Fighting Sleep: Understanding Your Body's Sleep Resistance

Feeling sleepy but not wanting to sleep can be a frustrating experience. This phenomenon, known as hypersomnia or insomnia, is characterised by excessive sleepiness during the day and difficulty falling or staying asleep at night. There are numerous factors that can contribute to this condition, including lifestyle choices, medical conditions, sleep disorders, medications, and mental health. Understanding and addressing the underlying causes are crucial for improving sleep quality and overall well-being.

Circadian rhythm issues

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. Each type of disorder has distinct symptoms and causes, but they all interfere with an individual's sleep patterns and daily functioning.

For example, in advanced sleep-wake phase disorder (ASWPD), individuals may find it challenging to stay awake in the early evening and, as a result, wake up too early in the morning, disrupting their daily routine. Delayed sleep-wake phase disorder (DSWPD), on the other hand, is characterised by falling asleep much later than intended and subsequently struggling to wake up on time. This disorder is prevalent among teens and young adults and can lead to insufficient sleep and daytime tiredness.

Irregular sleep-wake rhythm disorder (ISWRD) is another type of circadian rhythm issue where individuals experience multiple short periods of sleep and wakefulness throughout the day and night. This disorder is often temporary and associated with travelling across multiple time zones, causing the sleep-wake rhythm to fall out of sync with the local time.

Non-24-hour sleep-wake rhythm disorder occurs when an individual's sleep-wake cycle is not in sync with the standard 24-hour day. This disorder is common in people with visual impairments as the circadian clock is largely influenced by the light-dark cycle. As a result, individuals with this disorder may experience periods of insomnia and daytime sleepiness, followed by periods of normal sleep when their rhythms temporarily align with their environment.

Jet lag disorder and shift work disorder are also classified under circadian rhythm issues. Jet lag disorder arises when travelling across multiple time zones, leading to excessive sleepiness and a lack of alertness during the day. Shift work disorder affects those who work night shifts or rotating schedules, resulting in insomnia, extreme tiredness, and sleepiness while working.

Circadian rhythm disorders can be treated through various methods, including light therapy, chronotherapy (gradually adjusting bedtime), and medications such as melatonin. Lifestyle changes, such as improving sleep hygiene, adjusting lighting, setting a meal schedule, and regular exercise, can also help reset the circadian rhythm.

Daytime napping

Napping during the day can have several benefits, but it's important to keep in mind that it may not be suitable for everyone and can even be detrimental in certain cases.

The ideal time for a nap is usually in the afternoon, specifically between 1 pm and 3 pm, as this is when humans naturally experience a dip in alertness. However, the timing of your nap should also consider your level of rest. If you're well-rested, a slightly later nap is better, while an earlier nap is preferable if you're sleep-deprived.

For those who work from home, napping in the bedroom is a good option as it's already set up for sleep. Adding blackout curtains or a white noise machine can further enhance the napping environment. In an office setting, earplugs or an eye mask can help reduce distractions.

It's important to remember that napping may not be suitable for everyone. Excessive daytime sleepiness could indicate an underlying sleep disorder or a mental health condition. If you're experiencing persistent sleep issues, it's recommended to consult a healthcare professional for advice and evaluation.

Anxiety

Feeling sleepy but unable to fall asleep can be a symptom of anxiety. Anxiety is a feeling of worry and unease, and while it is normal to experience it occasionally, it can become a disorder when this distress becomes excessive.

There are several types of anxiety disorders, including:

• Generalized Anxiety Disorder (GAD): Characterized by significant, looming worries about many different things that cause an overarching sense of anxiety.
• Panic Disorder: Defined by extremely intense episodes of fear, known as panic attacks, that last for a few minutes.
• Social Anxiety Disorder: An extreme fear of social settings and potential embarrassment in front of others.
• Specific Phobias: Intense fears caused by particular triggers, such as agoraphobia or separation anxiety.
• Obsessive-Compulsive Disorder (OCD): Obsessing over an issue in a negative way, provoking anxiety, and leading to compulsions or rituals that directly impact everyday activities.
• Post-Traumatic Stress Disorder (PTSD): Can arise after exposure to a disturbing situation, with symptoms including reliving the event, feeling on edge, and experiencing anxiety.

If you are experiencing anxiety at night, there are several strategies that may help:

• Control your breathing: Try diaphragmatic (belly) breathing to activate the "rest and digest" response, which is the opposite of the fight-or-flight response.
• Write down your worries: Ruminating thoughts can be reduced by writing them down, freeing up space in your mind, and helping you wind down.
• Maintain a nightly schedule: Establish a regular sleep schedule and bedtime routine, including relaxing activities such as reading or listening to music.
• Focus your mental energy: Direct your attention to something soothing that you can imagine or something you can see or hear in your bedroom, like white noise or the sound of crashing waves.
• Create a comfortable environment: Make your bedroom a quiet, softly lit, and comfortable space, reserved primarily for sleep and sex.

If you think you have an anxiety disorder or a sleep disorder, seeking help from a mental health professional or a sleep clinic specialist is essential. Treatments may include therapy, improved sleep hygiene, or medication.

Caffeine consumption

Caffeine is a stimulant that can increase alertness and boost energy levels. However, it can also disrupt sleep when consumed close to bedtime. Caffeine blocks adenosine, a chemical that regulates the sleep-wake cycle, from binding to its receptors in the brain. This means that when the effects of caffeine wear off, there is a buildup of adenosine, leading to feelings of tiredness. Additionally, caffeine has a long half-life, with research suggesting that even 16 hours before bed, caffeine can impact sleep. Therefore, it is recommended to cut off caffeine consumption 4-6 hours before bedtime.

Furthermore, regular caffeine consumption can lead to the development of tolerance, where the body produces more adenosine receptors to counteract the effects of caffeine. This means that higher doses of caffeine may be needed to achieve the desired effects, which can further negatively impact sleep and contribute to feelings of sleepiness.

Additionally, caffeine has diuretic properties, which can increase urine output and lead to dehydration. Dehydration can cause fatigue and sluggishness, as it affects cardiovascular function and reduces fluid volume in the body's cells.

To minimise the negative impacts of caffeine on sleep, it is recommended to stick to a moderate caffeine intake of up to 400 milligrams per day and avoid caffeinated drinks close to bedtime.

Sleep disorders

Sleep apnea, for example, involves repeated pauses in breathing during sleep, causing the brain to send a 'wake-up' call. This leads to fragmented sleep and increased sleepiness during the day. Restless legs syndrome (RLS) causes a creepy, crawly feeling and uncontrollable leg movements at night, affecting sleep quality and increasing the risk of heart disease and depression.

Insomnia, a common sleep disorder, is characterised by difficulty falling asleep, staying asleep, or getting sufficient sleep. It can be acute (lasting a few nights) or chronic (occurring three times a week for at least three months). Insomnia can be caused by various factors, including medical or psychiatric conditions, medication side effects, and lifestyle factors such as an uncomfortable mattress, noise, or an uncomfortable bedroom temperature.

Other sleep disorders that can contribute to feeling sleepy but not wanting to sleep include narcolepsy, a rare disorder characterised by involuntary napping and muscle paralysis; idiopathic hypersomnia, which involves excessive nighttime sleeping and daytime napping without cataplexy or sleep paralysis; and sleepwalking, which is more common in children than adults.

Frequently asked questions