Sleep Eludes Me Every Other Night: Why?

Sleep is essential for our health and well-being, but many people struggle to get a good night's rest. Insomnia, which affects about 10% of the world's population, is characterised by difficulty falling or staying asleep, and can have a significant impact on daily life. There are many potential causes of insomnia, including lifestyle factors such as stress, caffeine consumption, and the use of electronic devices before bed. Additionally, underlying health conditions, such as anxiety, depression, and chronic pain, can also contribute to sleep disturbances. Addressing these issues and practising good sleep hygiene, such as maintaining a consistent sleep schedule and creating a comfortable sleep environment, can help improve sleep quality.

Lifestyle factors: Drinking alcohol, eating, and consuming caffeine too close to bedtime can disrupt sleep

Lifestyle choices can have a significant impact on the quality of your sleep. Here are some ways in which drinking alcohol, eating, and consuming caffeine too close to bedtime can disrupt your sleep:

Alcohol

While a nightcap may help you fall asleep, alcohol can also cause interruptions later in the night. It can disrupt your sleep architecture, the way your body cycles through the four stages of sleep. Typically, a sleep cycle begins with three non-rapid eye movement (NREM) stages of sleep, followed by the rapid eye movement (REM) stage. When you go to bed with alcohol in your system, you are likely to experience more deep sleep and less REM sleep. Later in the night, once your body has metabolised the alcohol, you may experience frequent wakings and fragmented sleep.

Alcohol can also disrupt your sleep by contributing to sleep disorders and interfering with your circadian rhythm. It can aggravate snoring and sleep apnea, causing more breathing-related sleep issues. For those with central sleep apnea, alcohol interferes with the brain's ability to receive chemical messages involved in breathing, decreasing respiratory drive and increasing the likelihood of pauses in breathing.

Additionally, heavy alcohol use can lead to the development of insomnia. As many as three-quarters of people with alcohol dependence experience insomnia symptoms when they drink. The opposite is also true; people with insomnia have an increased risk of developing alcohol use disorder, as they may turn to alcohol as a sleep aid.

Experts recommend avoiding alcohol at least three hours before bedtime. However, this may vary depending on individual factors such as the number of drinks consumed, drinking on an empty stomach, sensitivity to alcohol, and the use of certain medications.

Eating

Consuming a large meal within a few hours of bedtime can lead to heartburn, making it difficult to fall asleep and stay asleep. It is advisable to avoid lying down with a full stomach to prevent heartburn and promote better sleep.

Caffeine

Caffeine, found in coffee, tea, and sodas, blocks a brain chemical called adenosine that helps you sleep. Even if you are able to fall asleep after consuming caffeine later in the day, it can still impact your sleep stages without you realising it. The effects of caffeine can linger for hours, disrupting your sleep quality.

To minimise the impact of caffeine on your sleep, it is recommended to eliminate caffeinated products at least eight hours before bedtime. This guideline may vary depending on individual sensitivity to caffeine.

Medical conditions: Anxiety, depression, chronic pain, and enlarged prostate can cause sleep issues

Anxiety

Anxiety is a common cause of sleep issues. Excess worry and fear make it harder to fall asleep and stay asleep through the night. Sleep deprivation can, in turn, worsen anxiety, creating a negative cycle involving insomnia and anxiety disorders. Research has shown that people with insomnia have a tenfold higher risk of developing depression than people who get a good night's sleep. Furthermore, among people with depression, 75% have trouble falling asleep or staying asleep.

Depression

Depression and sleep issues are closely linked. Sleep experts say that either one can be the starting point. Poor sleep may create difficulties regulating emotions, which may leave you more vulnerable to depression in the future. On the other hand, depression is associated with sleep difficulties such as shortening the amount of restorative slow-wave sleep a person gets each night.

Chronic Pain

Chronic pain and sleep issues are bidirectionally linked. Sleep deprivation can increase pain sensitivity, and pain can disrupt sleep. This creates a vicious cycle that amplifies over time.

Enlarged Prostate

An enlarged prostate can cause frequent nighttime urination, which can lead to sleep deprivation and impaired quality of life. According to the American Urological Association, about 1 in 3 adults over the age of 30 experience nocturia, making it one of the most annoying urinary symptoms for men with an enlarged prostate.

Sleep disorders: Insomnia, sleep apnea, and restless leg syndrome can prevent restful sleep

Sleep disorders such as insomnia, sleep apnea, and restless leg syndrome can prevent you from getting a good night's rest. Insomnia is a common condition, affecting around 1 in 3 adults worldwide, and is characterised by trouble falling or staying asleep. It can be acute (short-term) or chronic (long-term), with the latter known as insomnia disorder. The effects of insomnia can vary, ranging from minor inconvenience to significant disruption. While it is usually not dangerous, severe or long-lasting insomnia can lead to sleep deprivation, causing daytime sleepiness and increasing the risk of high blood pressure, obstructive sleep apnea, and conditions involving psychosis.

There are various techniques to help with insomnia. These include controlled breathing, body scan meditation, progressive muscle relaxation, and visualisation techniques such as Dr Andrew Weil's 4-7-8 breathing method. Additionally, good sleep hygiene practices, such as maintaining a consistent sleep schedule, optimising your bedroom environment, and avoiding caffeine and alcohol close to bedtime, can also help improve sleep quality.

Sleep apnea is a disorder characterised by disrupted breathing during sleep. It can cause frequent interruptions in sleep, leading to daytime fatigue and sleepiness. Obstructive sleep apnea, the most common form, occurs when the throat muscles relax and block the airway, while central sleep apnea involves the brain not sending proper signals to the muscles controlling breathing. Treatment options for sleep apnea include the use of continuous positive airway pressure (CPAP) machines, oral appliances, and, in some cases, surgery.

Restless leg syndrome (RLS) is a condition that causes an overwhelming urge to move the legs, often accompanied by uncomfortable sensations. It typically occurs at rest or during sleep, and the sensations can range from mild to irritating or painful. RLS can lead to insomnia or sleep deprivation due to the difficulty in falling asleep or staying asleep. Treatment options for RLS include medications such as dopaminergic agents, benzodiazepines, and opioids, as well as lifestyle changes such as regular exercise, a balanced diet, and stress management.

Age: Older adults often experience interrupted sleep and shifts in their sleep-wake cycle

Age plays a significant role in the quality of sleep an individual gets. Older adults often experience interrupted sleep and shifts in their sleep-wake cycles due to various reasons.

Firstly, older adults may experience a shift in their circadian rhythm or sleep-wake cycle, causing them to feel sleepy earlier in the evening and wake up earlier in the morning. This shift can result in early morning awakenings, where they wake up earlier than desired and struggle to fall back asleep.

Secondly, age-related changes in the phase and amplitude of circadian rhythms can contribute to sleep interruptions. The timing of circadian rhythms, such as body temperature, melatonin, and cortisol levels, tend to move earlier in older adults compared to younger individuals. The amplitude of these rhythms, including those of body temperature and melatonin, also tends to decrease with age.

Additionally, older adults may have difficulty sleeping at adverse circadian phases. Their sleep is more sensitive to the circadian time at which it occurs, making them more vulnerable to circadian rhythm sleep-wake disorders like jet lag disorder and shift work disorder. As a result, older adults may find it challenging to adjust their sleep schedules when travelling across time zones or working night shifts.

Moreover, certain medical conditions and lifestyle factors common in older adults can disrupt their sleep. For example, chronic diseases such as heart failure, arthritis, and neurological conditions can impact sleep quality. Mental health issues like anxiety and depression are also prevalent in older adults and can lead to sleep disturbances.

Furthermore, older adults may experience pain and discomfort due to conditions like arthritis, making it challenging to fall asleep or maintain restful sleep. They may also need to urinate more frequently during the night (nocturia), disrupting their sleep patterns.

To improve sleep quality, older adults can make lifestyle changes such as maintaining a consistent sleep schedule, avoiding stimulants like caffeine, and engaging in regular physical activity. Creating a relaxing bedtime routine and optimizing their sleep environment by reducing noise and light can also help promote better sleep.

In summary, age-related factors, medical conditions, and lifestyle choices can contribute to interrupted sleep and shifts in sleep-wake cycles in older adults. By understanding these factors and making appropriate adjustments, older adults can improve their sleep quality and overall well-being.

Medication: Certain drugs, like antidepressants and beta-blockers, may contribute to sleep problems

Medication can be a significant factor in sleep problems, with certain drugs known to contribute to disrupted sleep. Here are some ways in which medication can impact sleep:

Antidepressants

Antidepressants are typically prescribed to treat depression or anxiety, and while they can be effective, they may also have side effects that disrupt sleep. For example, within the selective serotonin reuptake inhibitors (SSRIs) class of drugs, fluoxetine (Prozac) can be stimulating and make it difficult to fall or stay asleep. On the other hand, paroxetine (Paxil) from the same class can be more sedating and cause sleepiness. The antidepressant bupropion (Wellbutrin) is also known to be stimulating and may cause insomnia in some individuals.

Beta-blockers

Beta-blockers, such as metoprolol (Lopressor, Toprol XL) and atenolol (Tenormin), are commonly used to treat high blood pressure or an irregular heartbeat. One notable side effect of these medications is their potential to decrease the body's natural levels of melatonin, a hormone that plays a crucial role in regulating sleep-wake cycles. As a result, beta-blockers can make it challenging for some individuals to fall or stay asleep. Additionally, beta-blockers have been linked to sleep-related issues like unusual dreams, insomnia, and sleep disorders.

Other Medications

Aside from antidepressants and beta-blockers, other types of medication can also impact sleep. For instance, decongestants like phenylephrine and pseudoephedrine, which are used to treat nasal congestion, can be stimulating and lead to insomnia in certain people. Diuretics, prescribed for high blood pressure and kidney or liver disorders, can interrupt sleep by increasing the urge to urinate during the night. Smoking-cessation drugs, both over-the-counter and prescription, have also been associated with unusual dreams, nightmares, and sleep disturbances. Oral steroids, such as prednisone, which is used to reduce inflammation, can disrupt the sleep cycle by stimulating the production of cortisol, a stress hormone.

Frequently asked questions