Battling Insomnia: Awake But Not Tired

Sleep disorders such as insomnia, restless legs syndrome, and sleep apnea can significantly impact your sleep quality and daily life. Experiencing difficulty falling or staying asleep can lead to a frustrating cycle of fatigue, irritability, and anxiety. Various factors, including lifestyle choices, medications, and physical or mental health conditions, can contribute to sleep disturbances. Understanding and addressing these issues is essential for improving sleep hygiene and overall health.

Stress and anxiety

How Stress and Anxiety Affect Sleep

Bidirectional Relationship

Research has found a bidirectional relationship between sleep and anxiety, meaning that either disorder can come first. Sleep disturbances are often a symptom of anxiety-related disorders, and anxiety can be caused by sleep deprivation. People with anxiety disorders often have constant sleep-wake difficulties, which can present as insomnia.

Managing Stress and Anxiety at Night

• Control your breathing: Deep breathing exercises can activate a calming response through the parasympathetic nervous system.
• Write down your worries: Writing down anxious thoughts can help disconnect from them and free up mental space.
• Maintain a nightly schedule: Stick to a regular sleep schedule, even on weekends. Avoid stimulating activities before bed, such as watching TV or scrolling through social media.
• Focus your mental energy: Try to focus on something soothing, such as white noise or a calming visual image.
• Create a comfortable environment: Use your bedroom only for rest and intimacy. Sleep in a cool, dark, quiet, and comfortable space.

Medical Treatment Options

If you think you have an anxiety or sleep disorder, seek help from a mental health professional or a sleep clinic specialist. Treatment options include medication, herbal remedies such as melatonin or valerian root, cognitive behavioral therapy (CBT), mindfulness and relaxation techniques, light therapy, and sleep restraint therapy.

Caffeine consumption

Caffeine is a widely consumed stimulant that improves focus and alertness. It works by blocking the effects of adenosine, a sleep-inducing chemical in the body. While caffeine can reduce symptoms of sleep deprivation, it can also disrupt normal sleep patterns and increase the risk of insomnia, especially when consumed in high doses or close to bedtime.

Caffeine has a half-life of anywhere between 2 and 12 hours, and its effects may last up to eight hours after consumption. This means that afternoon or evening caffeine intake can negatively impact sleep quality. Caffeine can extend sleep latency (the time it takes to fall asleep), reduce total sleep time, and worsen sleep quality. It can also reduce the amount of deep, slow-wave sleep, which is critical for feeling refreshed the next day.

The disruptive effects of regular caffeine use can create a vicious cycle. Caffeine use can exacerbate sleep deprivation, leading to more caffeine consumption to cope with daytime sleepiness. This ongoing cycle of insufficient sleep and increased caffeine intake can result in a level of daytime sleepiness that even caffeine cannot counteract.

To improve sleep quality, it is recommended to avoid caffeine at least eight hours before bedtime. For those with chronic insomnia, reducing or eliminating caffeine intake or only consuming it early in the day may be beneficial. Additionally, establishing a caffeine cutoff time, being aware of your intake, and maintaining a consistent bedtime routine can help counteract the negative impact of caffeine on sleep.

Blue light exposure

Blue light suppresses the production of melatonin, a hormone that makes you feel drowsy and signals to your body that it is time for sleep. By suppressing melatonin, blue light leaves you feeling energised and alert when you should be feeling sleepy.

Research has shown that a majority of Americans use electronic devices within an hour of going to bed, which can lead to poor sleep. To mitigate the effects of blue light, it is recommended to limit exposure to blue light in the evening by dimming or reducing LED and fluorescent lighting and turning off electronic devices.

• Set an alarm to remind yourself to turn off electronics 2-3 hours before bedtime.
• Use lamps that emit red or orange light instead of blue light.
• Dim the brightness of your electronic screens or use the "night mode" feature.
• Use smartphone and computer applications that reduce blue light emission.
• Wear blue light-blocking glasses or install apps that filter blue/green wavelengths.
• Avoid looking at bright screens beginning 2-3 hours before bed.

Sleep disorders

Insomnia

This is the inability to fall asleep or stay asleep. It can be caused by stress, jet lag, health conditions, medications, or caffeine consumption. Insomnia can also be caused by other sleep disorders or mood disorders such as anxiety and depression. It is characterised by difficulty falling asleep, maintaining sleep, or waking up too early.

Sleep Apnea

A breathing disorder characterised by temporary pauses in breathing during sleep, often resulting in frequent awakenings. It can cause exhaustion during the day, irritability, and decreased productivity. Sleep apnea is a potentially life-threatening condition that requires immediate medical attention.

Restless Leg Syndrome (RLS)

This disorder causes an urge to move the legs or arms at night due to uncomfortable sensations. It often occurs when resting or lying down and can be relieved by moving or massaging the affected limbs.

Hypersomnia

Hypersomnia is the inability to stay awake during the day. This includes narcolepsy, which causes extreme daytime sleepiness. People with hypersomnia may find themselves falling asleep multiple times throughout the day.

Circadian Rhythm Disorders

These disorders occur when there is a misalignment between your internal body clock and the external light-dark cycle. This can lead to insomnia symptoms and excessive daytime fatigue. Jet lag and shift work are common causes of circadian rhythm disorders.

Parasomnia

Parasomnia involves unusual behaviours, movements, or experiences while falling asleep, sleeping, or waking up. This includes sleep talking, sleepwalking, nightmares, sexsomnia, night terrors, and sleep paralysis.

If you suspect you may have a sleep disorder, it is important to seek professional help. A healthcare provider can use your medical history, sleep history, and physical examination to diagnose and recommend appropriate treatments for your specific disorder.

Hormonal changes

Menstrual Cycle

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 drop, causing the uterine lining to shed and starting the menstrual cycle. This sudden dip in progesterone levels can make it challenging for some women to get quality sleep during the days leading up to their period.

Pregnancy

Pregnancy is a time of significant hormonal fluctuations, with both progesterone and estrogen levels surging to support the growing fetus. During the first trimester, progesterone levels rise exponentially, while estrogen levels also skyrocket. This may explain why many women experience drowsiness and take more naps during the initial 12 weeks of pregnancy. However, by the third trimester, progesterone and estrogen levels usually stabilize.

Menopause

As women approach menopause, they experience a dramatic drop in estrogen levels, which can profoundly affect sleep quality. Mood swings, hot flashes, and night sweats associated with low estrogen levels can make it challenging to relax and get a restful night's sleep. Additionally, lower progesterone levels during menopause can contribute to irritability and difficulty relaxing.

Polycystic Ovary Syndrome (PCOS)

Women with PCOS often have irregular periods, higher testosterone levels, and lower progesterone levels. These hormonal irregularities can exacerbate sleep difficulties. Furthermore, studies indicate that women with PCOS are at a higher risk of developing sleep apnea, a disorder that causes brief periods of breathing cessation during sleep.

Thyroid Hormones

Thyroid hormones play a crucial role in regulating metabolic rate and digestion. An overactive thyroid (hyperthyroidism) can lead to restlessness and difficulty falling or staying asleep. On the other hand, an underactive thyroid (hypothyroidism) can result in fatigue and is linked to sleep apnea, contributing to daytime fatigue.

Cortisol and Melatonin

Cortisol, often referred to as the stress hormone, and melatonin, the sleep hormone, work together to regulate sleep patterns. Stress, sugar intake, and exposure to blue light from electronic devices can disrupt the balance between these two hormones, leading to impaired sleep.

Frequently asked questions