Battling The Bedtime Blues: Sleep Or No Sleep?

Feeling too tired to function during the day, but unable to fall asleep at night is a common problem. This phenomenon is known as bedtime procrastination or revenge bedtime procrastination. It occurs when people put off sleep in favour of passive leisure activities, such as scrolling through social media or watching TV. While the immediate gratification of staying awake may feel appealing, it can have negative consequences on your health and well-being. Not getting enough sleep can lead to fatigue, cognitive issues, and even physical health problems such as obesity, heart disease, and high blood pressure.

So, what can you do if you're struggling with bedtime procrastination? Firstly, it's important to understand the underlying reasons for your sleep problems. It could be due to various factors such as stress, anxiety, poor sleep hygiene, or a misalignment with your circadian rhythm. Addressing these issues is crucial to improving your sleep habits. This may involve reducing stress, seeking professional help for mental health issues, or making changes to your daily routine and sleep environment.

Additionally, there are specific strategies you can implement to combat bedtime procrastination. These include setting realistic sleep goals, creating a relaxing wind-down routine before bed, and limiting screen time and caffeine intake close to bedtime. By making these changes and prioritising your sleep, you can improve your sleep quality and overall well-being.

Excessive caffeine consumption

Firstly, caffeine is a stimulant that increases alertness by blocking the effects of adenosine, a brain chemical that induces sleepiness. At higher doses, this effect can become more pronounced, leading to anxiety, nervousness, and jitteriness. Caffeine-induced anxiety disorder is recognised in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Extremely high daily intakes of 1000 mg or more per day can cause nervousness in most people, while even moderate amounts may have similar effects on caffeine-sensitive individuals.

Secondly, excessive caffeine consumption can negatively impact your sleep quality and quantity. Caffeine interferes with your ability to fall asleep quickly and may reduce your total sleeping time, especially in older adults. While low or moderate amounts may not significantly affect "good sleepers", it is important to note that caffeine can be found not only in coffee and tea but also in soda, cocoa, energy drinks, and certain medications. Therefore, it is easy to underestimate your caffeine intake and the subsequent impact on your sleep. The effects of caffeine can last several hours, and consuming it later in the day can disrupt sleep.

Thirdly, caffeine acts as a diuretic, which means it increases urination. This can lead to frequent urination and a sense of urgency, particularly in older individuals and those with overactive bladders or incontinence.

Additionally, high caffeine intake can cause digestive issues such as an upset stomach or heartburn. It may also interfere with the absorption of calcium in the body.

Lastly, excessive caffeine consumption can lead to physical dependency, with withdrawal symptoms such as headaches and fatigue occurring when intake is reduced or stopped.

To summarise, excessive caffeine consumption can lead to increased anxiety and nervousness, disrupted sleep, digestive issues, frequent urination, physical dependency, and withdrawal symptoms. It is important to monitor your caffeine intake and be mindful of its potential negative impacts on your health and well-being.

Hormonal changes

Menstruation

The menstrual cycle involves fluctuations in estrogen and progesterone levels, which can affect sleep. During the week before a person's period, progesterone levels rise to prepare the body for a potential pregnancy. If pregnancy does not occur, progesterone levels decrease sharply, causing the uterine lining to shed and initiating the menstrual cycle. This sudden drop in progesterone can make it challenging for some individuals to get quality sleep during the days leading up to their period. Additionally, high levels of estrogen prior to menstruation have been linked to anxiety, mood swings, and insomnia.

Pregnancy

Pregnancy is a period of significant hormonal changes, with both progesterone and estrogen playing crucial roles in supporting the growing fetus. During the first trimester, progesterone levels surge to relax the uterus muscle and boost the immune system. Estrogen levels also skyrocket, and a woman produces more estrogen during a single pregnancy than throughout her entire life outside of pregnancy. This surge in hormones may explain why many women experience increased drowsiness and take more naps during the first 12 weeks of pregnancy. By the third trimester, progesterone and estrogen levels typically stabilise. However, other factors, such as frequent urination, restless leg syndrome, and difficulty breathing, can make it challenging to get a full night's sleep.

Perimenopause and Menopause

Perimenopause, the transitional period before menopause, is characterised by declining hormone levels and irregular menstrual periods. This stage can last for several years, and sleep disturbances are common due to the hormonal changes and the onset of night sweats and hot flashes. Research suggests that even women who do not report hot flashes as disruptive to their sleep often experience more difficulty sleeping during perimenopause compared to before. Once menopause is reached, sleep patterns may stabilise, but the sharp decline in hormones, particularly estrogen, can make it harder to fall asleep. Additionally, the loss of reproductive hormones during menopause may increase the risk of developing sleep disorders such as sleep apnea.

Hormones and Sleep

Estrogen and progesterone play vital roles in maintaining reproductive health and influencing sleep. Estrogen allows the body to process serotonin, increases bone formation, and affects the skin. Progesterone, often referred to as the "relaxing hormone," has a mildly sedative effect and helps counter the effects of excess estrogen. When progesterone levels decline, such as during menstruation or menopause, it can cause anxiety and insomnia.

Cortisol, known as the "stress hormone," also plays a crucial role in sleep regulation. It is produced by the adrenal glands and helps the body cope with stress. Cortisol levels typically peak in the morning, facilitating wakefulness, and gradually decrease throughout the day. However, stress can trigger the release of cortisol at night, disrupting the sleep-wake cycle and reducing melatonin levels, which are essential for inducing sleep.

Poor sleep hygiene

Some of the most common poor sleep hygiene practices include:

• Using screens that emit bright blue light, such as phones or TVs, in the evening or before bed.
• Consuming caffeine, sugar, or other stimulants late in the day when you should be winding down.
• Waking up in a dark room.
• A sedentary lifestyle with little physical activity during the day.
• Using your bed for activities other than sleep, such as working, reading, or watching TV.
• An inconsistent sleep schedule, such as going to bed and waking up at different times each day.
• Drinking alcohol or using nicotine late in the evening, which can disrupt sleep later in the night.
• Eating a late dinner, especially if it is a large, heavy, or spicy meal, as your body may still be digesting when it's time for bed.

Stress and anxiety

Anxiety disorders can also cause sleep issues, and insomnia can make the symptoms of anxiety disorders worse. Research has found that 36% of people with an anxiety disorder also have insomnia. Sleep deprivation can elevate the risk of anxiety disorders, and insomnia can prevent recovery or worsen symptoms.

If you're experiencing stress and anxiety that's impacting your sleep, there are several strategies you can try:

• Practising relaxation techniques such as breathing exercises, progressive muscle relaxation, taking a warm bath, or meditating before bed.
• Setting a consistent bedtime and wake-up time to train your body for consistent sleep.
• Avoiding naps to increase tiredness at bedtime.
• Avoiding stimulants such as caffeine and nicotine close to bedtime.
• Creating a comfortable sleep environment by keeping the bedroom dimly lit, reducing outside noise, and maintaining a comfortable temperature (experts recommend between 60 and 68 degrees Fahrenheit).
• Keeping a sleep diary to help identify things that may be disrupting your sleep.
• Cognitive behavioural therapy for insomnia (CBT-I) can help change negative thoughts and behaviours that impact your sleep.
• Medication for sleep and/or anxiety may be recommended by a healthcare provider.

Circadian rhythm disorders

There are several types of circadian rhythm disorders, including advanced or delayed sleep-wake phase disorder, irregular or non-24-hour sleep-wake rhythm disorder, and shift work or jet lag disorder. Advanced sleep-wake phase disorder involves difficulty staying awake in the early evening and waking up too early in the morning, interfering with daily responsibilities. Delayed sleep-wake phase disorder, one of the most common types, is characterised by falling asleep later than intended and difficulty waking up on time. Irregular sleep-wake rhythm disorder involves multiple short periods of sleep and wakefulness, with excessive sleepiness during the day. This type of disorder is often temporary and associated with travelling across multiple time zones. Non-24-hour sleep-wake rhythm disorder occurs when an individual's sleep-wake cycle is not in sync with the 24-hour day, resulting in delayed sleep times that gradually get later and later. Shift work disorder affects those who work nights or rotating schedules, leading to insomnia and extreme tiredness.

Treatment for circadian rhythm disorders focuses on adjusting the patient's sleep pattern to align with their desired bedtime and daily activities. This may include external stimulus therapies such as bright light therapy or chronotherapy, a behavioural technique that gradually adjusts bedtime.

Frequently asked questions