describes it as usually recommended as the first treatment for long-term insomnia, and it can be very effective.
When CBT-I fits someone’s situation, I point them toward it and work alongside their primary care doctor. For chronic insomnia it belongs at the center of the plan, and nothing I do replaces it.
When is not sleeping a sign of something more?
Some stretches when you can’t fall asleep pass with the stress that set them off. The table sets typical patterns beside the ones that deserve a closer look, and what an evaluation would examine for each.
| Typical presentation | Patterns that suggest something more | What the evaluation looks at |
|---|---|---|
| A few bad nights after a stressful week or a change in schedule | Nights like this 3 or more times a week for more than 3 months | What may be keeping the pattern going, since chronic insomnia is often a symptom of something else |
| Lying awake while the mind runs through the day | The bed itself starts to feel like the place for being awake | Habits around bedtime and waking, and whether stimulus control or CBT-I is the right next step |
| Coffee in the afternoon, a drink in the evening | Trouble sleeping that persists after caffeine, nicotine and alcohol are adjusted | Medical conditions and medicines that can sit behind insomnia, coordinated with primary care |
| Waking in the night and drifting back | Waking fully alert and unable to return to sleep, night after night | Whether another sleep disorder may be involved, with referral to a sleep physician when needed |
| Sleep that slips during a demanding stretch | Sleep problems that began after a concussion and have not settled | How recovery from the head injury is going, with sleep treated as part of it |
| Feeling wired at bedtime now and then | Feeling wired at night alongside dizziness, headaches or a racing heart | How the autonomic nervous system is regulating itself, since insomnia has been associated with differences in autonomic activity |
When to seek emergency care
A sleep problem on its own belongs with your primary care doctor. Some symptoms that can arrive with it do not.
If symptoms come on suddenly or severely – a sudden severe headache, weakness, trouble speaking, vision loss, or fainting – that is an emergency. Call 911 or go to an emergency room, not a clinic appointment.
Where can I get help for trouble sleeping in Calabasas?
Dr. Alireza Chizari, DC, DACNB, sees patients at California Brain & Spine Center from across Calabasas, Agoura Hills and the wider West Valley. To be plain about scope: the practice is not a sleep clinic, and I do not prescribe or manage sleep medication.
The practice is set up for the cases where sleep is one thread in a larger neurological picture, such as a concussion that has not settled, dizziness, headaches or autonomic symptoms. The evaluation begins with a 120-minute neurodiagnostic assessment, and care may include neurological rehabilitation when clinically appropriate after that evaluation.
Sleep also comes up often with people who come in for brain fog treatment, and the evaluation treats it as part of the same picture rather than a separate complaint.
When the evaluation points somewhere else, toward another sleep disorder, a medical condition or a medicine, the next step is your primary care doctor or a sleep physician, and I am glad to work alongside them.
Can’t fall asleep? Answers to common questions
Should I stay in bed if I can’t fall asleep?
The stimulus control approach used in CBT-I says no. If you can’t fall asleep, at the start of the night or in the middle of it, get out of bed and return only when you feel sleepy again. The aim is to rebuild the bed as a cue for sleep rather than for lying awake.
When does trouble falling asleep count as insomnia?
Insomnia is a common sleep disorder that may involve trouble falling asleep, staying asleep, or both. A few rough nights after stress or a schedule change are often short-term. It is called chronic insomnia when it happens 3 or more nights a week for more than 3 months, and that is a good point to seek an evaluation.
Can caffeine or alcohol cause trouble staying asleep?
They can. Caffeine, nicotine and alcohol can all contribute to trouble sleeping. If you can’t fall asleep or you keep waking in the night, look honestly at when you have each of them, and notice whether your nights change when you adjust that timing. If they do not, that is useful information too.
What is CBT-I, and can it help if I can’t fall asleep?
CBT-I, cognitive behavioral therapy for insomnia, is a structured program meant to help people fall asleep faster and stay asleep longer. If you can’t fall asleep for months at a time, it is usually recommended as the first treatment and can be very effective. It is widely advocated after brain injury too.
Can a functional neurology evaluation in Calabasas help with trouble sleeping?
It can show whether sleep is part of a wider neurological picture, such as a slow concussion recovery, dizziness or autonomic symptoms. At California Brain & Spine Center in Calabasas, the evaluation looks for what may be driving it. When the driver is a medical condition, a medicine or another sleep disorder, I coordinate with your primary care doctor.
Where should you start if you can’t fall asleep?
If you can’t fall asleep, start with the basics and give them an honest try: the same rise time each morning, bed only when sleepy, and getting up when sleep does not come. If the nights still go the same way after months, or if poor sleep arrives with dizziness, headaches or a concussion that has not settled, it is worth a proper look. I would rather help you find what is driving it than leave you guessing on your own.
California Brain & Spine Center | (818) 649-5300 | Calabasas, CA 91302
Book online at californiabrainspine.janeapp.com
This content is for educational purposes only and is not medical advice. Consult a qualified healthcare provider about your specific situation.
Ready to find out what is keeping you awake?
A complimentary consultation in Calabasas is a chance to talk through your sleep, your other symptoms, and whether an evaluation makes sense for you.
Dr. Alireza Chizari
This article has been medically reviewed for clinical accuracy by Dr. Alireza Chizari, DC, DACNB. Committed to evidence-based practice, Dr. Chizari ensures all content reflects the highest standards of functional neurology care.
Comments
Find our article more easily in Google.
FAQ
What is Functional Neurology?
Functional Neurology is a healthcare specialty that focuses on assessing and rehabilitating the nervous system’s function. It emphasizes neuroplasticity—the brain’s ability to adapt and reorganize—using non-invasive, evidence-based interventions to improve neurological performance.
How does Functional Neurology differ from traditional neurology?
Traditional neurology often concentrates on diagnosing and treating neurological diseases through medications or surgery. In contrast, Functional Neurology aims to optimize the nervous system’s function by identifying and addressing dysfunctions through personalized, non-pharmaceutical interventions.
Is Functional Neurology a replacement for traditional medical care?
No. Functional Neurology is intended to complement, not replace, traditional medical care. Practitioners often collaborate with medical professionals to provide comprehensive care.
What conditions can Functional Neurology help manage?
Functional Neurology has been applied to various conditions, including:
• Concussions and Post-Concussion Syndrome
• Traumatic Brain Injuries (TBI)
• Vestibular Disorders
• Migraines and Headaches
• Neurodevelopmental Disorders (e.g., ADHD, Autism)
• Movement Disorders
• Dysautonomia
• Peripheral Neuropathy
• Functional Neurological Disorder (FND)
Can Functional Neurology assist with neurodegenerative diseases?
While Functional Neurology does not cure neurodegenerative diseases, it can help manage symptoms and improve quality of life by optimizing the function of existing neural pathways.
What diagnostic methods are used in Functional Neurology?
Functional Neurologists employ various assessments, including:
• Videonystagmography (VNG)
• Computerized Posturography
• Oculomotor Testing
• Vestibular Function Tests
• Neurocognitive Evaluations
How is a patient’s progress monitored?
Progress is tracked through repeated assessments, patient-reported outcomes, and objective measures such as balance tests, eye movement tracking, and cognitive performance evaluations.
What therapies are commonly used in Functional Neurology?
Interventions may include:
- Vestibular Rehabilitation
- Oculomotor Exercises
- Sensorimotor Integration
- Cognitive Training
- Balance and Coordination Exercises
- Nutritional Counseling
- Lifestyle Modifications
Are these therapies personalized?
Absolutely. Treatment plans are tailored to the individual’s specific neurological findings, symptoms, and functional goals.
Who can benefit from Functional Neurology?
Individuals with unresolved neurological symptoms, those seeking non-pharmaceutical interventions, or patients aiming to optimize brain function can benefit from Functional Neurology.
Is Functional Neurology suitable for children?
Yes. Children with developmental delays, learning difficulties, or neurodevelopmental disorders may benefit from Functional Neurology approaches.
How does Functional Neurology complement other medical treatments?
It can serve as an adjunct to traditional medical care, enhancing outcomes by addressing functional aspects of the nervous system that may not be targeted by conventional treatments.
How is technology integrated into Functional Neurology?
Technological tools such as virtual reality, neurofeedback, and advanced diagnostic equipment are increasingly used to assess and enhance neurological function.
What is the role of research in Functional Neurology?
Ongoing research continues to refine assessment techniques, therapeutic interventions, and our understanding of neuroplasticity, contributing to the evolution of Functional Neurology practices.
