Sleep Eludes Me: Why Can't I Rest?

Sleep is an essential part of our lives, and a good night's rest is crucial for our health and well-being. However, many people struggle with sleep issues, such as insomnia, sleep apnea, and restless leg syndrome. These disorders can impact your sleep quality and leave you feeling tired and irritable during the day. Understanding the causes of sleep problems is the first step towards improving your sleep hygiene and getting the rest you need. Factors such as stress, anxiety, depression, poor sleep habits, and even diet can contribute to sleep difficulties. Additionally, certain medications and health conditions can also disrupt your sleep. It is important to address sleep issues as they can have serious consequences on your physical and mental health, including obesity, high blood pressure, and heart disease.

Stress, anxiety, and depression

Anxiety disorders are the most common mental health disorders in the US, affecting about 40 million people. Research shows that most individuals with anxiety also experience some form of sleep disruption. Anxiety can cause a feeling of stress or fear about going to sleep, known as sleep anxiety. It can lead to difficulty falling asleep and staying asleep, resulting in a state of constant worry and restlessness. Sleep anxiety can manifest as behavioural or emotional symptoms, including feelings of being overwhelmed, an inability to concentrate, and a sense of impending danger. Physically, it may cause nocturnal panic attacks, sweaty palms, muscle tension, rapid heartbeat, and an upset stomach.

The relationship between anxiety and sleep is bidirectional. Poor sleep can increase the risk of developing anxiety or making existing anxiety worse. Sleep anxiety can be treated through therapy, improved sleep hygiene, or medication. Cognitive Behavioural Therapy for Insomnia (CBT-I) is a recommended treatment, teaching individuals to associate their bed with sleep and relaxation rather than worry and distress. Relaxation techniques, such as deep breathing exercises and listening to calming music, can also help reduce anxiety before bed.

Depression is also closely linked to sleep problems, with a majority of people experiencing depression reporting sleep issues. Depression can cause difficulty falling asleep, staying asleep, or even excessive daytime sleepiness. It is believed that about 20% of people with depression have obstructive sleep apnea, and 15% experience hypersomnia. Sleep issues in depression may be due to the influence of sleep disruptions on the body's stress system and serotonin function.

Additionally, stress and worries related to daily life, such as financial concerns or relationship issues, can further contribute to sleep disturbances for individuals with depression. Treating sleep problems can help alleviate depressive symptoms, and vice versa. Cognitive behavioural therapy and medication are common treatments for depression, but addressing sleep issues in conjunction with depression treatment is crucial for improving sleep quality and managing depression effectively.

Sleep apnea

Obstructive Sleep Apnea (OSA)

This is the most common form of sleep apnea. It occurs when the muscles in your head and neck relax while you're asleep, causing the surrounding tissue to block your airway and obstruct your breathing. This is often due to a narrow airway that you inherited or developed from large tonsils or adenoids, or a thick neck. Obstructive sleep apnea can also be caused by obesity, as excess weight can increase the risk of developing this condition.

Central Sleep Apnea (CSA)

With this type of sleep apnea, your airway doesn't get blocked. Instead, your brain fails to signal your muscles to breathe due to issues in your respiratory control centre. Central sleep apnea is often related to the function of your central nervous system and can be caused by anything that affects your brain's control of your breathing and chest muscles, such as hormone levels or certain health conditions like neuromuscular disease, heart failure, or lung disease.

Complex Sleep Apnea Syndrome

This type of sleep apnea is a combination of both obstructive and central sleep apnea. It occurs when you have obstructive sleep apnea that turns into central sleep apnea after treatment.

Regardless of the type, sleep apnea can cause loud snoring, daytime tiredness, and more serious problems like heart trouble, high blood pressure, and even diabetes if left untreated. It can also lead to abnormal heart rhythms and put you at a higher risk for recurrent heart attacks, strokes, or abnormal heartbeats.

The constant fatigue, brain fog, and mood changes resulting from lack of sleep can seriously affect your quality of life. Additionally, untreated sleep apnea can lead to long-term health conditions that could shorten your lifespan.

If you suspect you may have sleep apnea, it is important to see a specialist or your primary care doctor, who will likely recommend a sleep study for diagnosis. While there is no cure for sleep apnea, there are many treatment options available, including lifestyle changes, oral appliances, positive airway pressure (PAP) machines, and in some cases, medication or surgery.

Jet lag

The circadian clock takes about 1-1.5 days to adapt per time zone crossed, and the severity of jet lag tends to increase with the number of time zones crossed. The direction of travel also matters: eastward travel tends to cause more trouble than westward travel because the circadian clock in the brain, when not regulated by light exposure, naturally tends to lengthen each day.

Symptoms of jet lag include:

• Sleep disturbances, such as insomnia, fragmented sleep, or difficulty falling/staying asleep
• Daytime sleepiness or drowsiness
• Poor/depressed mood
• Poor physical performance
• Confusion or cognitive impairment
• Gut discomfort or other GI disturbances
• Headaches
• Lack of focus or concentration
• Extreme tiredness or fatigue
• Irritability
• A general feeling of being "off" or not like yourself
• Simulate your new schedule before you leave by gradually adjusting your mealtimes and bedtime to match the schedule of your destination.
• Adapt to your new schedule while in flight by changing your watch to the time at your destination and trying to sleep/stay awake according to that time.
• Drink plenty of water before, during, and after your flight to avoid dehydration, which can worsen jet lag symptoms. Avoid caffeine and alcohol, which can cause dehydration and disrupt sleep.
• Switch your bedtime as soon as possible upon arrival. Avoid napping when you arrive if it's daytime, as this can make it harder to sleep later.
• Use light therapy by getting morning sunlight if you're travelling west or afternoon sunlight if you're travelling east. Light helps reset your body's circadian clock.
• Take melatonin supplements to help regulate your sleep. Consult a doctor before taking melatonin to ensure it doesn't interact with any medications.
• Take a hot bath before bedtime to relax and make you feel sleepy.
• Minimize sleep distractions by using an eye mask or earplugs to block out light and noise.

Poor sleep environment

A poor sleep environment can be a major factor in sleep disruption. Here are some ways in which your surroundings may be affecting your sleep:

Light Exposure

The light from electronic devices such as phones, computers, and alarm clocks can impair your quality of sleep. Blue light from devices like smartphones and tablets can delay the release of melatonin, the hormone that helps you fall asleep. Try to avoid screens at least one hour before bedtime. It is also beneficial to hang blackout shades or curtains in your bedroom to block out any unwanted light.

Noise

Unwanted noise can prevent you from falling asleep or cause you to wake up during the night. This can include noise from a snoring partner, a pet, or sounds from outside your window. To block out unwanted noise, you can use earplugs, a fan, or a white noise machine.

Temperature

An overly hot or cold bedroom can disrupt your sleep. Most sleep experts recommend keeping your bedroom between 60 to 67 degrees Fahrenheit at night. Your body needs to cool down slightly for the most refreshing sleep, and a too-cold room will wake you up.

Bed Sharing

Sharing your bed with a partner, child, or pet can reduce your sleep quality, especially if your bed partner snores, crowds you, or hogs the covers. Additionally, you and your partner may have different preferred sleeping conditions regarding temperature, light, and noise level.

Work Schedule

Working early or late shifts, especially if they vary, can disrupt your circadian rhythm and affect your sleep. Long hours at a stressful job can also cause anxiety that may interfere with your sleep.

Travel

Jet lag and sleeping in unfamiliar environments can also impact your sleep.

Sleep maintenance insomnia

This type of insomnia can be caused by a variety of factors, including:

• Stress: Research has found that genetics, family history, being female, and environmental stressors are the main risk factors for stress-related sleep challenges.
• Sleep apnea, asthma, or other breathing problems: Respiratory disturbances can wake you up and make it hard to fall back asleep.
• Pain or illness: Conditions like fibromyalgia and arthritis can cause pain that wakes you up. Other illnesses associated with sleep issues include neurological conditions, cardiovascular conditions, and mental health disorders.
• Medication: Some over-the-counter and prescription medications can cause side effects that wake you up, such as excitability, frequent urination, and vivid dreams.
• Hormone fluctuations: Hormone changes can trigger sleep-disrupting symptoms like anxiety, hot flashes, and night sweats.
• Poor sleep environment: Factors like bright lights, street noise, or an air conditioner humming can wake you up. Screen time and exposure to blue light can also disrupt your sleep.
• Age: Older adults often experience nighttime arousal, shorter periods of deep sleep, and fragmented sleep.

If you are experiencing sleep maintenance insomnia, there are several things you can try to improve your sleep:

• Relaxation techniques: Try progressive muscle relaxation or other calming activities like reading, journaling, or meditation.
• Medication review: Talk to your doctor about your medication to see if insomnia is a known side effect. They may recommend adjusting the timing or changing the medication.
• Consistent bedtime: Aim for a strict bedtime, going to bed and waking up at the same time each night to get your body used to sleeping at that time.
• Avoid caffeine and alcohol: Caffeine and alcohol can disrupt your sleep, so it's best to avoid them later in the day.
• Exercise: Physical activity can improve your sleep and reduce stress and anxiety, but avoid exercising too close to bedtime as it may perk you up.
• Limit food and drink before bed: Eating or drinking too close to bedtime can cause nocturnal heartburn and reflux, and increase the need to urinate during the night.
• Improve your sleep environment: Keep your room at a comfortable temperature and minimise light and noise distractions.
• No napping: Napping during the day can disrupt your sleep at night. If you do nap, keep it short and earlier in the day.

Frequently asked questions