The Autumn Sleep Effect: Why We Snooze Through Fall

Feeling sleepy all day in the fall could be due to several reasons. Firstly, it is important to rule out any underlying medical conditions or sleep disorders, such as insomnia, sleep apnea, narcolepsy, or restless leg syndrome. These conditions can cause excessive daytime sleepiness and should be evaluated by a healthcare professional. Other potential causes include lifestyle factors such as sleep deprivation, alcohol or drug use, lack of physical activity, and the use of certain medications. Additionally, environmental factors like noise pollution and temperature can also impact sleep quality. Addressing these issues and making lifestyle changes can help improve sleep habits and reduce daytime sleepiness.

Sleep disorders such as sleep apnea, restless leg syndrome, and narcolepsy

Restless leg syndrome (RLS) is a common sleep-related movement disorder characterized by an unpleasant or uncomfortable urge to move the legs during periods of inactivity, particularly in the evenings. RLS is more common in individuals over 60, and symptoms often improve with activity. However, increased activity at night can cause insomnia in some patients. RLS is often treated with medication, which can reduce or eliminate symptoms and improve daytime function and quality of life.

Narcolepsy is a neurological disorder caused by a lack of hypocretin in the brain, a chemical that helps keep the brain awake and active. People with narcolepsy experience excessive daytime sleepiness and uncontrollable episodes of falling asleep during the day. They tend to fall into a deep sleep almost immediately, even during waking hours, and may suddenly fall asleep while eating, talking, or driving. Other symptoms of narcolepsy include cataplexy, hallucinations, and sleep paralysis.

Underlying health conditions like kidney disease, thyroid disorders, and depression

Sleep disturbances are common in people with underlying health conditions, including kidney disease, thyroid disorders, and depression.

Kidney Disease

Chronic kidney disease (CKD) is associated with a reduction in sleep quality and an increased rate of sleep disorders. Research has shown that people who sleep less tend to experience a faster decline in kidney function. This may be because kidney function is regulated by the sleep-wake cycle, which helps coordinate the kidneys' workload over 24 hours. Nocturnal patterns can also affect chronic kidney disease.

Thyroid Disorders

Thyroid problems can also cause sleep issues. The thyroid gland, located at the base of the neck, produces hormones that influence muscle control, brain function, metabolism, heart rate, and digestion. When the thyroid produces too much or too little of certain hormones, it can disrupt the body's internal clock that regulates the sleep-wake cycle. Hyperthyroidism, or an overactive thyroid, can cause nervousness, irritability, night sweats, and frequent urination at night. On the other hand, hypothyroidism, or an underactive thyroid, can make it difficult to fall asleep or stay asleep, leading to unrefreshing sleep. People with hypothyroidism may also experience daytime sleepiness or hypersomnia.

Depression

Depression is known to disrupt sleep patterns, causing either insomnia or excessive sleep. Sleep abnormalities in people with depression are characterized by increased rapid eye movement (REM) sleep and reduced slow-wave sleep. This can lead to difficulty falling asleep, frequent awakenings during the night, and non-restorative sleep. The presence of depression in primary sleep disorders is common, and treatment often involves psychotherapy, medications such as antidepressants, or alternative therapies like meditation, acupuncture, or light therapy.

Lifestyle factors including bedtime habits, substance use, and diet

Lifestyle factors, including bedtime habits, substance use, and diet, can significantly impact sleep quality and duration. Here are some essential considerations regarding these factors:

Bedtime Habits

• Sleep schedule: Maintaining a consistent sleep schedule is crucial. Going to bed and waking up at the same time each day helps regulate your body's sleep-wake cycle.
• Sleep duration: Ensure you get at least seven hours of sleep per night. This amount is recommended for adults to maintain optimal health and well-being.
• Napping: Naps can be beneficial, but their timing and duration are essential. Aim for naps of around 20 minutes in the early afternoon to avoid disrupting your nighttime sleep.
• Bedtime routine: Establish a relaxing bedtime routine. This may include activities such as reading, stretching, listening to soothing music, or practicing relaxation techniques like controlled breathing or meditation.
• Device usage: Disconnect from electronic devices at least an hour before bedtime. The light from smartphones, tablets, and laptops can suppress melatonin production and make it challenging to wind down.
• Light exposure: Minimize bright light exposure in the evening, and consider using blackout curtains or a sleep mask to block light in your bedroom. This helps maintain your body's natural melatonin production.
• Thermoregulation: Keep your bedroom temperature cool, around 65-68°F (18.8-21.1°C). A cooler environment can promote better sleep.

Substance Use

• Caffeine: Limit caffeine intake, especially after 2 p.m. Caffeinated drinks can disrupt sleep, especially when consumed close to bedtime.
• Alcohol: Avoid alcohol consumption in the hour before bedtime. While it may induce drowsiness, alcohol negatively affects sleep quality and can cause fragmented sleep.
• Nicotine: Nicotine is a stimulant that can disrupt sleep, especially when used in the evening. If possible, limit nicotine use and avoid secondhand smoke exposure.

Diet

• Balanced diet: Consume a balanced diet with adequate amounts of carbohydrates, protein, and healthy fats. Whole grains, fruits, and vegetables are essential for optimal sleep.
• Tryptophan-rich foods: Include foods containing tryptophan, an amino acid that promotes sleep. This includes certain grain mixes, oily fish like salmon and tuna, and specific cherry varieties.
• Simple carbohydrates: While simple carbs can help you fall asleep faster, they may not be the best long-term strategy for improving sleep quality.
• Meal timing: Avoid late dinners and leave at least a few hours between your last meal and bedtime. This gives your body time to digest and reduces the risk of food-induced sleep disruptions.
• Spicy and fatty foods: Limit spicy and fatty foods, especially close to bedtime. These can contribute to acid reflux, which can disrupt sleep.
• Skipping meals: Maintain regular mealtimes and avoid skipping meals. Irregular eating patterns can impact your circadian rhythms and sleep quality.

Environmental factors such as noise and temperature

Noise pollution, particularly from traffic, construction, and airplanes, can cause sleep disruption and insomnia. It can trigger a fight-or-flight response, flooding the body with stress hormones that cause inflammation and potentially leading to disease. Additionally, noise can affect the sleep stages we cycle through each night, increasing light sleep and decreasing deep sleep and REM sleep. This can lead to short-term issues like sleepiness, irritability, and poorer mental health, as well as long-term health consequences such as high blood pressure, heart disease, weight gain, and certain types of cancer.

Temperature also plays a crucial role in sleep. The thermal environment is one of the most important factors affecting sleep, with excessively high or low temperatures disrupting sleep even in healthy individuals without insomnia. The ideal bedroom temperature for sleep is generally considered to be between 66°F and 70°F (18.8°C to 21.1°C), and the body's sleep-wake cycle is strongly linked to the sun's daily cycle. Our core body temperature naturally decreases during the nocturnal sleep phase, and sleep is most likely to occur when body temperature is lowered. This decrease in body temperature is regulated by our circadian rhythm and is crucial for maintaining sleep.

Additionally, humidity can also impact sleep. Humid heat exposure further increases thermal load during sleep, affecting sleep stages and thermoregulation. It suppresses the decrease in core body temperature and increases skin temperature and sweating, making it challenging to fall and stay asleep.

To optimize sleep, it is essential to maintain a comfortable and cool bedroom environment, use bedding and clothing that aids in thermoregulation, and minimize noise exposure.

Medications and medical treatments

• Wakefulness-promoting agents, such as modafinil (Provigil), armodafinil (Nuvigil), pitolisant (Wakix), and solriamfetol (Sunosi). These are usually tried first.
• Psychostimulants, such as amphetamine, methylphenidate (Ritalin, Daytrana, Methylin, Concerta), or dextroamphetamine (Procentra, Dexedrine, Zenzedi). These drugs have more abuse potential and side effects than first-line agents.
• Other drug options, such as sodium oxybate (Xyrem or Xywav), flumazenil (Romazicon), and clarithromycin (Biaxin).
• Sleeping pills or alerting agents, such as melatonin, zolpidem, zaleplon, eszopiclone, ramelteon, suvorexant, lemborexant, or doxepin.
• Medications for restless leg syndrome, such as gabapentin, gabapentin enacarbil, or pregabalin.
• Stimulants or wake-promoting medications for narcolepsy, such as modafinil, armodafinil, pitolisant, mixed salt, sodium oxybate, and solriamfetol.

It is important to note that medications for sleep disorders can have side effects and may not be suitable for everyone. It is always best to consult a doctor before starting any new medication or treatment.

Frequently asked questions