Insomnia: Battling The Nightly Struggle Of Not Wanting Sleep

Not wanting to sleep is a common issue, with many factors influencing an individual's reluctance to sleep. One key factor is smartphone use, with adults who procrastinate about sleep spending an average of 80 minutes on their devices before bed, compared to 18 minutes for non-procrastinators. This phenomenon is known as revenge bedtime procrastination, where individuals put off sleep in favour of passive leisure activities, such as watching TV or browsing social media. While this may be driven by a desire for more me-time, it can have negative consequences on health, including cardiovascular issues, cognitive problems, and depression.

There are also physical reasons why individuals may struggle to sleep, such as sleep apnea, restless leg syndrome, or pain caused by conditions like arthritis. Additionally, certain medications and substances, such as caffeine, alcohol, and antidepressants, can interfere with sleep. Addressing these issues and improving sleep hygiene, such as establishing a wind-down routine and maintaining a consistent sleep schedule, can help individuals overcome their reluctance to sleep and improve their overall health and well-being.

Revenge bedtime procrastination

Causes

There are several factors that may contribute to revenge bedtime procrastination:

• Lack of free time during the day: Individuals with busy work schedules or other commitments may feel that staying up late is the only way to carve out time for themselves.
• Stress: Revenge bedtime procrastination can be a way to find relief from a stressful day or a demanding job.
• Evening chronotype: Some people are naturally inclined to be "night owls", but if they are forced to adhere to schedules designed for "early birds", they may engage in revenge bedtime procrastination.
• Self-control: Low self-control or self-regulation has been linked to bedtime procrastination. Individuals may find it challenging to regulate their device usage or may be prone to procrastination in general.
• Boredom: Boredom can increase inattention, making it easier to fall into bedtime procrastination.

Effects

• Sleep deprivation: Insufficient sleep can lead to fatigue, irritability, and impaired thinking, memory, and decision-making.
• Health risks: Long-term sleep deprivation is associated with an increased risk of cardiovascular problems, metabolic disorders, weakened immune system, and mental health issues such as depression and anxiety.
• Daytime sleepiness: Lack of sleep can impact productivity, academic achievement, and increase the risk of drowsy driving.

Strategies to prevent revenge bedtime procrastination:

• Limit screen time: Reduce the use of electronic devices, especially smartphones, at least one hour before bed.
• Relaxing routine: Establish a relaxing bedtime routine, such as reading, meditating, or stretching.
• Consistent sleep schedule: Maintain a regular bedtime and wake-up time, even on weekends.
• Avoid stimulants: Cut back on caffeine, alcohol, and tobacco, especially close to bedtime.
• Create a sleep-friendly environment: Make your bedroom dark, quiet, and comfortable.
• Address underlying issues: If these strategies don't help, consider seeking professional help to address any underlying health conditions or sleep disorders.

Circadian misalignment

Circadian rhythms are near 24-hour patterns of physiology and behaviour that are present independent of external cues including hormones, body temperature, mood, and sleep propensity. The circadian timing system cannot adjust to a "day" length that is shorter or longer than 24 hours, and thus free runs at its own endogenous period, which is slightly longer than 24 hours in humans.

The effects of circadian misalignment include:

• Sleep disturbance and/or daytime sleepiness
• Changes in feeding patterns, metabolic function, and risk for mood disorders
• Dysregulation of feeding behaviours
• Changes in appetite-stimulating hormones, glucose metabolism, and mood
• Increased risk of physical (cardiovascular disease, diabetes, obesity, cancer) and psychiatric (depression, bipolar, schizophrenia, attention deficit) disorders

Sleep anxiety

Symptoms and Causes

People with sleep anxiety may experience behavioural, emotional, or physical symptoms, such as:

• Feelings of being overwhelmed
• Inability to concentrate
• A sense of impending danger or doom
• Nocturnal panic attacks
• Difficulty falling asleep or staying asleep

The causes of sleep anxiety can vary and are often interconnected. Research has found links between sleep anxiety and insomnia, other sleep disorders, and mental health conditions such as anxiety disorders, depression, and post-traumatic stress disorder (PTSD). Sleep anxiety can also be triggered by daily stress, traumatic events, or lifestyle habits that interfere with a restful night's sleep.

Treatment

Poor sleep hygiene

Set a Sleep Schedule

• Have a fixed wake-up time: Try to wake up at the same time every day, including weekends. A fluctuating schedule disrupts your body's sleep rhythm.
• Prioritize sleep: Avoid skipping sleep to work, study, socialise, or exercise. Calculate your target bedtime based on your wake-up time and prepare for bed around that time each night.
• Make gradual adjustments: If you need to shift your sleep times, do so gradually in small steps of up to an hour or two at a time to avoid throwing off your schedule.
• Be mindful of napping: Naps can be energising, but too much or too late in the day can disrupt your nighttime sleep. Keep them short and early in the afternoon.

Follow a Nightly Routine

• Keep your routine consistent: Following the same steps each night reinforces the mental association between your routine and bedtime.
• Wind down: Take 30 minutes to calm yourself with soft music, light stretching, reading, or relaxation exercises.
• Dim the lights: Bright lights hinder melatonin production. Try to avoid bright lights before bed, and consider using blue-light blocking glasses 90 minutes beforehand.
• Unplug from electronics: The mental stimulation from devices and the blue light they emit can disrupt your sleep. Build in a 30-60 minute buffer before bed where you put the devices away.
• Test relaxation techniques: Instead of pressuring yourself to fall asleep, focus on relaxation. Techniques like meditation, mindfulness, and paced breathing can help.
• Avoid tossing and turning: If you can't sleep after 20 minutes, get up and do something calming in low light before trying again.

Cultivate Healthy Daily Habits

• Get daylight exposure: Sunlight is a key driver of circadian rhythms, encouraging quality sleep.
• Be physically active: Regular exercise improves sleep and offers other health benefits.
• Avoid nicotine: Nicotine disrupts sleep, so reduce or refrain from smoking.
• Reduce alcohol consumption: While alcohol may help you fall asleep initially, it disrupts sleep later in the night. Moderate your intake and avoid it later in the evening.
• Cut down on caffeine: As a stimulant, caffeine can keep you wired when you want to rest. Avoid it in the afternoon and evening.
• Avoid late dinners: Eating a large, heavy, or spicy meal late in the evening can disrupt sleep as your body is still digesting. Keep any pre-bed snacks light.
• Restrict in-bed activity: Using your bed only for sleep (and sex) helps build a mental association between your bed and sleep.

Optimise Your Bedroom

• Comfortable mattress and pillow: Your sleeping surface is critical for comfort and pain-free sleep, so choose wisely.
• Excellent bedding: Ensure your sheets and blankets match your needs and preferences.
• Set a cool temperature: Fine-tune the temperature to your preferences, but err on the cooler side (around 65°F or 18.3°C).
• Block out light: Use heavy curtains or an eye mask to prevent light from interrupting your sleep.
• Drown out noise: Use earplugs, a white noise machine, or a fan to block out bothersome sounds.
• Try calming scents: Light scents like lavender may induce a calmer state of mind and help create a positive space for sleep.

Depression

Sleep and depression are closely linked. People with insomnia may have a tenfold higher risk of developing depression, and among people with depression, 75% have trouble falling or staying asleep. This can create a cycle where anxious thoughts keep a person awake, leading to more anxious thoughts the next day.

If you are experiencing depression, daily stresses can lead to more nighttime wake-ups and more trouble getting back to sleep. This can be due to the impact of depression on the amount of restorative slow-wave sleep a person gets each night.

There are several treatments for depression that can help improve sleep quality. These include:

• Counselling: Several types of counselling can help treat depression, including cognitive behavioural therapy (CBT) and interpersonal therapy (IPT). CBT-I is a type of CBT that focuses on managing chronic insomnia.
• Medication: Antidepressants can improve mood and outlook, but they may not be enough to improve sleep. It may be necessary to try several different medications at various doses to find the right fit.
• Brain stimulation therapies: If medication and other treatments are ineffective, some people consider electroconvulsive therapy (ECT) or emerging methods like repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS).
• Lifestyle changes: Implementing healthy habits can help improve sleep and boost mood. This includes getting daily exercise, spending time outdoors, and keeping a consistent sleep schedule.

If you are experiencing symptoms of depression, it is important to seek help from a doctor or mental health professional. They can work with you to understand the type and severity of your depression and create a treatment plan.

Frequently asked questions