Sleepless Before Big Days: Why It Happens

Sleep is an essential part of our daily routine, and quality sleep is as crucial to our survival as food and water. However, many people struggle with getting a good night's rest, especially on important days. This phenomenon, often referred to as important day insomnia, can be attributed to various factors, including stress, anxiety, and changes in sleep habits. The inability to fall asleep on important days can have significant impacts on our mood, behaviour, and performance. It can also lead to more severe consequences, such as impaired coordination, memory issues, and increased risk of accidents. Understanding the causes and addressing them through lifestyle changes, relaxation techniques, and medical assistance can help individuals improve their sleep quality and overall well-being.

Stress and anxiety

Sleep and anxiety are highly interconnected. Sleep deprivation can make you feel anxious, and anxiety can affect your sleep. This can create a negative cycle, where anxiety leads to a lack of sleep, which in turn increases anxiety.

Anxiety disorders are the most common mental health problem in the United States, and insufficient sleep is known to have far-reaching negative implications for overall health. Therefore, understanding and addressing the links between anxiety and sleep are essential for maintaining physical and emotional wellness.

Anxiety can keep people from falling asleep, creating a loop of insomnia, stress, and worry. Research has shown that sleep deprivation amplifies reactions in the amygdala and anterior insula, parts of the brain associated with anxiety. This effect is strongest in people with high levels of trait anxiety, which refers to anxiety that is part of one's personality.

Additionally, anxiety can affect rapid eye movement (REM) sleep, the phase when people tend to have vivid dreams. Disturbing dreams or nightmares during REM sleep can wake people up, further disrupting their sleep.

Lack of sleep increases the body's production of cortisol, a hormone associated with stress. This can cause uncomfortable symptoms such as headaches or digestive issues, leading to increased anxiety or low energy due to poor sleep.

Sleep deprivation can also instigate or worsen anxiety disorders. People prone to anxiety are especially sensitive to the effects of insufficient sleep on mood and emotional health, creating a bidirectional relationship where worrying causes poor sleep, and further sleep difficulties increase anxiety.

Breaking the Cycle of Sleep Deprivation and Anxiety

• Establish a bedtime routine: Try to get 7-10 hours of sleep each night and wake up and go to bed at the same time every day. Do something relaxing before bedtime, such as taking a warm bath or reading.
• Create a sleep-friendly environment: Sleep in a cool, dark, and quiet room. Use a fan or sound machine to block out noise, and ensure comfortable bedding and pillows.
• Get regular exercise: Daily exercise is beneficial for physical and mental health and helps release endorphins. Yoga, in particular, is known to reduce anxiety and stress.
• Challenge catastrophic thoughts about sleep: Notice and challenge unhelpful thoughts about sleep, such as believing that not getting enough sleep will render you unable to function the next day.
• Seek professional help: If you're still experiencing problems falling asleep, consider sleep therapy, such as cognitive behavioral therapy for insomnia (CBT-i), or consult a doctor or therapist for further guidance.

By implementing these strategies and practicing good sleep hygiene, you can work towards breaking the cycle of sleep deprivation and anxiety.

Sleep disorders

Sleep Deprivation

Sleep deprivation occurs when an individual does not get enough sleep or enough quality sleep. This can be a short-term or chronic issue and can be caused by a variety of factors, including medical conditions, mental health issues, and poor sleep habits. Sleep deprivation can have negative effects on the body and brain, including fatigue, poor balance and coordination, mood changes, forgetfulness, and a weakened immune system. It is also associated with an increased risk of accidents, cardiovascular disease, and other health issues such as Alzheimer's disease and pre-diabetes.

Insomnia

Insomnia is characterised by disruptions in sleep that affect an individual's ability to function. It can be acute (short-term) or chronic (long-term), and can be caused by various factors such as genetics, brain activity differences, medical conditions, mental health issues, and lifestyle habits. Insomnia can lead to daytime sleepiness, which can be dangerous when performing tasks that require alertness, such as driving. It can also increase the risk of developing conditions such as high blood pressure, obstructive sleep apnea, and psychosis.

Hypersomnia

Hypersomnia is a condition where individuals feel extreme daytime sleepiness despite getting adequate or more than adequate amounts of nighttime sleep. It affects an individual's ability to function at work and socially and can increase the chance of accidents. Hypersomnia can be secondary, caused by medical conditions, medications, alcohol, or insufficient sleep, or primary, where hypersomnia is its own condition. Treatment options include medication and lifestyle changes, such as establishing a regular sleeping schedule and avoiding caffeine and alcohol before bedtime.

Delayed Sleep Phase Syndrome (DSPS)

DSPS is a condition where individuals fall asleep 2 or more hours later than what is considered normal, making it difficult to wake up in the morning. It is more prevalent in young people, with about 1% of adults affected. DSPS can be caused by a variety of factors, including genetics and environmental factors. Treatment options include establishing a consistent sleep and wake schedule, limiting exposure to blue light from electronic devices, and improving sleep practices, such as keeping the bedroom dark and cool.

Hormone fluctuations

Hormones are chemicals that instruct your organs and body what to do, such as when to sleep and when to wake up. Fluctuations in hormone levels can therefore have a significant impact on sleep.

Estrogen and Progesterone

The two major female hormones are estrogen and progesterone. Estrogen is the main female sex hormone, and it helps control the monthly menstruation cycle. Progesterone, meanwhile, is the "relaxing hormone" that helps maintain pregnancy.

During the week before a woman's period, progesterone levels rise to prepare the body for a potential pregnancy. If there is no pregnancy, progesterone levels decrease dramatically, causing the uterine lining to shed and starting the menstrual cycle. This dip in progesterone levels can make it difficult to get quality sleep in the days leading up to the period.

Estrogen levels, meanwhile, tend to be higher during pregnancy, which is why pregnant people often feel more tired. However, by the third trimester, progesterone and estrogen levels even out.

Menopause

As a woman approaches menopause, her hormone levels fluctuate dramatically, causing night sweats and hot flashes that can disrupt sleep. Lower levels of progesterone can also make women more irritable and less able to relax.

Polycystic Ovary Syndrome (PCOS)

Women with PCOS may experience irregular periods, higher levels of testosterone, and lower levels of progesterone. These hormonal irregularities can exacerbate sleep difficulties. Additionally, studies show that women with PCOS are at a higher risk of developing sleep apnea, a sleep disorder that causes a person to stop breathing for brief periods during sleep.

Thyroid

The thyroid can affect sleep in a couple of ways. When the thyroid produces too much thyroid hormone (hyperthyroidism), it can cause anxiety and make it difficult to sleep. On the other hand, when the thyroid doesn't produce enough hormone, you may feel like you can't get enough sleep.

Cortisol

Cortisol is often referred to as the "fight or flight" stress hormone. If cortisol levels get too high, it can inhibit the ovaries, which can cause a drop in estrogen levels and subsequently affect sleep quality.

Melatonin

Melatonin is a naturally occurring hormone that regulates the sleep cycle. Being around bright lights before bed or working the night shift can affect the body's release of melatonin, so the body doesn't get the signal that it's time to sleep.

Testosterone and Growth Hormone

While everyone has some testosterone, low testosterone levels in people with uteruses can cause sleep difficulties.

Low levels of growth hormone can also impact sleep. The growth hormone is secreted by the pituitary gland at night, so if levels are off, sleep will be affected.

Poor sleep environment

A poor sleep environment can be a major contributor to sleep deprivation. Environmental conditions such as temperature, noise, light, bed comfort, and electronic distractions can significantly impact sleep quality.

For instance, excessive exposure to electronic media, particularly in the bedroom, can lead to daytime sleep-related problems. Adolescents with televisions in their bedrooms tend to go to bed later and sleep less. Similarly, blue light emitted from smartphones, tablets, laptops, and TV screens suppresses melatonin production, disrupting sleep patterns. It is recommended to refrain from using electronic devices at least two hours before bedtime.

Noise is another crucial factor influencing sleep-wake behaviour and sleep quality. High sound levels during sleep, whether from traffic, neighbours, or disturbances within the home, can cause frequent awakenings, reduce sleep intensity, and increase stress hormone secretion. Intermittent sounds, such as occasional honking or revving cars, are more disruptive than continuous noise, and young adults living in urban areas may experience chronic sleep deprivation as a result.

Light exposure also plays a role in sleep regulation. Excess artificial light from streets, residences, and businesses can disrupt circadian rhythms by suppressing melatonin production, leading to delayed sleep and prolonged sleep latency.

Additionally, physical comfort is essential for quality sleep. Ensuring comfortable bedding, temperature control, and a dark, quiet bedroom can improve sleep.

Furthermore, certain family and environmental risk factors, such as parental depression, living in a single-caregiver household, and residing in a lower-income neighbourhood, have been linked to poor sleep habits in young children.

Sleep and mental health

How Sleep Affects Mental Health

Sleep is critical for our mental health. Poor or insufficient sleep can increase negative emotional responses to stressors and decrease positive emotions. Sleep deprivation can make it harder to cope with even minor stressors and can impact our ability to perceive the world accurately. It can also lead to increased anxiety and distress levels and make individuals more prone to developing mental health disorders such as depression and anxiety.

How Mental Health Affects Sleep

Living with a mental health problem can also affect sleep. For example, individuals with depression often experience insomnia, excessive daytime sleepiness, and hypersomnia. Anxiety disorders are strongly associated with sleeping problems, with worry and fear contributing to a state of hyperarousal, making it difficult to fall asleep.

Bidirectional Relationship

The relationship between sleep and mental health is bidirectional, meaning that sleeping problems may be both a cause and consequence of mental health problems. Addressing sleep issues can be an important component of treating various psychiatric disorders.

Improving Sleep and Mental Health

Adopting good sleep hygiene practices, such as maintaining a consistent sleep schedule, establishing a relaxing bedtime routine, and limiting exposure to bright lights and electronics before bed, can help improve sleep quality and mental well-being. Cognitive-behavioural therapy (CBT) and medication are also effective treatments for sleep difficulties.

Frequently asked questions