Fighting Sleepiness: Strategies For Staying Awake

Feeling tired but unable to sleep is a common problem that can be caused by a variety of factors, including poor sleep hygiene, an irregular sleep schedule, stress and anxiety, hormonal changes, caffeine consumption, and the use of electronic devices before bed. This phenomenon, known as bedtime procrastination, can lead to a vicious cycle of fatigue, irritability, and anxiety, further perpetuating sleeplessness and stress. Understanding and addressing these factors is crucial for improving sleep quality and overall health.

Stress and anxiety

Feeling tired but unable to sleep can be a symptom of stress and anxiety. Sleep anxiety is a common feeling of stress or fear about going to sleep. It can be a phobia about sleep, known as somniphobia, where one might think something bad will happen to them while they sleep.

Anxiety is a hard-wired response in the nervous system, alerting you to threats in your environment. It can be helpful in certain situations, but it can also be extremely disruptive. In modern society, there are few immediate threats to our physical safety, so feelings of anxiety can last for long periods, upsetting your sleep schedule and becoming an ongoing distraction.

Research suggests that most people with mental health disorders like anxiety also experience some form of sleep disruption. Sleep deprivation can, in turn, worsen anxiety, creating a negative cycle of insomnia and anxiety.

• Deep breathing exercises before bed can activate a calming response through the parasympathetic nervous system.
• Listen to relaxing music, affirmations, or guided meditations with nature sounds.
• Reduce or eliminate substances that can affect your anxiety, such as alcohol, nicotine, and caffeine.
• Avoid eating large meals or spicy foods before bed, as your digestive system is more sensitive when you feel anxious or stressed.
• Get out of bed if you feel anxious and try to associate your bed with peaceful and restful feelings.
• Avoid checking social media or reading the news before bed.
• Discuss medication side effects with your doctor, as some medications can disrupt sleep.
• Write down your worries and to-dos before bed to help free up mental space.
• Maintain a regular sleep schedule and bedtime routine.
• Avoid stimulating activities before bed, such as watching TV or scrolling through social media.
• Focus your mental energy on something soothing, such as white noise or a calming visual image.
• Create a comfortable sleep environment that is cool, dark, quiet, and free from distractions.
• Consider sleeping with a weighted blanket, which can help ease anxiety.
• Practice relaxation techniques such as meditation, yoga, exercise, and massage therapy.

Hormones

Melatonin

Melatonin is a natural hormone produced by the pineal gland. It plays a key role in adjusting your body clock and regulating sleep. Darkness increases melatonin production, indicating that it is time to go to sleep, while light decreases its production, signalling the body to stay awake.

Serotonin

Serotonin is a neurotransmitter that controls the sleep-wake cycle and helps maintain energy and a positive mood. It can be converted into melatonin in the pineal gland. Abnormal levels of serotonin may cause sleeping problems.

Oestrogen

Oestrogen is the primary female sex hormone, promoting the growth and maintenance of the female reproductive organs. It also allows the body to use serotonin effectively. Low levels of oestrogen are associated with poor sleep and decreased energy levels, particularly during menopause.

Progesterone

Progesterone is another crucial sex hormone, which aids in the production of gamma-aminobutyric acid (GABA), promoting sleep. Progesterone levels tend to be highest towards the end of the menstrual cycle, leading to increased GABA production and better sleep. However, at the beginning of the cycle and during menopause, progesterone levels decrease, which may result in tiredness.

Testosterone

Testosterone is a sex hormone produced by both males and females, although men produce more. It plays a role in the reproductive system and improves muscle and bone mass in males. Poor sleeping patterns may reduce testosterone levels, as they increase during REM sleep.

Cortisol

Cortisol is often called the "stress hormone" as it modulates the body's stress response. When the body is not functioning properly, cortisol can spike at the wrong time, causing sleep difficulties and leading to fatigue. Long-term stress can also affect the adrenal glands, leading to chronic fatigue.

Thyroid Hormones

The thyroid gland produces hormones that control metabolism. An underactive thyroid (hypothyroidism) can cause fatigue, depression, and memory problems, while an overactive thyroid (hyperthyroidism) may result in anxiety, restlessness, and sleep issues.

Other Factors Influencing Hormones and Sleep

In addition to hormonal imbalances, other factors can impact sleep and energy levels. These include:

• Caffeine consumption
• Blue light from electronic devices
• Diet
• Stress and anxiety
• Sleep disorders, such as delayed sleep phase syndrome, sleep apnea, and restless legs syndrome
• Napping habits
• Medication and drug use
• Obesity
• Shift work

Caffeine, alcohol, and large meals

Caffeine, a stimulant, is a popular way to boost energy levels and stay alert. It is found in coffee, tea, energy drinks, soda, snack foods, and medications. However, it is important to understand that caffeine does not affect everyone the same way. While some people can consume multiple cups of caffeinated drinks without any adverse effects, others may feel tired after just one cup.

Adenosine Blockage

Adenosine is a chemical in the central nervous system that regulates the sleep-wake cycle. Caffeine blocks adenosine receptors in the brain from receiving adenosine. However, caffeine does not stop the production of adenosine or the formation of additional receptors. So, when the effects of caffeine wear off, there is a buildup of adenosine, leading to feelings of tiredness.

Diuretic Effects

Caffeine is a diuretic, which means it can make you urinate more frequently. This can lead to dehydration, which in turn causes fatigue and sluggishness. The cycle of dehydration and caffeine consumption can be challenging to break.

Blood Sugar Increase

Caffeine can increase blood sugar levels by reducing insulin sensitivity. People with high blood sugar may experience fatigue, among other symptoms, until their blood sugar levels return to normal.

Tolerance Build-up

Regular caffeine consumers can develop a tolerance to its stimulant effects. As a result, they may need to increase their caffeine intake over time to achieve the same level of alertness.

Interaction with Alcohol

Mixing caffeine with alcohol is not recommended. Caffeine can block the brain from feeling the depressant effects of alcohol, which may lead to overconsumption of alcohol and increased impairment.

Other Considerations

Caffeine can also cause jitteriness, rapid heart rate, nervousness, and anxiety in some individuals. Additionally, it is important to be mindful of the sugar content in caffeinated drinks, as excess sugar can lead to energy crashes.

To minimize fatigue related to caffeine consumption, it is recommended to stick to a moderate intake of up to 400 milligrams (mg) of caffeine per day for adults. This is equivalent to about two to four 8-ounce cups of brewed coffee, depending on the coffee mixture. It is also suggested to avoid coffee-based drinks with sugary syrups and creams and limit the use of added sweeteners. Alternating between caffeinated drinks and water can help maintain hydration and reduce the risk of dehydration-related fatigue.

In summary, while caffeine can be an effective way to boost energy and improve alertness, it is important to be mindful of potential side effects, including tiredness. Understanding how caffeine affects your body and consuming it in moderation can help minimize negative consequences.

Screen time

To mitigate the impact of screen time on sleep, it is recommended to avoid screens for at least one to two hours before bedtime. This includes activities such as watching TV, using a laptop, or scrolling through your phone. Instead, opt for calming activities like reading, journaling, or meditation. If you must use screens before bed, consider lowering the brightness and volume, and try to enforce a screen ban for at least the last hour before you plan to sleep.

Additionally, blue-light blocking glasses can be helpful in reducing the impact of screen time on your sleep. These glasses can be worn in the evening to minimize blue light exposure and help signal to your body that it's time to wind down. Another strategy is to install blue light filters on your electronic devices, which will also reduce your overall exposure.

It's important to note that while screen time can impact sleep, there are also other factors at play, such as stress, anxiety, caffeine consumption, and sleep disorders. Addressing these issues in conjunction with managing screen time will help improve your sleep quality.

Sleep disorders

Insomnia

Insomnia is the most common sleep disorder, affecting about one-third of adults. It involves problems with falling and/or staying asleep. To be diagnosed with insomnia disorder, sleep difficulties must occur at least three nights a week for at least three months and cause significant distress or problems at work, school, or other important areas of a person's daily functioning.

Sleep Apnea

Sleep apnea is a breathing disorder characterised by interruptions in breathing during sleep, lasting for 10 seconds or more. This can cause snoring, snorting/gasping, or breathing pauses. Sleep apnea is diagnosed through a clinical sleep study and is treated with lifestyle changes, mouthpieces, or a CPAP (continuous positive airway pressure) device.

Restless Leg Syndrome (RLS)

RLS involves a tingling or prickly sensation in the legs, along with a powerful urge to move them. The symptoms occur at least three times a week, lasting for at least three months, and cause significant distress or problems in daily functioning.

Hypersomnia

Hypersomnia is a condition where individuals are unable to stay awake during the day, experiencing extreme daytime sleepiness. This includes narcolepsy, which causes sudden lapses into sleep multiple times within the same day.

Circadian Rhythm Disorders

Circadian rhythm disorders are problems with the sleep-wake cycle, making it difficult to sleep and wake at the right times. These disorders can be caused by internal factors, such as a person's body clock being out of sync, or external factors like shift work or jet lag.

Parasomnia

Parasomnia involves acting in unusual ways while falling asleep, sleeping, or waking from sleep, such as walking, talking, or eating.

Symptoms of Sleep Disorders

Signs that you may have a sleep disorder include regularly taking more than 30 minutes to fall asleep, frequently waking up during the night, feeling sleepy during the day, and snoring loudly or making choking sounds during sleep.

Diagnosis and Treatment

Frequently asked questions