The Sleep Conundrum: Caught Between Awake And Asleep

Sleep is a vital part of our lives, but it can be difficult to get out of bed in the morning, even if we've had a full night's rest. This phenomenon is known as dysania, a non-medical term for the feeling of not wanting to get out of bed in the morning. This can be a sign of mental health issues such as depression, stress, or anxiety, which can be exacerbated by irregular sleep patterns.

On the other hand, staying in bed can also worsen symptoms of depression and insomnia. It is recommended to maintain a consistent sleep schedule and adopt healthy habits to improve overall physical health, which can positively impact sleep quality.

For those who struggle with bedtime procrastination, there are strategies to curb the habit, such as setting realistic goals, creating a calming bedtime routine, and limiting screen time before bed. Seeking professional help is also important if underlying mental health conditions are causing sleep disturbances.

Sleep procrastination and the intention-behaviour gap

Sleep procrastination is a self-regulation failure that can be defined as the voluntary delay of an intended course of action despite expecting to be worse off for the delay. It is a specific form of health behaviour procrastination, which is closely associated with the intention-behaviour gap.

The intention-behaviour gap refers to the gap between behavioural intentions for specific health behaviours and the actual behaviours. In other words, the intention to perform a health behaviour does not always translate into the behaviour itself.

Sleep procrastination can take two forms: delaying the act of getting into bed, and delaying the time of trying to fall asleep once in bed. Both forms can reduce nightly sleep.

The intention-behaviour gap in sleep can be explained by a failure in self-regulation or self-control. Our capacity for self-control is already at its lowest at the end of the day, which may facilitate sleep procrastination. Some people may be naturally inclined to procrastinate in general, including at bedtime. Additionally, daytime demands at work or school may reduce the reserves of self-control available in the evening.

Research has found that students and women are most likely to engage in bedtime procrastination. People with an evening chronotype, or "night owls", are also inclined to stay up later, which may manifest as bedtime procrastination. Sleep procrastination also appears more frequent in people who procrastinate in other aspects of their life.

To prevent sleep procrastination, it is recommended to develop a relaxing nightly routine and avoid stimulants that encourage bedtime procrastination, like smartphones. Having set routines can make behaviours feel almost automatic and reduce the impulse to stay up late. Examples of positive sleep habits include keeping a consistent bedtime and wake-up time and avoiding caffeine and alcohol late in the afternoon or evening.

Mental health conditions and sleep disturbances

Sleep disturbances are often linked to mental health conditions. Sleep problems can be a symptom of, or a contributor to, mental health issues. Mental health conditions can make it hard to fall asleep or wake up, and being unable to fall asleep or wake up can, in turn, affect your mental health.

Depression

Around 75% of people with depression experience insomnia. Depression is also associated with excessive daytime sleepiness and hypersomnia (sleeping too much). Sleep problems may be a symptom of depression, but they can also induce or exacerbate it. This creates a negative feedback loop where poor sleep worsens depression, which then further interrupts sleep. However, this also opens up the possibility of new treatments for depression, such as a focus on improving sleep.

Anxiety

Anxiety disorders affect an estimated 20% of adults and 25% of teenagers. Worry and fear contribute to a state of hyperarousal, which is considered a central contributor to insomnia. Sleep problems may become an additional source of worry, creating anticipatory anxiety that makes it harder to fall asleep. Research indicates that poor sleep can also activate anxiety in people at high risk for it.

Bipolar Disorder

Bipolar disorder involves episodes of extreme moods that can be high (mania) or low (depression). Sleep patterns change significantly depending on the emotional state of a person with bipolar disorder. During manic periods, they usually feel less need to sleep, but during depressive periods, they may sleep excessively. Sleep problems can induce or worsen manic and depressive periods.

Seasonal Affective Disorder (SAD)

SAD is a subtype of depression that tends to affect people during times of the year when there are reduced daylight hours. People with SAD often sleep too much or too little or experience changes to their sleep cycles.

Post-Traumatic Stress Disorder (PTSD)

PTSD affects many veterans, and at least 90% of US veterans with combat-related PTSD experience insomnia symptoms. People with PTSD frequently replay negative events in their minds, suffer from nightmares, and experience a state of being constantly alert, all of which can interfere with sleep.

Attention-Deficit/Hyperactivity Disorder (ADHD)

People with ADHD may have difficulty falling asleep, frequent awakenings, and excessive daytime sleepiness. Sleep difficulties associated with ADHD have been primarily studied in children but have also been found to affect adults. There is evidence of a bidirectional relationship between sleep and ADHD, where sleep problems may aggravate ADHD symptoms such as reduced attention span and behaviour problems.

Other Conditions

Other mental health conditions that can impact sleep include schizophrenia, which is associated with insomnia and circadian rhythm disorders, and autism spectrum disorder (ASD), where children and adolescents with ASD have a higher prevalence of insomnia and sleep-disordered breathing.

Improving Sleep and Mental Health

Given the complex relationship between sleep and mental health, treatment for both issues can go hand-in-hand. Cognitive behavioural therapy (CBT) is a type of counselling that can help improve both sleep and mental state by examining and reformulating negative thought patterns. CBT for insomnia (CBT-I) has been proven to reduce sleeping problems and improve emotional well-being. Additionally, adopting healthy sleep habits and improving sleep hygiene can help reduce sleep disruptions. This includes having a set bedtime and maintaining a steady sleep schedule, finding ways to wind down before bedtime, avoiding alcohol, tobacco, and caffeine in the evening, getting regular exercise and natural light exposure during the day, maximising comfort from your bedding, and blocking out excess light and sound.

Passive suicidal depression

The phrase "don't want to sleep, don't want to wake up" may be indicative of passive suicidal ideation, a warning sign that should not be ignored. Passive suicidal ideation is the desire to die without a plan to act on those thoughts. It is often linked to feelings of depression or anxiety and can be a recurring experience for those with chronic mood disorders.

Passive suicidal ideation can take many forms, such as "I don't want to live anymore, it's just too hard", "I wish I was never born", or "I hope I die in my sleep". These thoughts are serious and should not be taken lightly, even if there is no immediate risk of self-harm. People with passive suicidal ideation are more likely to engage in reckless behaviours and are at risk of progressing to active suicidal ideation.

If you or someone you know is experiencing passive suicidal ideation, it is crucial to seek professional help immediately. Treatment options such as therapy, medication, and lifestyle changes can effectively address the root causes of these thoughts and provide coping mechanisms for better mental health.

• Verbally expressing a desire to die or end their life, even in jokes
• Researching or showing interest in objects that could be used for suicide, such as prescription drugs, dangerous substances, or weapons
• Engaging in risky or reckless behaviour
• Expressing feelings of hopelessness, isolation, rejection, or apathy
• Increased substance abuse, such as drugs or alcohol
• Anxiety, irritability, or aggression
• Changes in sleep patterns, such as sleeping too much or too little
• Withdrawing from social activities and self-isolating
• Giving away meaningful personal belongings
• Visible signs of self-harm or scars
• Saying goodbye to loved ones as if they won't see them again

If you recognise any of these signs in yourself or others, it is important to take them seriously and seek help.

Passive suicidal ideation is a complex issue, and there is no one-size-fits-all explanation or solution. However, by seeking professional help and support, individuals can effectively manage their condition and improve their overall well-being.

Strategies to manage morning wake-up routines

A good morning routine promotes both wellness and productivity for the day ahead. Here are some strategies to help you manage your morning wake-up routine:

• Get a good night's sleep: Wind down at the end of the day by avoiding strenuous activities and set a time to turn off the TV and other electronics. Set your alarm for eight hours or more after bedtime to ensure you're well-rested.
• Avoid the snooze button: Hitting snooze can be detrimental to your morning routine. Avoid snoozing by creating a routine of waking up the first time your alarm goes off. Keep slippers by your bed and preset your coffee machine to help you get up.
• Give yourself enough time to get to work: Be intentional about when you wake up and ensure you have enough time to complete your morning routine and develop productive new habits.
• Drink a full glass of water: Create a routine of staying hydrated in the morning by drinking a full glass of water when you first wake up.
• Enjoy a cup of coffee or tea: Appreciating an aromatic cup of coffee or tea can make starting your day more enjoyable. Combine your morning beverage with an opportunity to spend time with your housemates, family, or pets.
• Prepare a healthy breakfast: Eating healthy can be easier than you think. A simple bowl of oatmeal or a quick smoothie can support your health without requiring a lot of prep time.
• Fit in a quick workout: Data suggests that active people are more relaxed and in better spirits than inactive people. Working out can help prevent depression, promote better sleep, and increase energy.
• Say positive affirmations: Affirmations help combat limiting beliefs about yourself and support a confident mindset. Saying positive affirmations to yourself in the morning can motivate you to do your best and believe in yourself throughout the day.
• Meditate by taking deep breaths: Meditation can support relaxation and can be paired with positive affirmations. Take time to sit with your thoughts and breathe deeply, or pair your affirmations with a deep breathing exercise such as roll breathing.
• Prioritize important tasks: Transition your mind from personal time to professional by dedicating time each morning to reviewing and prioritizing your tasks for the day. Write down your most important deliverables and goals, or record them in a digital project management tool.
• Listen to motivational music: Music can promote happiness and relaxation. Listen to your favorite artist or a playlist that promotes relaxation to put a smile on your face in the morning.
• Call a loved one: Speak to loved ones in the morning to help put you in a good mood. Talk to those you care about to encourage a positive mindset.
• Spend time on a hobby: Prioritize your personal life to cultivate a healthy work-life balance. Spend a little time each morning on a hobby to make you feel fulfilled both personally and professionally.

These strategies can help you manage your morning wake-up routine and promote a sense of wellness and productivity throughout your day.

Bedtime procrastination and its negative health impacts

Bedtime procrastination is a psychological phenomenon where individuals needlessly and voluntarily delay going to bed, despite knowing that doing so will negatively affect them. It is often driven by a daily schedule lacking in free time, with individuals choosing to sacrifice sleep for personal time. This behaviour can have several negative health impacts.

Sleep deprivation

Later bedtimes can result in sleep deprivation, which can affect both mental and physical well-being. Without enough hours of sleep, the mind and body cannot properly recharge, leading to negative health consequences. Sleep deprivation can cause slow thinking, low attention levels, bad memory, poor decision-making, stress, anxiety, and irritation.

Cardiovascular problems

Insufficient sleep has been linked to cardiovascular issues such as high blood pressure and heart problems.

Metabolic disorders

Sleep deprivation can make individuals more susceptible to metabolic disorders like diabetes.

Weakened immune system

Lack of sleep can erode immune function, which is especially concerning in light of the COVID-19 pandemic.

Mental health issues

Bedtime procrastination has been associated with mental health disorders such as depression and anxiety. It can also lead to fatigue, mood swings, and difficulty concentrating.

Long-term consequences

If left untreated, sleep deprivation can have long-term consequences, including heart disease, diabetes, obesity, pain, hormone issues, and mental health issues.

Strategies for prevention

To prevent bedtime procrastination, individuals can try turning off electronic devices at least one hour before bed, taking a hot shower or bath to reduce stress, writing down thoughts and feelings, maintaining a regular bedtime and wake-up time, and setting a bedtime routine.

Frequently asked questions