Staying Up Late: Why Can't I Sleep?

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Feeling tired and not being able to sleep is a common problem. Insomnia is a sleep disorder characterised by difficulty falling asleep, staying asleep, or getting the amount of sleep you need to wake up feeling rested. It can be acute (lasting one to several nights) or chronic (occurring three times a week for at least three months).

There are many reasons why you might feel tired but can't sleep. You may be overtired, which is common in people with busy lives and high expectations of their social and professional lives. Exercising too late in the day, consuming stimulants such as caffeine and nicotine, and an active mind can also be factors.

If you're struggling to fall asleep, there are several techniques you can try, such as controlled breathing, meditation, muscle relaxation, visualisation, and autogenic training.

Characteristics of 'Don't feel tired, can't sleep'

Characteristics Values
Difficulty Falling asleep, staying asleep, or getting the amount of sleep you need to wake up feeling rested
Frequency Acute (lasting one to several nights) or chronic (occurring three times a week for at least three months)
Causes Underlying medical or psychiatric conditions, medication side effects, or lifestyle factors
Symptoms Difficulty falling asleep, frequent wake-ups during the night, waking up too early, difficulty concentrating
Risk Factors Age (common in thirty- and forty-somethings), gender (more common in women)
Complications Reduced life expectancy, heart problems, compromised immunity, obesity, diabetes, seizures, asthma
Treatment Relaxation techniques, sleep hygiene, cognitive behavioral therapy, medication

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Insomnia: the inability to fall asleep, stay asleep, or get sufficient sleep

Insomnia is a sleep disorder characterised by the inability to fall asleep, stay asleep, or get sufficient sleep. It is incredibly common, with about 30% of American adults experiencing some form of insomnia, and it is more prevalent in women than in men. Insomnia can be acute, lasting one to several nights, or chronic, occurring at least three times a week for a minimum of three months.

There are several factors that can contribute to insomnia. These include underlying medical or psychiatric conditions, medication side effects, and lifestyle factors. Identifying the root cause of insomnia is crucial, and addressing these factors can help improve sleep quality.

  • Optimise your sleep environment: Create a bedroom that is cool, dark, and comfortable. Invest in a good mattress and pillows, as uncomfortable bedding can hinder sleep quality.
  • Dim the lights: Bright lights before bed can negatively impact your sleep duration and quality. Dim the lights as bedtime approaches, and consider using light bulbs with a "colour temperature" below 3,000 kelvins, which have less impact on your nervous system.
  • Reduce screen time: The blue light emitted by electronic screens can disrupt your body's natural sleep preparation. Turn off TVs, phones, and computers at least an hour before bedtime. If this is not possible, consider using blue-light-blocking glasses.
  • Minimise noise: Disturbing noises can interrupt your sleep. Use a bedside fan, white noise machine, or soothing sleep sounds to mask unwanted sounds.
  • Maintain a cool temperature: A cool bedroom promotes restful sleep. Set your thermostat between 60 and 75°F, and experiment to find your ideal temperature.
  • Block out light: Use heavy curtains, blackout shades, or an eye mask to block out light. Even the small light from charging devices can disrupt sleep, so charge your phone and laptop outside the bedroom.
  • Establish a sleep routine: Develop a consistent sleep-wake schedule, even on weekends. Stick to the same bedtime and wake-up time to train your body to fall asleep more easily.
  • Set aside "worry time": Allocate 15 minutes during the day to address problems and concerns. This helps prevent these thoughts from keeping you awake at night.
  • Adopt healthier habits: Improve your overall health and sleep by maintaining a balanced diet, exercising regularly, and finding effective ways to manage stress.
  • Avoid caffeine and nicotine: These stimulants can make it challenging to reduce arousal and initiate sleep. Limit caffeine intake and avoid it completely in the second half of the day to ensure it's out of your system by bedtime.
  • Nap wisely: Short naps of 10 to 20 minutes during the day can boost your energy and creativity. However, avoid napping for longer than 20 minutes, as it may disrupt your nighttime sleep.
  • Increase natural light exposure: Expose yourself to natural light during the day to promote a healthy balance of melatonin, the sleep hormone.
  • Consider supplements: Magnesium and B vitamins may enhance sleep quality. Additionally, natural supplements like valerian, tryptophan, and melatonin can promote sleep, although their effectiveness varies. Always consult your doctor before taking any supplements.
  • Relax and unwind: Engage in relaxation techniques such as meditation, yoga, deep breathing, and progressive muscle relaxation. These practices can help calm your mind and body, making it easier to fall asleep.
  • Avoid large meals close to bedtime: Eating a big meal before bed can cause discomfort and hinder sleep. Finish dinner at least a few hours before bedtime to give your body time to digest.
  • Limit alcohol: While alcohol may seem calming, it can disrupt your sleep cycles. If you choose to drink, do so with dinner and avoid nightcaps.
  • Engage in soothing activities: Before bed, avoid stimulating activities such as work, watching intense TV shows or movies, or reading complex material. Instead, opt for relaxing activities like gentle yoga, meditation, or listening to soothing music.
  • Visualise yourself asleep: Use deep breathing and progressive muscle relaxation techniques while visualising yourself drifting into a peaceful slumber.
  • Seek therapy: Cognitive Behavioural Therapy for Insomnia (CBT-I) is a common technique that involves self-monitoring, developing positive thoughts about sleep, and creating a sleep-promoting environment. It has been shown to improve sleep quality.
  • Consult a healthcare professional: If insomnia persists despite your efforts, reach out to a doctor or sleep specialist. They can help identify any underlying sleep disorders, health issues, or medications that may be interfering with your sleep.
Heartless Insomnia: Glick's Tale

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Sleep paralysis: a person is conscious but unable to move

Sleep paralysis is a temporary condition in which a person is conscious but unable to move or speak. It occurs when an individual is stuck between sleep phases, usually during the rapid eye movement (REM) stage of the sleep cycle. During an episode, you may feel scared or anxious and experience hallucinations that can be frightening.

Sleep paralysis is not typically dangerous, but it can cause emotional distress. It is often linked to other sleep disorders, such as narcolepsy, and mental health conditions like anxiety, bipolar disorder, post-traumatic stress disorder (PTSD), or panic disorder. It is also associated with irregular sleep schedules, sleep deprivation, and sleeping on your back.

While there is no treatment to stop sleep paralysis during an episode, there are strategies to help manage it. These include focusing on moving one body part at a time and making small movements, such as wiggling your fingers or toes. Additionally, improving sleep hygiene can help prevent sleep paralysis and reduce its frequency. This includes maintaining a consistent sleep schedule, creating a comfortable sleep environment, limiting screen time before bed, and managing stress.

If you experience frequent sleep paralysis or if it interferes with your daily life, it is recommended to consult a healthcare provider or a sleep specialist for further evaluation and treatment.

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Sleep and mental health: the bidirectional relationship between sleep and mental health

Sleep is often described as a pillar of well-being, and its complex relationship with mental health is being increasingly studied. Research has shown a strong connection between sleep quality and mental health, indicating that one often influences the other. This is known as a bidirectional relationship.

The Impact of Sleep on Mental Health

Chronic poor sleep has been proven to affect mood, amplifying feelings of sadness, anxiety, and stress. Persistent sleep disturbances are linked to heightened risks for several mental health disorders, including depression, bipolar disorder, and even ADHD. Sleep disturbances can also be a symptom of these disorders, creating a vicious cycle.

Mental Health Disorders and Sleep

Depression

Around 75% of people with depression experience insomnia, and many also suffer from excessive daytime sleepiness and hypersomnia. Poor sleep may induce or exacerbate depression, and vice versa, creating a negative feedback loop.

Anxiety Disorders

Anxiety disorders are strongly associated with sleeping problems. Worry and fear contribute to a state of hyperarousal, which is a central contributor to insomnia. Sleep problems may become an additional source of worry, creating anticipatory anxiety that makes it harder to fall asleep.

Post-Traumatic Stress Disorder (PTSD)

PTSD is linked to sleep disturbances, with sufferers frequently replaying negative events in their minds, suffering from nightmares, and experiencing a state of hyperarousal, all of which can interfere with sleep.

Bipolar Disorder

During manic periods, people with bipolar disorder usually feel less need to sleep, but during depressed periods, they may sleep excessively. Sleep problems can induce or worsen manic and depressive periods.

Schizophrenia

People with schizophrenia are more likely to experience insomnia and circadian rhythm disorders. Poor sleep and symptoms of schizophrenia may be mutually reinforcing.

Attention-Deficit/Hyperactivity Disorder (ADHD)

Sleeping problems are common in people with ADHD, who may have difficulty falling asleep, frequent awakenings, and excessive daytime sleepiness. Sleep problems may be a consequence of ADHD, but they can also aggravate symptoms such as reduced attention span and behavior problems.

Autism Spectrum Disorder (ASD)

Children and adolescents with ASD have a higher prevalence of sleep problems, including insomnia and sleep-disordered breathing. Addressing insomnia and other sleep disturbances is an important component of care as it may decrease excessive daytime sleepiness and other health and behavior problems.

Improving Sleep and Mental Health

The complex relationship between sleep and mental health means that treatment for both issues can go hand-in-hand. Improving sleep may form part of a preventive mental health strategy, and there are various solutions tailored for those grappling with sleep disturbances rooted in mental health issues.

Cognitive Behavioral Therapy (CBT)

CBT examines patterns of thinking and works to reformulate negative thoughts. It can help improve both sleep and mental state, and CBT for insomnia (CBT-I) has proven effective in reducing sleeping problems and improving emotional well-being.

Relaxation Techniques

Techniques such as progressive muscle relaxation, deep breathing exercises, meditation, and visualization can help calm an anxious or restless mind, preparing it for sleep.

Sleep Environment Optimization

A conducive sleep environment can aid those struggling with mental health issues. This includes maintaining a dark, cool room, using white noise machines if needed, and ensuring a comfortable mattress and pillows.

Limiting Stimulants and Alcohol

Reducing the intake of caffeine, nicotine, and alcohol, especially before bedtime, can promote deeper, uninterrupted sleep.

Structured Sleep Schedule

Establishing a regular sleep-wake cycle by going to bed and waking up at the same time daily can reinforce the body's natural circadian rhythm, aiding in better sleep quality.

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Circadian rhythm sleep disorders: disruptions to the internal biological clock

Circadian rhythm sleep disorders are disruptions to a person's internal biological clock, which regulates biological processes such as brain wave activity, hormone production, and cell regeneration. This 24-hour cycle, also known as the circadian rhythm, is linked to light cues from the environment, influencing when we feel sleepy or alert. When this rhythm is disrupted, individuals may experience excessive sleepiness, decreased alertness, and problems with memory and decision-making.

There are several types of circadian rhythm sleep disorders, including:

  • Jet lag disorder: This occurs when an individual travels across multiple time zones, resulting in a misalignment between their internal clock and the external environment.
  • Shift work sleep disorder (SWSD): This affects individuals who work night shifts or rotating shifts, as their work schedule conflicts with their natural sleep-wake cycle.
  • Delayed sleep-wake phase disorder (DSWPD): Individuals with this disorder have a sleep/wake schedule that is significantly delayed compared to the average person, making it challenging for them to maintain a conventional daily routine.
  • Advanced sleep-wake phase disorder (ASWPD): In contrast to DSWPD, individuals with ASWPD tend to go to bed and wake up much earlier than others.
  • Irregular sleep-wake rhythm disorder (ISWRD): This disorder is commonly observed in individuals with degenerative brain diseases, where sleep and wake times occur at unpredictable intervals.
  • Non-24-hour sleep-wake rhythm disorder (N24SWD): In this disorder, the individual's circadian rhythm deviates from the typical 24-hour cycle, resulting in a longer or shorter sleep-wake cycle.

The symptoms of these disorders can vary, but commonly include insomnia, difficulty staying asleep, and trouble falling back asleep. Treatment options may involve adjusting lighting, taking melatonin supplements, and implementing sleep behavior adjustments, such as maintaining a consistent sleep schedule and avoiding bright lights and electronic screens before bedtime.

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Sleep deprivation: the symptoms, causes, and effects of insufficient sleep

Sleep deprivation is a condition that affects people who don't get enough sleep or don't get good quality sleep. It can be a short-term issue, lasting one or a few nights, or it can be a chronic problem lasting weeks, months, or even years. Sleep deprivation interferes with everyday activities and can worsen other health conditions. It is a very common problem, with 50-70 million US adults experiencing it at any given time.

Symptoms

The symptoms of sleep deprivation vary depending on its duration and cause. Common symptoms include:

  • Trouble thinking, focusing, and remembering
  • Slowed reaction times
  • "Microsleeps," or brief episodes of sleep lasting a few seconds
  • Uncontrollable eye movements (nystagmus)
  • Drooping eyelids (ptosis)
  • Hallucinations
  • Impulsive or reckless behavior

As sleep deprivation becomes more severe and prolonged, symptoms can intensify and resemble alcohol intoxication. These severe symptoms include:

  • Intense hallucinations
  • Extreme confusion
  • Inability to communicate
  • Difficulty distinguishing reality from hallucinations

Causes

Sleep deprivation can be caused by various factors, including:

  • Shift work, especially night shifts
  • Alcohol use, especially misuse
  • Use of stimulants like caffeine late in the day
  • Poor sleep habits and hygiene
  • Sleeping in a new or unfamiliar place
  • Underlying medical conditions such as sleep apnea, degenerative brain disorders, mental health issues, and short-term illnesses

Effects

Sleep deprivation can have far-reaching effects on the body and mind, impacting multiple systems and processes:

  • Heart and circulatory systems: Chronic sleep deprivation increases the risk of high blood pressure and high cholesterol.
  • Metabolic systems: Lack of sleep raises the likelihood of developing Type 2 diabetes.
  • Immune system: Insufficient sleep weakens the body's defences against infections.
  • Nervous system: Sleep-deprived individuals often experience higher pain sensitivity.
  • Brain: Sleep plays a crucial role in brain function, learning, and memory. Sleep deprivation may also be a factor in Alzheimer's disease development.
  • Mental health: Sleep deprivation makes it challenging to manage emotions and increases the risk of depression and anxiety symptoms.

Treatment and Prevention

Sleep deprivation is usually treatable, and individuals can often manage it by adjusting their sleep habits and routines. Behavioural changes, such as establishing a consistent sleep schedule and improving sleep hygiene, are often recommended. In some cases, medication or breathing support methods may be necessary.

To prevent sleep deprivation, it is essential to prioritise sleep and create a bedtime routine that ensures you get the recommended amount of sleep for your age. Limiting screen time and bright lights before bed, avoiding alcohol and heavy meals close to bedtime, and engaging in physical activity can also help improve sleep quality.

Frequently asked questions

Feeling tired and feeling sleepy are two different things. A person might feel extremely fatigued but not be ready for sleep. Feeling sleepy is a discriminative stimulus for sleep, meaning it predicts sleep is about to occur. Signs that you are sleepy include itchy eyes, a lack of energy, aching muscles, yawning and a tendency to “nod off”.

Try to relax and reduce over-arousal. People with sleep problems often have difficulty relaxing and 'letting-go'. Try different activities to see what works for you. For example, you could try meditation, deep breathing, or progressive muscle relaxation.

Try Cognitive Behavioral Therapy (CBT). CBT trains you to use techniques that help overcome the negative emotions that come with being unable to sleep. It can also help you establish a healthy sleep pattern and achieve a strong connection between bed and successful sleep.

Your bedroom should be quiet, dark, and cool, and your bed should be comfortable. Make sure your bedroom is optimally set up for sleep.

Get at least 30 minutes of natural light early in the day, maintain a consistent sleep schedule, and avoid caffeine at least eight hours before bed.

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