What is usually happening
Chronic insomnia is often maintained by conditioned arousal. The bed becomes associated with frustration, effort, clock-watching, and “what if tomorrow is ruined?” thoughts. That makes bedtime physiologically noisy even when the person feels depleted.
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Difficulty falling asleep can also be shaped by circadian mismatch, stimulant use, alcohol or cannabis rebound, medication effects, untreated breathing or movement disorders, pain, trauma, and the plain fact that some people are trying to sleep at a biologically wrong time.
Why this matters clinically
If the answer is only “try harder to relax,” people usually feel blamed instead of helped. A better plan asks what keeps the pattern alive and then treats that mechanism directly.