Battling Insomnia: Why Can't I Sleep And Feel Rested?

There are many reasons why you might be tired but unable to fall asleep. This could be due to your circadian rhythm being off, daytime napping, anxiety, or many other factors.

Your circadian rhythm, or body clock, is like an internal timekeeper that runs on a roughly 24-hour cycle and dictates your sleep schedule, body temperature, and the production of certain hormones, including melatonin, the sleep hormone. An irregular sleep schedule or jet lag can disrupt your circadian rhythm, leaving you tired during the day but wide awake at night.

Other factors that can contribute to tiredness and sleep difficulties include stress and anxiety, hormonal changes, caffeine consumption, blue light exposure from electronic devices, and sleep disorders such as insomnia. Identifying and addressing these factors can help improve your sleep quality and overall health.

Circadian rhythm disorders

Your body tries to align your sleep-wake cycle with cues from the environment, such as light and darkness, your eating habits, and your physical activity. When your sleep-wake cycle is out of sync with your environment, you may experience difficulty sleeping and poor sleep quality. Disruptions in your sleep patterns can be temporary, caused by factors such as your sleep habits, job, or travel. They can also be long-term, caused by ageing, genetics, or a medical condition.

There are several types of circadian rhythm disorders:

• Advanced or delayed sleep-wake phase disorder: This disorder involves difficulty staying awake in the early evening and waking up too early or too late in the morning, respectively. This can interfere with daily responsibilities and lead to insufficient sleep, resulting in daytime tiredness or anxiety.
• Irregular or non-24-hour sleep-wake rhythm disorder: Individuals with this disorder may experience multiple short periods of sleep and wakefulness throughout the day and night, often feeling unrefreshed after sleep. Jet lag is a form of this disorder, occurring when travelling across multiple time zones, and social jet lag can occur when one's weekend or day-off activities are much later than their usual weekday or work activities.
• Shift work disorder: This disorder affects those who work night shifts or rotating schedules, disrupting their ability to get quality sleep when their body needs it.

Treatment for circadian rhythm disorders aims to adjust the patient's sleep pattern to ensure they get sufficient sleep and can function daily. This may include external stimulus therapies such as bright light therapy or chronotherapy, a behavioural technique that gradually adjusts bedtime to achieve the desired sleep schedule.

Stress and anxiety

The relationship between stress, anxiety, and sleep is complex and bidirectional. Sleep deprivation can elevate the risk for anxiety disorders, while anxiety can contribute to disrupted sleep in the form of insomnia or nightmares. This creates a vicious cycle where anxiety and sleep deprivation reinforce each other, leading to further sleep problems and increased anxiety. Additionally, the inability to sleep due to anxiety can lead to feelings of being overwhelmed, a sense of impending danger, and physical effects such as nocturnal panic attacks.

To break this cycle, it is important to address both stress and anxiety, as well as improve sleep habits. Cognitive behavioral therapy for insomnia (CBT-I) is often recommended as a first-line treatment. CBT-I helps individuals understand and change negative or inaccurate thoughts and behaviours that impact their sleep. It also includes relaxation strategies and mindfulness techniques to reduce anxiety and improve sleep quality. Other suggestions for improving sleep include practicing relaxation techniques such as breathing exercises and progressive muscle relaxation, setting a consistent bedtime, avoiding naps and stimulants close to bedtime, and creating a comfortable and technology-free bedroom environment.

By addressing stress and anxiety, and making changes to improve sleep habits, individuals can break the cycle of sleep deprivation and anxiety, leading to improved sleep quality and overall well-being.

Hormones

Melatonin

Melatonin is a hormone that helps regulate the body's circadian rhythm, telling your body when to get to sleep. Darkness increases melatonin production, indicating it is time to sleep, while light decreases its production, signalling the body to stay awake. The body's master clock, the suprachiasmatic nucleus (SCN), controls melatonin production. Its levels peak between 2 and 4 am before falling again. Our bodies are best primed for sleep about two hours after melatonin levels start to rise.

Cortisol

Cortisol is known as the stress hormone and is produced by the adrenal glands. Sleep timing, duration, and quality influence its release. When you sleep well and wake up feeling rested, cortisol reaches a peak within 30 minutes of waking up, setting off other hormones like thyroid and estrogen. Poor sleep can negatively affect cortisol release, so it is important to aim for 7 to 9 hours of sleep per night.

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 serotonin levels can cause sleep problems. Low serotonin levels have been linked to poor sleep and depression. Not getting enough sleep can result in lower serotonin levels, leading to fatigue and low mood the next day.

Estrogen and Progesterone

Estrogen and progesterone are the two major female sex hormones. Estrogen helps control the monthly menstrual cycle, while progesterone, often referred to as the "relaxing hormone," aids in maintaining pregnancy. These hormones fluctuate throughout a woman's life, impacting sleep. For example, during the week before a woman's period, progesterone levels rise, and if there is no pregnancy, they drop, causing the uterine lining to shed and the menstrual cycle to begin. This drop in progesterone can make it challenging to get quality sleep in the days leading up to menstruation. Additionally, lower levels of progesterone during menopause can contribute to irritability and difficulty relaxing, further impacting sleep.

Testosterone

Testosterone is a sex hormone produced by both males and females, although men produce more of it. It plays a role in the reproductive system and bone and muscle mass development in males. Testosterone levels naturally decrease with age, starting at around 30. Poor sleep patterns can reduce the amount of rapid eye movement (REM) sleep, leading to lower testosterone levels. Fatigue and low energy are common symptoms of low testosterone.

Thyroid Hormones

The thyroid gland produces two crucial hormones: triiodothyronine (T3) and thyroxine (T4). These hormones ensure that the body's cells work effectively and play a role in brain development and mood regulation. An underactive thyroid, or hypothyroidism, can lead to fatigue, muscle aches, and weakness. Stress can also impact thyroid function, as it increases the demand for hormones that the thyroid assists in producing.

Caffeine

Adenosine is a brain chemical that affects the sleep-wake cycle. Adenosine levels increase during waking hours and decrease during sleep. Caffeine blocks adenosine from working on brain cells, preventing you from feeling sleepy. However, the body can build a tolerance to caffeine over time. This means that people need more caffeine over time to get the same wakeful feeling.

If you are a regular caffeine consumer, you may experience caffeine withdrawal if you suddenly stop or reduce your intake. Withdrawal symptoms include increased sleepiness and headaches.

How caffeine affects your body depends on how quickly your body can metabolize it, which varies from person to person. Factors that affect how quickly you metabolize caffeine include nicotine use, pregnancy, liver disease, and genetics.

If you are experiencing sleep difficulties, it is recommended that you avoid caffeine at least 6 to 8 hours before bedtime. Reducing your daily caffeine intake can also help improve sleep quality and reduce insomnia, anxiety, or headaches.

Screen time

To combat this, it is recommended to avoid looking at screens within two hours of going to bed. Instead, try other relaxation methods to help you fall asleep more easily, such as listening to soothing music or reading a book.

In addition, it is important to establish a wind-down period before bed that does not involve a screen. This could include talking to a friend or family member, sewing, or reading a physical book.

If you work in a job that requires a lot of screen time, there are several measures you can take to reduce eye strain and other symptoms of screen fatigue, including:

• Setting up proper ergonomics for your workspace
• Taking regular breaks from looking at screens
• Using the 20-20-20 rule (taking a 20-second break every 20 minutes to look at something 20 feet away)
• Installing proper lighting to minimize glare
• Minimizing blue light exposure with screen filters or blue light filtering glasses
• Limiting unnecessary screen time
• Getting regular eye check-ups

Frequently asked questions